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October 18, 2013 Association of Nutrition and Foodservice Professionals Sandra Frahm RD, LD Health Facilities Surveyor

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Presentation on theme: "October 18, 2013 Association of Nutrition and Foodservice Professionals Sandra Frahm RD, LD Health Facilities Surveyor"— Presentation transcript:

1 October 18, 2013 Association of Nutrition and Foodservice Professionals Sandra Frahm RD, LD Health Facilities Surveyor

2 Participants will: Learn about common survey deficiencies. Key quality improvement activities to consider, analyze, implement, or improve to meet applicable regulations. Learn about available resources for federal and state regulations applicable to healthcare facilities.

3 Resident-Centered – based on investigation of the care and services provided to meet the individual needs and preferences of the sample residents Outcome-Oriented – look at actual and potential for negative outcomes and failure by the facility to help residents achieve their highest practicable level of well-being

4 Outcome-oriented approach Actual and potential outcome Look for implementation of systems to meet regulations Investigation based on observations, interviews, and review of documents

5 Statement of deficiencies – Form CMS-2567 which includes: Problems found Evidence to support the deficiency Serves as the basis for the plan of correction

6 F323 – Free of accident, hazards, supervision (298) F441 – Infection control (162) F312 – ADL care provided for dependent residents (160) F281 – Services provided meet professional standards (160) F371 – Food procure, store, prepare, serve (134)

7 F309 – Provide care/services for highest well being (125) F465 – Safe, functional, sanitary, comfortable environment (77) F363 – Menus meet resident needs, menus prepared in advance and followed (73) F156 – Notice of Rights, Rules, Services (61) F329 – Drug regimen free from unnecessary drugs

8 F360 - Dietary Services – the facility must provide each resident with a nourishing, palatable, well-balanced diet that meets the daily nutritional and special dietary needs of each resident F361 – Staffing: the facility must employ a qualified dietitian either full-time, part-time, or on a consultant basis (2) F362 – Standard Sufficient Staff – adequate support personnel to carry out department functions (2)

9 364 – Food : Each resident receives and the facility provides: food prepared by methods that conserve nutritive value, flavor, and appearances; Food that is palatable, attractive, and at proper temperature 365 – Food prepared in a form designed to meet individual needs (3) 366 - Substitutes offered of similar nutritive value to residents who refuse food served (1)

10 367 – Therapeutic Diets: therapeutic diets must be prescribed by the attending physician (5) Intent - Assure the resident receives and consumes foods in the appropriate form and/or the appropriate nutritive content as prescribed by a physician

11 368 – Frequency of meals: the facility provides at least three meals daily, at regular times comparable to normal mealtimes in the community, no more than 14 hours between a substantial evening meal and breakfast the following day unless a nourishing snack is provided at bedtime, must offer snacks at bedtime daily (19) 369 - Assistive Devices - The facility must provide special eating equipment and utensils for residents who need them

12 F325 – Maintain nutrition status unless unavoidable (16) F327 – Sufficient fluid to maintain hydration (6)

13 Guidance, clarifications and instructions to State Survey Agencies and CMS Regional Offices May simply provide clarification of an existing federal tag May accompany a new or revised tag with an explanation and instructions

14 Dementia Care in Nursing Homes Released May 24, 2013 Provides clarification to Appendix P State Operations Manual (SOM) and Appendix PP in the SOM for F309 – Quality of Care and F329 – Unnecessary Drugs

15 New Dining Standards of Practice Resources Available Released March 1, 2013

16 August 2011 – Pioneer Network Food and Dining Clinical Standards Task Force GOAL STATEMENT: Establish nationally agreed upon new standards of practice supporting individualized care and selfdirected living versus traditional diagnosisfocused treatment. ningPracticeStandards/ ningPracticeStandards/

17 Nine Standards Individualized Nutrition Approaches/Diet Liberalization Individualized Diabetic/Calorie Controlled Diet Individualized Cardiac Diet Individualized Altered Consistency Diet Individualized Tube Feeding Real Food First Honoring Food Choices Shifting Traditional Professional Control to Individualized Support of SelfDirected Care New Negative Outcome

18 Offer resident choices Encourage individual resident decisions Homelike atmosphere Less institutional Replace large units w/smaller ones Eliminate/reduce overhead paging Close relationships between resident and staff – promotes same care givers (consistent staffing)

19 Diet determined with the person and in consideration of his/her informed choices, goals, and preferences rather than exclusively by diagnosis Consider beginning with a regular diet and monitoring the individual response to it, unless a medical condition warrants a restricted diet.

20 Ensure the physician and pharmacist are aware of resident food & dining preferences and intake so medication can be addressed & coordinated (e.g. med timing & impact on appetite)

21 Explain the nutrition problem you identified to the resident Develop an agreed upon, measurable nutrition goal Develop interventions with resident input If resident refuses any interventions, explain risk/benefit and honor choice Documentation is an important part of this process!

22 Preview of Nursing Home Quality Assurance & Performance Improvement (QAPI) Guide – QAPI at a Glance Released December 14, 2012 Rollout of Quality Assurance and Performance Improvement (QAPI) Materials for Nursing Homes Released June 7, 2013

23 QAPI is the combination of two complementary approaches to quality management, Quality Assurance (QA) and Performance Improvement (PI). They both involve gathering and using information, but differ in specific ways.

24 Design and Scope Governance and Leadership Feedback, Data Systems and Monitoring Performance Improvement Projects Systematic Analysis and Systemic Action

25 QA and PI are never a quantity: Number of meals served Number of hours staff worked Cafeteria income Number of diet instructions

26 QA is a process of meeting quality standards and assuring that care is at an acceptable level. Nursing homes typically set QA thresholds to comply with regulations or may create standards that go beyond regulations.

27 PI (also called Quality Improvement - QI) is a pro-active, continuous study of systems with the intent to prevent or decrease the likelihood of problems The goal is to improve systems involved in the delivery of care and resident quality of life

28 Includes routine actions to assure a certain standard is continually achieved Examples: Refrigerator and freezer logs Meal service food temperature logs Practitioners order matches diet card/list

29 Involves identification of a system breakdown and/or identification of a problem (may be a single incident) Can be identified Objectively or subjectively Formally or informally

30 Examples: Nutritional screening not complete and/or not timely Nutritional assessments - not complete, accurate, timely, communicated, implemented Snacks not distributed Excessive plate waste Improper food handling

31 Collection of interrelated parts/subsystems Unified by design or flow of work Designed to meet one or more objectives

32 Food handling Menu planning Holding Cooling Purchasing Distribution Receiving Serving Storing Preparation Reheating

33 Nutritional Care Nutritional screening Nutritional assessment Communication - implementation of recommendations and evaluation of implemented recommendations

34 Physical Environment Safety Sanitation Maintenance

35 Staff Hiring Training Evaluating

36 Management Leadership and organizational change Decision Making Communication Budget Management of human resources Management of financial resources Quality Assurance Marketing

37 Steps include: Identification of problem or opportunity for improvement Gathering data Considering options to correct problem Implementing solution(s) Gathering data after implementation Evaluating (current and, then, long-term correction)

38 Enrollment-and- Certification/SurveyCertificationGenInfo/Dow nloads/Survey-and-Cert-Letter-13-05.pdf Enrollment-and- Certification/SurveyCertificationGenInfo/Dow nloads/Survey-and-Cert-Letter-13-05.pdf Enrollment-and- Certification/QAPI/NHQAPI.html Enrollment-and- Certification/QAPI/NHQAPI.html

39 State Operations Manual - Appendix P and PP – Long term care - Appendix W – Critical Access Hospital Website: Guidance/Guidance/Manuals/downloads//so m107_Appendixtoc.pdf

40 Survey and Certification Letters web site: Enrollment-and- Certification/SurveyCertificationGenInfo/Polic y-and-Memos-to-States-and-Regions.html

41 Iowa Administrative Code Chapter 51 – hospitals Chapter 58 – nursing facilities Code/chapterDocs.aspx?pubDate=01-11- 2012 &agency=481 Department of Inspections and Appeals

42 Chapter 51 – refers to the 2005 version Protection/FoodCode/ucm2016793.htm Chapter 58 – refers to the 1999 version Protection/FoodCode/ucm2018345.htm 2009 version Protection/FoodCode/default.htm

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