2. Agenda Regulatory/Department Updates Compliance Trend Report Compliance Tips: Deborah Cateora Hot Topics: Manager’s Corner: Cory Oace

3. Regulatory/Department Updates 1. Be sure to notify OLRO for change of Administrator 2. Please be timely sending in license renewal documentation. New Employees: Sean Scott: Policy Analyst/Corrective Action Cynthia Vargo: Surveyor Supervisor

4. Compliance Tips Deborah Cateora

5. Deborah Cateora, BSN, RN

6. MULTIDRUG RESISTANT ORGANISMS MDROs: Are infectious organisms that no longer respond to most antibiotics or antiviral medications, currently available; CDC and state Health Departments are taking strong actions to reduce the transmission of drug resistant and multi-drug resistant infections organisms; Continue to be a growing issue.

7. MULTIDRUG RESISTANT ORGANISMS Efforts to reduce the transmission of MDROs include: Aggressive infection control training efforts; and Use of the MDRO transfer form. Reduction of infectious organisms non-MDROs and MDROs include: Hand Hygiene; Respiratory Hygiene; and Appropriate use of Standard and Contact Precautions.

8. MULTIDRUG RESISTANT ORGANISMS More training will be available for caregivers in all settings in October or November 2014. Effective January 1, 2014 a new law requires certain facilities to fill out and/or provide a MDRO transfer form to another facility when an individual with a confirmed or suspected MDRO is being transferred to another facility.

9. MULTIDRUG RESISTANT ORGANISMS Currently, ALFs/RCFs are not mandated to create a form but if they receive a MDRO transfer form here is what needs to be done: Assure all appropriate standard precautions are implemented at all times; Keep the MDRO transfer form with the resident’s record; Provide a copy to any emergency personnel (i.e. paramedics etc.) when treating and/or transporting the resident from their home;

10. MULTIDRUG RESISTANT ORGANISMS Provide a copy to the facility when a resident is being transferred to the hospital, emergency room, ambulatory surgical center, nursing facility or another licensed or certified care setting; and Notify the local health department within one working day of the date of transfer. Example of MDRO transfer forms can be found at: https://public.health.oregon.gov/DiseasesConditions/C ommunicableDisease/HAI/Prevention/Pages/Interfacili ty-Communication.aspx. https://public.health.oregon.gov/DiseasesConditions/C ommunicableDisease/HAI/Prevention/Pages/Interfacili ty-Communication.aspx

11. RN DELEGATION RN Delegation (Division 47) has specific requirements regarding actions and documentation. Current issues that we see are: Only indicating the resident is “Stable and Predictable”: This is a statement only and is not the documentation that supports the statement. Forms that have a check box still have to have supporting data recorded in the residents’ record.

12. RN DELEGATION Step-by-step instructions are not unique to the individual resident: There must be resident specific information regarding how the caregiver is to perform the task. Step-by-step instructions kept in a central location: The step-by-step instructions are resident specific and should be kept with the MAR for that resident. Not watching each caregiver perform the task both on the initial and subsequent re-evaluations: Must be performed at the frequency ordered.

13. RN DELEGATION RN not reviewing the MAR routinely for medications or treatments specific to the delegated task; Incoming RN not following the transfer of delegation as outlined in Division 45: The only potential time saver if, after reviewing the step-by- step instructions, the incoming RN deems sufficient. Caregivers continue to perform delegated tasks even after the RN has left or quit and the task has not been re-delegated; Sliding scale information is not addressed adequately;

14. RN DELEGATION RN not leaving sufficient instructions on when to contact the delegating RN immediately; and Not specifying when the re-evaulation will be completed. In 90 days or 180 days etc. is not sufficient must at minimum indicate the week of or an actual date.

15. Compliance Trend Report Top Ten Citations: 4/1/2014-6/30/2014 1: 260 Service Plans (45) 2: 270 Change of Condition(45) 3: 280 Resident Health Services (36) 4: 303 Treatment Orders (32) 5:310 Medication administration (32) 6: 240 Food Sanitation (30) 7: 370 Staffing Training(29) 8: 252 Resident Move in and eval (27) 9: 290 Resident Health Services (24) 10: 160 Reasonable Precautions (21) 999: Technical assistance (52)

16. Hot Topics CBC Web Site: http://www.oregon.gov/dhs/licensing/cbc/Pages/index. aspx Oregon.gov, type in CBC provider tools

17. Manager’s Corner Cory Oace, Residential and Assisted Living Manager

18. Thanks so much! Next News hour: October, 9 th, 2014 Questions???? CBCTeam@state.or.us CBC web site Address: http://www.oregon.gov/dhs/spd/Pages/provtools/cbc/index.aspx