1. Fall Region Forums - 2014 Doug Beardsley VP Member Services Care Providers of Minnesota Nursing Home Survey Findings

2. Many similar trends, but a few new ones Increased Problem Areas: Infection Control Dialysis Antipsychotic Medications Physician Responses to Pharmaceutical Recommendations Drug Storage

3. Many similar trends, but a few new ones Decreased Problem Areas: Pressure Ulcers Incontinence Reporting of Suspected Abuse Policies regarding reporting of suspected abuse

4. Many similar trends, but a few new ones Oddities: Posting of Staff Hours Dialysis focus Expired Nurses licenses Failure to act/respond to issues in the Resident Council Minutes Providing notice of new roommate Call lights not within reach

5. Average Number of Deficiencies per Survey

7. 40%+ Infection Control 30%-40% Qualified Staff Unnecessary DrugsKitchen Issues 20%-30% Highest Practicable LevelStorage of DrugsAccidents & SupervisionCare PlansMonthly Med Review

8. Current Nursing Home survey deficiencies issued in 40% or more of surveys F441: Infection Control Infection control program Staff infection control breaches Resource – QIS Infection Control List

9. Current Nursing Home survey deficiencies issued in 30% - 40% of surveys F282: Qualified Staff F329: Unnecessary Drugs F371: Kitchen Issues

10. Current Nursing Home survey deficiencies issued in 30% - 40% of surveys F282: Qualified Staff Staff not performing their job consistent with the directives of the Care Plan or facility policies and procedures.

11. Current Nursing Home survey deficiencies issued in 30% - 40% of surveys F329: Unnecessary Drug Antipsychotics remain the major focus Also sleep medications, antidepressants, & prn Resource – QIS Unnecessary Meds Pathway

12. Current Nursing Home survey deficiencies issued in 30% - 40% of surveys F371: Kitchen Stuff Cleanliness and upkeep of the kitchen Infection control (hand washing/gloving) Proper cooling of food for storage Steam table food temps during meal Dishwasher temperatures Resources – Food Cooling Poster and Training Sheet QIS Kitchen/Food Service Observation Form

13. Current Nursing Home survey deficiencies issued in 20% - 30% of surveys F309: Highest Practicable Level F431: Storage of Drugs F323: Accidents & Supervision F279: Care Plans F428: Monthly Med Review

14. Current Nursing Home survey deficiencies issued in 20% - 30% of surveys F309: Highest Practicable Level Pain Dialysis Hospice Positioning Etc. Resources – QIS Resident Interview QIS Dialysis Critical Elements form

15. Current Nursing Home survey deficiencies issued in 20% - 30% of surveys F431: Storage of Drugs Expired Meds Multi-Use Vials not dated when opened Temperatures Unsecured meds

16. Current Nursing Home survey deficiencies issued in 20% - 30% of surveys F323: Accidents & Supervision Falls Alarms Siderails

17. Current Nursing Home survey deficiencies issued in 20% - 30% of surveys F279: Care Plans Ineffective or nonexistent approaches to identified or observed patient care needs or issues Dialysis

18. Current Nursing Home survey deficiencies issued in 20% - 30% of surveys F428: Monthly Med Review Consultant Pharmacist missed something Physician failed to act on Consultant Pharmacists recommendations

19. Take-Aways : Look at the examples provided Audit your nursing home to determine if you have similar deficient practices Make changes, and re-audit!