Long-Term Care Survey Alert

Could these scenarios happen in your facility?

The revised survey guidance for the following three F tags spells out specific examples of deficiencies rising to the level of IJ:

• F329 (unnecessary medications)

The facility fails to recognize a resident on an SSRI developing serotonin syndrome (confusion, motor restlessness, tremor). The physicians order additional medications that add to the serotonin effect or medications to suppress symptoms.

• F425 (pharmacy services)

The facility fails to assure it has pain medication to meet residents' needs -- for example, a recently admitted resident, resulting in his complaining of excruciating pain (a pain score of "9" out of "10").

• F428 (drug regimen review)

The physician and/or director of nursing fails to take action in response to a pharmacist's medication regimen review identifying a resident with no history of depression receiving "indefinite continuation" of an antidepressant. The resident had "no evaluation to confirm presence of depression." Neither had the facility monitored the resident's function and mood while he received the medication for months. As a result of the antidepressant, the resident experienced "clinically significant adverse consequences," such as falls, constipation or change in weight.