MDS Alert

3 ways to tell if you're wide open for F tags.

A few common shortfalls in your care planning process can cause the facility to slip up big time during the survey. To make sure your team is on top of pivotal issues that can derail care plans, answer these questions.

1. Does the care plan address the resident's individual risks? For example, one "very nice facility" had fall care plans that didn't include individualized risk factors for falls and fall-related injuries, reports Marilyn Mines, RN, RAC-CT, BC, manager of clinical services for FR&R Healthcare Consulting in Deerfield, Ill.

As a result, the facility wasn't in compliance with the F323 tag, she cautions. The facility risk manager explained that the QA and safety committees looked at risk factors during the meetings but didn't put them on the residents' care plans, Mines relays.

Example: A resident with Parkinson's disease is at risk for falling due to a gait disturbance. The care plan should include specific interventions, such as a therapy screen and restorative nursing, as examples, to address that risk factor.

2. Do you triage your care plan efforts? Spend more time on the high-risk problems, such as a clinical issue that's not improving or getting worse -- or a resident at high risk for developing a negative outcome, advises Mardy Chizek, RN, FNP, BSN, MBA, AAS, CLNC, a legal nurse consultant in Westmont, Ill. "Talk to the resident about the interventions and what the staff has tried [and is going to try next]. Also get the resident or responsible party's input," advises Chizek.

3. Do you ensure care plan compliance during the survey? The best-laid care plans can translate into F tags if staff don't implement them consistently during the survey.

Smart strategy: Identify residents whom surveyors will likely target. The QIs and QMs can help you do that, but you also should track when surveyors take charts from the units, suggests Patricia Boyer, RN, NHA, principal of Boyer & Associates in Brookfield, Wis. For example, "if the nursing facility has a process by which everyone signs out charts, including staff on an ongoing basis, it's reasonable to ask surveyors to sign out charts, as well," she adds.

"You can also see what rooms the surveyors are going in and who they are observing."

Mock surveys or practice runs also help ensure frontline staff members don't freeze in their tracks in the heat of the survey moment.

Boyer has seen survey jitters cause CNAs to avoid residents because they fear making a mistake while surveyors are watching. And when that happens, "the CNAs end up hurting the nursing facility because they don't provide the care on the plan of care -- for example, an intervention that says turn the patient every two hours," she adds.

Editor's note: For a case study n a mock survey approach that has saved one organization $100,000 in liability insurance, e-mail the editor your request at www.KarenL@Eliresearch.com.