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Category Archives: SLCR Guidance

MDS and Flu Season

CMS posts the public Quality Measures on Nursing Home Compare, and consumers are able to view the percentage data that your nursing home offered and administered the flu vaccine during the current or most recent influenza season.

The 3.0 Resident Assessment Instrument (RAI) manual does not provide specific dates for influenza season.  This has prompted Missouri facilities to ask what dates are considered the influenza season in Missouri, in order to correctly code the MDS, which will be reflected in their Quality Measures.  Seasonal flu monitoring and reporting to the CDC in Missouri begins in early October and extends well in to the month of May.

For MDS coding purposes, if the resident is not in the facility between October 1 and May 31, you should code in Section O:  “Resident not in facility during this year’s flu season.”  For residents who are in the facility from October 1 through the last week of May, the facility is required to offer the flu vaccine as long as it is “reasonably available,” which means that it is still available to be ordered from your local pharmacy or supplier.

If you have any questions, you may contact Joan Brundick, State RAI Coordinator, at 573-751-6308 or email joan.brundick@health.mo.gov.

Health Advisory: pH1N1 Influenza

Health Advisory:  Pandemic pH1N1 Virus-Associated Illnesses and the Influenza Season in Missouri (12.26.13)

CDC Health Advisory:  Notice to Clinicians: Early Reports of pH1N1-Associated Illnesses for the 2013-14 Influenza Season (12.24.13)

Health Alerts, Advisories, and Updates are available on the Department of Health and Senior Services website.  For the most current information, please visit: http://health.mo.gov/emergencies/ert/alertsadvisories/index.php.

Flu Season is Here

Homes are required to offer the flu vaccine to all of their residents.  Vaccination of your healthcare workers, although not mandated, is also important in preventing the spread of flu in your home.  Encouraging your staff to receive the vaccination can also help reduce absenteeism due to illness and reduce the costs of care associated with ill residents. 

Flu season information is available on the CDC website at www.cdc.gov/flu/index.htm.

Safety Reminders: Holiday Decorations

It is that time of year when people are decorating their homes and businesses with festive décor and anticipating upcoming holiday celebrations.  Residents and staff in your care home also look forward to festivities and enjoy holiday decorations.  It is important for residents, staff and visitors to carry on traditions and to feel a sense of joy and peace we all want this time of year.

The Section for Long-Term Care Regulation (SLCR) wants to help you and your residents have a safe holiday season by sending out the following safety tips, references and regulatory reminders.

Fires or other accidents are not something anyone wants! 

Safe decorations include:

  • Artificial Christmas trees, and decorations that are non-combustible or flame retardant.
  • UL approved decorative lighting (use in supervised areas and turn off when not in use).
  • UL approved outdoor lighting.
  • Holiday decorations, including evergreen wreaths, ornaments, photos, etc. can be used on resident’s doors, and in hallways, as long as they do not exceed 3 ½” in depth and they are not blocking the entrances or exits.*

*Any combustible decorations hung from doors or walls in corridors may be used with a waiver.  Non-rated combustible decorations cannot exceed 20% of the wall space in an exit egress corridor.

SLCR published an article regarding holiday decorating in the winter 2011 edition of the quarterly newsletter.  Please visit http://health.mo.gov/seniors/nursinghomes/providerinfo.php.

Although the 2000 Edition National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) is the official reference, the 2012 Edition contains some less restrictive requirements.  Please refer to the CMS memo regarding waivers here: CMS Memo S&C 13-58-LSC 2000 Edition National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) Waivers, or visit the CMS website at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.html.

Prohibited decorations include displays, hangings, and other decorations that block exits, visibility of exits, or fire protection appliances.  Never hang decorations from fire sprinkler heads or pipes.

NFPA 101, Section 19.7.5.4:  Combustible decorations shall be prohibited in any health care occupancy unless they are flame retardant.

NFPA 101, Section 7.1.10.1:  Means of egress shall be continuously maintained free of all obstructions or impediments to full instant use in the case of fire or other emergency.

NFPA 101, Section 7.1.10.2.1:  No furnishings, decorations, or other objects shall obstruct exits, access thereto, egress therefrom, or visibility thereof.

 

Please note, some county or city local ordinances may also require compliance with more restrictive standards, including the International Fire Code (IFC).

 

  • F323:  Electrical Safety – Any electrical device, whether or not it needs to be plugged into an electric outlet, can become hazardous to the residents through improper use or improper maintenance.  Electrical equipment such as electrical cords can become tripping hazards.  Halogen lamps or heat lamps can cause burns or fires if not properly installed away from combustibles in the resident environment.  The Life Safety Code prohibits the use of portable electrical space heaters in resident areas.

 

 

  • Can candles be used in nursing homes under supervision, in sprinklered facilities?

CMS Memo S&C-07-07:  Nursing Home Culture Change Regulatory Compliance Questions and Answers

Answer: Regarding the request to use candles in sprinklered facilities under staff supervision, National Fire Protection Association data shows candles to be the number one cause of fires in dwellings.  Candles cannot be used in resident rooms, but may be used in other locations where they are placed in a substantial candle holder and supervised at all times while they are lighted.  Lighted candles are not to be handled by residents due to the risk of fire and burns.

This holiday season, consider using battery-operated flameless candles.  They look and smell real!  Learn more about candle fire safety from the U.S. Fire Administration at www.usfa.fema.gov/citizens/home_fire_prev/holiday-seasonal/holiday.shtm.

If you have any questions regarding the Life Safety Code, please contact SLCR at 573-526-8524.  We wish you a wonderful and safe holiday season.

Tuberculin Skin Test Antigen Available – Shortage Resolved

The national shortage of TUBERSOL® used in the administration of PPD tuberculin skin tests appears to be resolved and is now widely available.  Providers should administer PPD tuberculin skin tests that were deferred due to the shortage.  Please make every effort to complete all deferred testing within the next 30 days.  If you are unable to meet this timeframe, please work with your Regional Office to establish an acceptable timeframe to complete your deferred testing.  If you have any questions, you may also contact Joan Brundick at 573-751-6308 or send an email to joan.brundick@health.mo.gov.

posted December 6, 2013

 

RAI Process & Medicare from Start to Finish 2014 Workshops

July 8 – 9, October 7 – 8, 2014:  RAI Process from Start to Finish

April 25, August 12, November 12, 2014:  Medicare from Start to Finish

Location:  Courtyard by Marriott in Columbia, Missouri.  View the brochure here: RAI – Medicare from Start to Finish Workshops Updated Brochure 2014 or visit www.mlnmonursing.org/MDS.

The Missouri Coalition Celebrating Care Continuum Change

The Missouri Coalition Celebrating Care Continuum Change (MC5)

by Sam Plaster, State Culture Change Coordinator 

The Patient Protection and Affordable Care Act passed by Congress in 2010 requires that all nursing homes develop Quality Assurance and Performance Improvement (QAPI) programs, ensuring that homes continuously identify and correct quality deficiencies as well as sustain performance improvement.  While the Center for Medicare & Medicaid Services (CMS) has yet to promulgate the specific regulatory requirements, many homes are already initiating or improving their QAPI processes… to read more and view photos click here: MC5

Cardiopulmonary Resuscitation (CPR) in Nursing Homes

CMS Memo S&C: 14-01-NH

The Section for Long-Term Care Regulation wants to make certified providers aware that this Memo requires “certification” of some nursing home staff as part of the nursing home’s compliance with regard to CPR.  CMS’ guidance had previously been that an on-duty staff member be able to perform CPR appropriately at all times.  If a question arose during a federal process regarding whether someone could perform CPR properly, a surveyor may have needed to ask for an explanation of appropriate technique from some available staff member to verify compliance with that requirement, but verifying the certification of a particular staff member typically wasn’t necessary.

One point that remains unaddressed in this new S&C Memo is that many different CPR training agencies offer “certification” of their own, and this Memo doesn’t specify which agency’s certifications are acceptable to CMS and which are not.  SLCR has requested a clarification of this point from the CMS Central Office, and so has the Kansas City Regional CMS office.  Neither of our offices have received a response.  When we receive further guidance, we will provide it to you via this Listserv.  Until then, we will not be altering our current survey practices, but we want to make providers aware that this new S&C Memo has been issued by CMS, and that depending on their answer to our questions, it’s likely that some of your staff may need to obtain CPR certification with very short notice.

Because this memo references the American Heart Association as a standard-setting organization with regard to CPR, it is our belief that provider certification through the AHA will almost certainly be deemed acceptable by CMS.  Whether other certifications will suffice is less clear at this time.  As soon as we have some clarification on this point, we will share it with you.  We apologize that we can’t offer more specific guidance at this time, and appreciate your patience.

View the CMS Memo S&C: 14-01-NH here:  Survey-and-Cert-Letter-14-01 or click here. 

UPDATED GUIDANCE HAS BEEN POSTED – PLEASE REFER TO:

http://health.mo.gov/blogs/ltcblog/2014/02/24/cardiopulmonary-resuscitation-cpr-in-nursing-homes-guidance-clarification-update/