Friday, May 2, 2008

F309: Quality of Care

Requirement:

Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well being, in accordance with the comprehensive assessment and plan of care.

Intent:

It is the nursing home’s responsibility to make sure that residents either get better or stay the same (within the resident’s right to refuse treatment), within the limits of the resident’s medical condition and/or the normal effects of aging.

Common Reasons for Citing F309:

The most common reason this tag is cited is for failure to reposition. For example, a resident is observed sitting in the same position for 3 hours, even though they are care planned to be repositioned every 2 hours. Another common reason for this tag is missing lab work. Other reasons that have been used to justify this citation include failing to properly manage pain, noting that residents are not wearing TED hose that has been care planned, failure to protect fragile skin, and lack of foot pedals when their use is obviously necessary. F309 is a sort of catchall citation and is frequently cross referenced to other tags.

Preparation:

Because of the vague nature of F309, it is often difficult to adequately plan for this. Missing lab work can be oftentimes be prevented by requiring nurses to maintain a log of lab work or having all labs being coordinated through just one individual, usually a RN supervisor or administrative nurse. Issues with repositioning can be handled by educating and monitoring staff on its importance. Some facilities have attempted to tackle persistent repositioning problems by keeping underpads in three different colors and requiring direct care staff to change the existing pad to one of another color every two hours. The resident will be repositioned in the process of the pad change, and it becomes rather easy to monitor staff compliance by just checking to see what color the pad is. The other issues can be addressed by frequently walking around and observing how residents are cared for.

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