Thursday, July 24, 2008

F314: Pressure Ulcers


The facility must prevent pressure ulcers and effectively treat those that are present.


Pressure ulcer prevention must be promoted. Existing pressure ulcers must be treated appropriately, and the development of additional pressure ulcers must be prevented as well.

Common Reasons for Citing F314:

The lack of documentation and monitoring is the most common reason this tag is cited. Other causes include the care plan not being individualized for the resident with a pressure ulcer, failure of the communication process between CNA and nurse regarding the development of pressure ulcers, the lack of dietary intervention, failure of the nurse to notify the physician, the lack of pressure relieving devices even if not ordered, wound care not being provided per physician order, the nurse’s failure to maintain clean or sterile technique as indicated, using a shearing motion while turning and repositioning the resident, and providing wound care without cleaning up incontinence beforehand.


With the lack of documentation being the biggest factor with this citation, frequent chart audits are essential. It is also essential that nurses providing wound care be observed for their compliance with physician orders and established guidelines. Some facilities have had great success by having weekly skin rounds, in which an interdisciplinary team (including at a minimum the skin or wound care coordinator, MDS coordinator, DON or ADON, and dietician) shadow the treatment nurse as wound care is provided. This team based approach provides the opportunity for all of the above-mentioned audits to be done in a timely and efficient manner. It is also necessary to have an effective system in place for addressing CNA-nurse communication.

Thursday, July 17, 2008

Reminder about restorative

If a resident is receiving two different forms of restorative nursing at least 6 days a week, they will RUG into RLA or RLB (depending on the ADL score). This can mean up to an extra $75 per day, which amounts to roughly an additional 2K/month - 24K/year.

Tuesday, July 8, 2008

Profiting from Private Duty

At the beginning of this month, the state of Tennessee enacted a new law that shifted a large portion of Medicaid's long term care designated funds from nursing homes to in home private duty care services. This has obviously caused nursing home providers a great deal of worry, a' la "We're gonna lose all our patients!" The new law is actually a blessing in disguise to nursing homes because it gives us a perfectly valid reason to expand our product lines. Having a nursing home to provide home care services is a winner. The biggest issue in private duty nursing is human resources (recruiting and retaining nurses and techs, credentialing, staffing, etc.). Nursing homes have been dealing with these same issues for years and have the tools to address them (although many choose not to use for whatever reason). Since most nursing homes have an existing CNA training program in place, training additional caregivers would not become a problem. Staff could (not should) be rotated in between private duty and nursing home divisions, and developing a PRN pool would be a little bit easier. Additionally, community relations could be maintained and/or improved, particularly in rural areas, and continuity of care could be taken to new heights.