Nursing Home Federal Requirements by Allen James E.;James E Allen Msph Phd;

Author:Allen, James E.;James E Allen Msph, Phd;
Language: eng
Format: epub
Publisher: Springer Publishing Company, Incorporated
Published: 2011-08-15T00:00:00+00:00

IV. DEFICIENCY CATEGORIZATION (PART IV, APPENDIX P)

Once the team has completed its investigation, analyzed the data, reviewed the regulatory requirement, and identified any deficient practice(s) that demonstrate that noncompliance with the regulation at F329 exists, the team must determine the severity of each deficiency, based on the resultant harm or potential for harm to the resident.

The key elements for severity determination for F329 are as follows:

1. Presence of potential or actual harm/negative outcome(s) due to a failure related to unnecessary medications.

Examples of actual or potential harm/negative outcomes for F329 may include, but are not limited to:

Potential for life-threatening toxicity from excessive dose or lack of indication for the use of digoxin.

Complications (such as diarrhea with life threatening fluid loss, nephrotoxicity, hearing loss, or anaphylactic shock) from use of an antibiotic when no clear indication for use has been established or response to the use has not been monitored.

Fractures or falls with injury resulting from the continuing use of medications (e.g., hypnotics/sedatives, antipsychotics, antidepressants, antihypertensives) in the presence of predisposing risks or adverse consequences such as persistent dizziness or recurrent falling without intervening or reevaluating the need for and dose of the medication believed to be the cause of the gait instability.

2. Degree of potential or actual harm/negative outcome(s) due to a failure related to unnecessary medications.

Identify how the facility practices caused, resulted in, allowed, or contributed to the actual or potential for harm:

If harm has occurred, determine if the harm is at the level of serious injury, impairment, death, compromise, or discomfort; or

If harm has not yet occurred, determine how likely is the potential for serious injury, impairment, death, compromise, or discomfort to occur to the resident.

3. The immediacy of correction required.

Determine whether the noncompliance requires immediate correction in order to prevent serious injury, harm, impairment, or death to one or more residents.

The survey team must evaluate the harm or potential for harm based upon the following levels of severity for tag F329. First, the team must rule out whether Severity Level 4, Immediate Jeopardy to a resident’s health or safety, exists by evaluating the deficient practice in relation to immediacy, culpability, and severity. (Follow the guidance in Appendix Q.)

NOTE: The death or transfer of a resident who was harmed or injured as a result of facility noncompliance does not remove a finding of immediate jeopardy. The facility is required to implement specific actions to remove the jeopardy and correct the noncompliance which allowed or caused the immediate jeopardy.

Severity Level 4 Considerations: Immediate Jeopardy to Resident Health or Safety

Immediate Jeopardy is a situation in which the facility’s noncompliance with one or more requirements of participation:

Has allowed, caused, or resulted in, or is likely to allow, cause, or result in serious injury, harm, impairment, or death to a resident; and

Requires immediate correction, as the facility either created the situation or allowed the situation to continue by failing to implement preventative or corrective measures.

Examples may include, but are not limited to:

Failure to assess or respond appropriately for a resident taking warfarin who

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