Category: CMS Memo

CMS National Nursing Home Quality Care Collaborative (NNHQCC) Change Package v2.0 – Now Available

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The Change Package developed as part of the CMS National Nursing Home Quality Care Collaborative is being used by CMS and Quality Improvement Organizations and is intended to complement evidence-based tools and resources.  A change package is a menu of strategies, change concepts and specific actionable items that any nursing home can choose from to begin testing for purposes of improving quality of care.

Please visit Advancing Excellence’s website here for more information and to download the full package.

RAI Manual Update

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On February 5, 2015, CMS posted a new Errata document on the RAI manual page of their website.  It is designed so that you can remove the old page of the RAI and insert the new corrected page.  The revisions to pages in Chapter 2 & 3 clarify the meaning of entry/reentry and the coding for A1600, A1700, A1800 and A1900.  You can find the revised pages on CMS’s website by clicking here.

If you have any questions, please contact Stacey Kempker, BSN, RN, State RAI Coordinator for DHSS, by calling 573-751-6308 or via email at stacey.kempker@health.mo.gov.

CMS Announces Important Changes to Nursing Home Compare Website

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CMS has announced that they are preparing to make changes to the Nursing Home Compare website this month.  Specific changes include:

  • Addition of two (2) quality measures for antipsychotic medication use in nursing homes to the Five Star rating system calculations.
  • Raising the standard for nursing homes to achieve a high rating on all measures publicly reported in the Quality Measure (QM) dimension on the website
  • Adjustment of the algorithm used for calculating staffing ratings to more accurately reflect staffing levels.

CMS discussed these important changes and the impact on the Five Star rating system during the CMS Skilled Nursing Facilities (SNF)/Long Term Care (LTC) Open Door Forum that was held Thursday, February 12, 2015.

Please visit here on the CMS website where you will find more information.

Holidays & Decorating

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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.

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.
  • Extension cords may be used on a TEMPORARY basis.  For information regarding the use of extension cords, please visit the SLCR website at http://health.mo.gov/safety/ltcqa/questionsandanswers.php#no13.
  •  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!

We wish you a wonderful and safe holiday season.  If you have any questions regarding the Life Safety Code, please contact SLCR at 573-526-8610.

CMS Memo S&C 14-46-LSC: Categorical Waiver for Power Strips Use in Patient Care Areas

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Memo Summary:

  • Categorical Waiver:  CMS has determined that the 2000 edition of the National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) contains provisions on the use of power strips in health care facilities that may result in unreasonable hardship for providers or suppliers.  Further, an adequate alternative level of protection may be achieved by compliance with the 2012 edition of the LSC, which has extended allowances on the use of power strips in patient care areas.

 

  • CMS is permitting a categorical waiver to allow for the use of power strips in existing and new health care facility patient care areas, if the provider/supplier is in compliance with all applicable 2012 LSC power strip requirements and with all other 2000 LSC electrical system and equipment provisions.

 

  •  Resident rooms in long-term care or other residential care facilities that do not use line-operated electrical appliances for diagnostic, therapeutic, or monitoring purposes are not subject to the more restrictive NFPA 99 requirements regarding the use of power strips in patient care areas/rooms.  Resident rooms using line-operated patient-care-related electrical equipment in the patient care vicinity must comply with the NFPA 99 power strip requirement and may elect to utilize this categorical waiver.

 

  • Individual waiver applications are not required:  Providers and suppliers are expected to have written documentation that they have elected to use the waiver.  A provider or supplier must notify the LSC survey team at the entrance conference that it has elected the use the waiver permitted under this guidance and that it meets the applicable waiver requirements. The survey team will review the information and confirm the facility meets the conditions for the waiver.

Please see the complete memo here or visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-14-46.html?DLPage=1&DLFilter=14-46&DLSort=3&DLSortDir=ascending.

Revised RAI Manual

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The complete set of RAI Manual v.1.12 pages and change tables and the Replacement Pages file, both in the Downloads section below, now contain revised versions of Chapter 2; pages A-8, A-10, and A-13 (Chapter 3 Section A); pages E-2 through E-8 (Chapter 3 Section E); page 6-12 (Chapter 6); the Appendix B, F, and H cover pages; and Appendix G. Files affected by this revision contain an R in the version number (“1.12R”) and pages affected include an “(R)” in the page footer.

This most recent version can be located at the following link: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html.
The complete manual can be found in the box labeled “downloads” at the bottom
of that page.

CMS Memorandum S&C 14-42-NH: Release of Learning Tool on Building Respect for Lesbian, Gay, Bisexual, Transgender (LGBT) Older Adults

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CMS Memorandum S&C 14-42-NH: Release of Learning Tool on Building Respect for Lesbian, Gay, Bisexual, Transgender (LGBT) Older Adults

Summary:

  • Release of Training Materials: The Centers for Medicare & Medicaid Services (CMS) announce the release of a free learning tool on Building Respect for LGBT Older Adults.
  • Program Content and Design: The learning tool addresses the needs and rights of older LGBT adults in long-term care (LTC) and is presented in six online training modules.
  • Target Audience: The learning tool is intended for LTC providers.

View the memo S&C 14-42-NH  or visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-14-42.html.

Updated RAI Manual

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CMS has posted the updated version (v.1.12.0) of the Resident Assessment Instrument (RAI) User’s Manual, which goes into effect on October 1, 2014.

Go to https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html, and then look under Downloads where you can view/print the entire manual or only the replacement pages.  Change tables are also available which summarize the deleted and added wording.

You may also sign up for any of the following FREE webinars done by Carol Siem, MSN, RN, BC, GNP, Clinical Educator, QIPMO.
Monday, September 22, 2014: 2:00 p.m. – 4:00 p.m.
Tuesday, September 23, 2014: 10:00 a.m. – 12:00 noon
Tuesday, September 23, 2014: 1:00 p.m. – 3:00 p.m.
Thursday, September 25, 2014: 10:00 a.m. – 12:00 noon
Friday, September 26, 2014: 9:00 a.m. – 11:00 a.m.
Friday, September 26, 2014: 2:00 p.m. – 4:00 p.m.
To sign up go to: https://attendee.gotowebinar.com/rt/8072217808620282113.  After registering, you will receive a confirmation email containing information about joining the webinar.

Along with the updated manual is a new version of the Minimum Data Set (MDS) Item Set (v.1.12.0).  Software vendors should be making contact with providers to update/patch the MDS software.  In order to successfully transmit the MDS on and after October 1, 2014, providers will need to use the new version Item Set with Assessment Reference Dates (ARDs) of October 1, 2014 and later.

Questions may be directed to the MDS unit at 573-751-6308 or 573-522-8421.

Top 5 Life Safety Code (LSC) Deficiencies cited by CMS during LSC Comparative surveys in FY’14

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As part of CMS’s annual evaluation of the State Agency’s compliance with specific responsibilities, CMS conducts a LSC “comparative” survey in a number of facilities after SLCR completes the annual LSC survey in these facilities.  The results of these comparative surveys are shared with SLCR.  Here is a list containing the top five deficiencies CMS identified during completion of the past year’s LSC comparative surveys, including a brief summary of the most commonly identified issues found for each of these deficiencies.

CMS Memorandum S&C 14-43-NH: Completion of Minimum Data Set(MDS) 3.0 Discharge Assessments for Transfer from Medicare- and/or Medicaid-Certified Beds to Non-Certified Beds

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CMS reinforces the need to do MDS discharge assessments in the attached Survey & Certification memo 14-43-NH dated August 25, 2014.  Specifically, if a resident is moving from a certified bed to a non-certified bed in the same facility, then a discharge assessment is completed and transmitted.  The reverse then would apply:  If the resident moves from a non-certified bed to a certified bed, the OBRA MDS process begins.  The MDS is required to be completed and transmitted only for certified beds.  Furthermore, if a facility chooses to do the MDS for a non-certified bed, then they must not transmit that MDS.

View the memo here:  S&C 14-43-NH or visit http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-14-43.html

Announcement from CMS – National Provider Call: QIO Program Transition

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You are invited to join the Centers for Medicare and Medicaid Services (CMS) – Center for Clinical Standards and Quality, for a discussion on the restructuring of Quality Improvement (QIO) Program effective August 1, 2014.  We recognize the unique impact of the changes on the provider community as it relates to areas such as provider’s procedures for notifying beneficiaries regarding rights to appeals of discharge determinations, addressing quality of care concerns, provision of medical records, working on quality improvement initiatives and receiving technical assistance on value and incentive programs.  The purpose of this meeting is to share an overview of the QIO Program changes, provide an update on the transition process, discuss its impact on the provider community, share critical resources, and to answer any questions.

We have scheduled the National Provider Call for Wednesday, July 23, 2014 from 11:00 am – 12:00 pm EDT (10:00 am – 11:00 am CDT) via webinar.

Here is how you can join:

Audio:  Telephone Number: 1-877-267-1577

MeetingPlace ID: 993 182 797 (This meeting does not require a password.)

Webinar:  https://webinar.cms.hhs.gov/qio-provider-call/

Users without an Adobe Connect login may sign-in as a guest.  Pre-registration is not required.  This session will be recorded.  Thank you for your participation in this call to advance health care quality for Medicare beneficiaries.  We look forward to hearing from you.

CMS Memorandum S&C 14-34-NH: Advance Copy of Revised F371; Preparation of Eggs in Nursing Homes

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CMS Memorandum S&C 14-34-NH:  Advance Copy of Revised F371; Interpretive guidance and Procedures for Sanitary Conditions, Preparation of Eggs in Nursing Homes

Summary:

  • Guidance for Nursing Homes: Skilled nursing and nursing facilities should use pasteurized shell eggs or liquid pasteurized eggs to eliminate the risk of residents contracting Salmonella Enteritidis (SE).  The use of pasteurized eggs allows for resident preference for soft-cooked, undercooked or sunny-side up eggs while maintaining food safety.  In accordance with the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) standards, skilled nursing and nursing facilities should not prepare nor serve soft-cooked, undercooked or sunny-side up eggs from unpasteurized eggs.
  • Guidance for Surveyors: Signed health release agreements between the resident (or the resident’s representative) and the facility that acknowledges the resident’s acceptance of the risk of eating undercooked unpasteurized eggs are not permitted.  Pasteurized eggs are commercially available and allow the safe consumption of eggs.  If the facility prepares or serves unpasteurized or undercooked eggs which are not cooked until both the yolk and white are completely firm, surveyors should consider citing deficiencies at F371.  Determination of the appropriate scope and severity shall be based upon the actual or potential negative resident outcomes in accordance with guidance given at F371.  We are revising F371 to clarify this section; a revised F371 is attached.

View the memo here:  S&C 14-34-NH or visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-14-34-.html?DLPage=1&DLSort=2&DLSortDir=descending.

CMS Memorandum S&C 14-30-NH: Grant Solicitation for the Reinvestment of Federal Civil Money Penalty (CMP) Funds

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CMS Memorandum S&C 14-30-NH:  Grant Solicitation for the Reinvestment of Federal Civil Money Penalty (CMP) Funds to Benefit Nursing Home Residents

Summary:

  • Grant Solicitation for the Reinvestment of Civil Money Penalty (CMP) Funds to Benefit Nursing Home Residents: As part of the 2010 Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) is soliciting proposals for a grant opportunity in which Federal CMP Funds will be utilized to support and further expand the National Partnership to Improve Dementia Care in Nursing Homes.
  • Funds: A total of $500,000 for FY2014-2015 will be available for a three year period of performance.  Funding will be awarded in 12 month budget periods.
  • Terms: Further information about this new initiative may be accessed at http://www.grants.gov.

View the memo here:  S&C 14-30-NH or visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-14-30.html?DLPage=1&DLSort=2&DLSortDir=descending.

CMS Memorandum S&C 14-25-NH: Advance Copy – Single Use Device Reprocessing under Tag F441

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CMS Memorandum S&C 14-25-NH:  Advance Copy – Single Use Device Reprocessing under Tag F441, Revisions to Interpretive Guidance in Appendix PP, State Operations Manual (SOM) on Infection Control

Summary:

  • Advance Copy: The guidance under Tag F441, Infection Control, Preventing Spread of Infection/Indirect Transmission has been revised.
  • Single-Use Device Guidance: Nursing homes may purchase reprocessed single-use devices when these devices are reprocessed by an entity or a third party reprocessor that is registered with the Food and Drug Administration.
  • Single-Use Device (SUD): A SUD is a device that is intended for one use on a single patient during a single procedure.
  • Reprocessed SUD: A reprocessed SUD is an original device that has previously been used on a patient and has been subjected to additional processing and manufacturing for the purpose of an additional single use on a patient.

View the memo here:  S&C 14-25-NH or visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-14-25.html?DLPage=1&DLSort=2&DLSortDir=descending.

Cardiopulmonary Resuscitation (CPR) in Nursing Homes – Updated Guidance Clarification Addressing Transportation

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 (see bolded, italicized information below)

The Section for Long-Term Care Regulation (SLCR) wants to make certified providers aware that updated guidance from CMS (S&C: 14-01-NH) now requires “certification” of some nursing home staff as part of the nursing home’s compliance with regard to CPR.  Previously, if a question arose during a federal regulatory 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 was not necessary.

This most recent memo states that “certification” of some staff members is mandatory, but the memo does not clarify which certifying agencies are acceptable (i.e., American Heart Association).  SLCR and the Kansas City Regional CMS office requested a clarification of this point.

We have received guidance indicating that the purpose of this memo was to, “…ensure that facilities do not implement facility-wide ‘no CPR’ policies and that facilities have CPR-certified staff available at all times,” but that CMS does not intend to review or approve all certification agencies.

A wide range of organizations offer CPR certification – some are based online and some are conducted in-person.  To this point, CMS has clarified that while S&C: 14-01-NH does not require the use of any specific certifying agency, there are two components that are required with regard to CPR certification:

  • The certification must be designed for healthcare providers (therefore, CPR courses for laypersons which teach chest compressions, but not mouth breathing, are not sufficient); and
  • Nursing home policies should address how staff members should maintain and document their CPR certification.

The American Heart Association certification is acceptable under this guidance, but it is not the only acceptable certification.  Many homes in Missouri are currently obtaining CPR certification through the American Safety & Health Institute (ASHI), which is also acceptable, as are others, as long as they are designed for professional healthcare providers.

In addition, this guidance also applies to nursing home residents who are being transported or accompanied by facility staff to various appointments, outings or events.  Nursing homes will need to ensure that staff who are CPR certified accompany residents during such transports.

You may view the memo here: CMS Memo S&C: 14-01-NH, or visit

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-14-01.html?DLPage=4&DLSort=2&DLSortDir=descending.

View all CMS Memos at http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.html.

ICD-10 Coding Basics National Provider Call – Registration Now Open June 2014

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June 4, 2014

12:30 p.m. – 2:00 p.m. Central Time

To Register:  Visit MLN Connects™ Upcoming Calls.  Space may be limited, register early.

HHS expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015.  Providers would have an extra year to prepare.  During this MLN Connects™ National Provider Call, join us for a keynote presentation on more ICD-10 coding basics by Sue Bowman from the American Health Information Management Association (AHIMA), along with updates from CMS.  A question and answer session will follow the presentation.

Agenda:

  • CMS updates, including the partial code freeze and 2015 code updates
  • Why ICD-9-CM is being replaced with ICD-10-CM
  • Benefits of ICD-10-CM
  • Similarities and differences from ICD-9-CM
  • Coding: Process of assigning a diagnosis code, 7th character, placeholder “x,” excludes notes, unspecified codes, external cause of injury codes, type of encounter
  • Documentation tips
  • How to obtain answers to coding questions
  • How to request modifications to ICD-10-CM

Target Audience:  Medical coders, physicians, physician office staff, nurses and other non-physician practitioners, provider billing staff, health records staff, vendors, educators, system maintainers, laboratories, and all Medicare providers.  Continuing education credit may be awarded for participation in certain MLN Connects Calls.  Visit the Continuing Education Credit Information web page to learn more.

Keep up with the latest news regarding ICD-10, visit http://cms.gov/Medicare/Coding/ICD10/Latest_News.html.

CMS Memo: Fiscal Year (FY) 2014 Post Sequester Adjustment for Special Focus Facility (SFF) Nursing Homes

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S&C: 14-20-NH

Memorandum Summary:

  • Revised total SFF Slots:  Effective April 2014, we have adjusted the number of designated slots and candidates so States can resume selecting and replacing nursing homes for SFF designation.
  • Adjustment to Number of Slots:  Pursuant to the FY2013 budget sequestration, we reduced the number of SFF slots. We are now re-building the program by a gradual increase in the number of SFF slots from its reduced base. Later, we will also introduce additional methods to address persistently poor quality in nursing homes.
  • Phase in period: States may have the option to start selecting SFFs immediately or phase in the total to meet the required number by July 2014.
  • Continuation of Program Changes: As outlined previously the Centers for Medicare & Medicaid Services (CMS) Regions and States will continue with the Programmatic and Operational Adjustment by conducting the 18-month “last chance” onsite survey and reviewing the progress of all facilities that have been on the SFF list for more than 12 months.

View the memo by visiting www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-14-20.html.

CMS Proposes Adoption of Updated Life Safety Code

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To view this complete announcement from CMS, please visit www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-04-14.html.

The Centers for Medicare & Medicaid Services (CMS) has announced a proposed rule on the adoption of updated life safety code (LSC) that CMS would use in its ongoing work to ensure the health and safety of all patients, family, and staff in every provider and supplier setting.  The updated code contains new provisions that are vital to the health and safety of all patients and staff.

A key priority of CMS is to ensure that patients and staff continue to experience the highest degree of safety possible, including fire safety.  CMS intends to adopt the National Fire Protection Association’s (NFPA) 2012 editions of the (LSC) and the Health Care Facilities Code (HCFC).  This would reduce burden on health care providers, as the 2012 edition of the LSC also is aligned with the international building codes and would make compliance across codes much simpler for Medicare and Medicaid-participating facilities.

PUBLIC INPUT INVITED:

To view the proposed rule you may visit www.federalregister.gov/articles/2014/04/16/2014-08602/medicare-and-medicaid-programs-fire-safety-requirements-for-certain-health-care-facilities.  PDF format is available for download in the right-hand column or click here.

View CMS Memo S&C: 14-21-LSC issued April 18, 2014 here:  www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-14-21.html.

Antipsychotic Drug use in Nursing Homes: Trend Update

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CMS is tracking the progress of the Partnership to Improve Dementia Care in Nursing Homes by reviewing publicly reported MDS quality measures. The official measure of the Partnership is the percentage of long-stay nursing home residents who are receiving an antipsychotic medication, excluding those residents diagnosed with schizophrenia, Huntington’s Disease or Tourette’s Syndrome.

Since the Partnership began in 2012, this data indicates Missouri’s percentage rates have dropped every quarter, with an overall decrease of 9.17 percent. This is encouraging and shows that Missouri is making improvements towards decreasing the use of antipsychotic medications for residents with dementia when their use is not indicated or appropriate. Please view the trend update here: CMS Trend Update – Antipsychotic Drug Use in Nursing Homes.

Cardiopulmonary Resuscitation (CPR) in Nursing Homes – Guidance Clarification Update

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Guidance Clarification Update February 21, 2014

CMS Memo S&C: 14-01-NH

The Section for Long-Term Care Regulation (SLCR) wants to make certified providers aware that updated guidance from CMS (S&C: 14-01-NH) now requires “certification” of some nursing home staff as part of the nursing home’s compliance with regard to CPR.  Previously, if a question arose during a federal regulatory 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 was not necessary.

This most recent memo states that “certification” of some staff members is mandatory, but the memo does not clarify which certifying agencies are acceptable (i.e., American Heart Association).  SLCR and the Kansas City Regional CMS office requested a clarification of this point.

We have now received guidance indicating that the purpose of this memo was to, “…ensure that facilities do not implement facility-wide ‘no CPR’ policies and that facilities have CPR-certified staff available at all times,” but that CMS does not intend to review or approve all certification agencies.

A wide range of organizations offer CPR certification – some are based online and some are conducted in-person.  To this point, CMS has clarified that while S&C: 14-01-NH does not require the use of any specific certifying agency, there are two components that are required with regard to CPR certification:

  • The certification must be designed for healthcare providers (therefore, CPR courses for laypersons which teach chest compressions, but not mouth breathing, are not sufficient); and
  • Nursing home policies should address how staff members should maintain and document their CPR certification.

The American Heart Association certification is acceptable under this guidance, but it is not the only acceptable certification.  Many homes in Missouri are currently obtaining CPR certification through the American Safety & Health Institute (ASHI), which is also acceptable, as are others, as long as they are designed for professional healthcare providers.

You may view the memo here: CMS Memo S&C: 14-01-NH, or visit www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.html.

Safety Reminders: Holiday Decorations

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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.