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Tip of the week: Understanding the resident review process of the QIS

Contemporary Long-Term Care Weekly, July 1, 2010

The resident review looks at major care issues that will be targeted and whether important quality of life issues exist. Surveyors will look at whether residents have been properly evaluated through use of the MDS process and how accurate this process has been in the facility’s evaluation. Surveyors will pay attention to major areas of investigative protocol that are prominent concerns to CMS, including the following:

• Adverse drug reactions (ADRs) – Drugs included on the Beers List (drugs that have been noted to cause certain problems in the elderly population) will be given close attention. Individuals on large numbers of medications that can potentially interact are another concern. Drugs believed to have a high likelihood for ADRs, such as antipsychotic agents, will also be targeted.
• Pressure ulcers – Pressure ulcers are categorized as being either avoidable or unavoidable. Facilities can be cited at the level of harm due to avoidable pressure ulcers.
• Hydration – Surveyors will look at tube feedings to make sure adequate hydration exists.
• Unintended weight loss – The operative word here is unintended. If the weight loss is planned for, leading to a therapeutic reduction in weight, this is not a major issue.
• Dining and food service – Surveyors will look at the dining arrangement and the psychosocial involvement of residents with similar psychosocial levels.
• Nursing services and appropriate staffing – Even though a facility may be at the appropriate state ratios for staffing, surveyors will also look at the level of acuity. Federal regulations provide surveyors the latitude to make a determination on this level based on the number of staff members and whether that is appropriate to service the needs of the residents.
• Hospice and dialysis – A review of residents receiving hospice care and dialysis services will be conducted to verify that these residents are being addressed according to their care plans.

This is an excerpt from the HCPro book, The Long-Term Care Administrator’s Field Guide, by Brian Garavaglia, PhD.

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