A client recently asked me to review its fall policies and procedures as they relate to the standard of care. Because that project was on my mind, the new training modules for nurse aides in long term care that were recently published by the Agency for Healthcare Research and Quality (AHRQ) caught my eye. The three published modules are:
- Module 1: Detecting Change in a Resident’s Condition
- Module 2: Communicating Change in a Resident’s Condition; and
- Module 3: Falls Prevention and Management
Each module has an instructor’s guide and a student workbook that includes training materials, summaries and “Pearls and Pitfalls” to help staff become more aware of residents’ needs. For example, the module on falls includes a mnemonic checklist “HEAR ME” to help prevent falls in the facility:
- Hazards in the environment.
- Educate residents.
- Anticipate residents’ needs.
- Round frequently.
- Materials and equipment.
- Exercises and ambulation.
Module 1 notes that the elderly do not exhibit the same signs and symptoms of illness that are seen in younger persons. Therefore, identification of subtle changes can alert staff to a serious illness. The AHRQ notes the top 12 changes in residents are:
A. Physical Changes: Walking; Urination and bowel patterns; Skin; Level of weakness; Falls; and Vital signs.
B. Non- Physical Signs: Demeanor, Appetite, Sleeping, Speech, Confusion or agitation, complaints of pain.
Our Insight. Your Advantage. Much of the material will not be new to many providers. However, use of the training modules developed, and following the steps advocated, by the AHRQ will provide strong evidence that the provider’s care was within the standard of care. Long term care facilities that incorporate the AHRQ’s training standards into their care will be ahead of the game in number of areas such as:
- Regulatory compliance;
- Limiting exposure to civil malpractice;
- Reimbursement matters.
The AHRQ, the quality and research arm for the U.S. Department of Health and Human Services, has been at the forefront for developing quality indicators which later translate to payment standards. While reimbursement concerns may be down the road, regulatory compliance is not. Studies have shown that survey standards often differ depending on the surveyor and where the facility is located. Furthermore, the OIG developed its “worthless services” theory for services provided at skilled nursing facilities. That theory is that the care was so deficient that it amounted to no care at all and any claims for payment from Medicare constitutes a false claim. Concerns raised by either agency can be reduced if the provider can show adherence to the AHRQ’s guidance.