IMMEDIATE JEOPARDY CITATION SUMMARY

1. IMMEDIATE JEOPARDY CITATION SUMMARY Presented by: Mary Fleming BSN, MHR January 13, 2010

2. What Is Immediate Jeopardy? • A situation in which the facility’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.

3. What Is Immediate Jeopardy? • The facility either created the situation or allowed it to continue and had the opportunity to prevent or correct the situation. • Repeated occurrences without intervention.

4. Three Components of Immediate Jeopardy • Harm – Actual or potential serious injury, harm or death • Immediacy – Death or harm has / will occur if not corrected immediately • Culpability – The facility knew or should have known about the situation

5. Definition of Immediate Jeopardy • May have occurred in the past • May be occurring presently • May likely occur in the immediate future

6. Immediate Jeopardy Is Costly • Risk to health and safety of residents • Financial penalties • Provider’s reputation and esteem

7. TRIGGERS • Unexplained serious injuries that have not been investigated such as head trauma or fractures • Suspicious injuries around breasts and/or genital areas • Uninvestigated allegations of abuse or assault

8. TRIGGERS • Lack of timely assessment after injury • Failure to carry out doctor orders • Repeated occurrences without intervention

9. TRIGGERS • Access to chemical and physical hazards (cleaners, razors, etc) • Access to scalding water • Lack of supervision to prevent elopement • Lack of smoking safety

10. Number Of Immediate Jeopardy Citations All Nursing Facilities Surveys (Source CMS ASPEN Reports FFY) • 2009 – 88 (four outliers included two special focus facilities and two that closed {31 IJ’s}) • 2008 – 56 (two outliers including one special focus facility {7 IJ’s}) • 2007 – 35

11. TOP IMMEDIATE JEOPARDY CITATION (FFY 2007 – 2009) • F323 – QUALITY OF CARE -Failure to ensure the environment remains free of accident hazards. • 2009 - Cited 33 times (8.6% of homes) • 2008 – Cited 18 times (4.7% of homes) • 2007 – Cited 13 times (3.4% of homes)

12. ENVIRONMENTAL HAZARDS - SIDERAILS/RESTRAINTS CAUSING INJURIES • Resident climbs over bedrails repeatedly with injuries and side-rails remain up • Resident gets caught between mattress and side-rails because of poor fit • Resident climbing out of restraints

13. ENVIRONMENTAL HAZARDS CONTINUED • Lack of supervision to prevent resident to resident assaults • Lack of supervision to prevent smoking without burning clothes or bedding • Scalding hot water in resident use areas • Chemicals and disinfectants available to residents at risk for ingestion

14. SECOND MOST CITED IJ • F309 – Failure to provide nursing assessment, intervention and follow-up during injuries or illnesses • 2009 – Cited 11 times (2.1% of homes) • 2008 – Cited 10 times (2.6% of homes) • 2007 – Cited 1 time (.3% of homes)

15. NURSING ASSESSMENT and DIABETIC CARE • Failure to check blood sugars and: • Notify physician of low blood sugar • Notify physician of significant change in level of consciousness • Administer or hold insulin as ordered for high or low blood sugar with critical labs, injured kidneys, injured feet

16. NURSING ASSESSMENT AND CARE CONTINUED • Failure to notify the physician of acute changes in condition (example chest pain, shortness of breath) • Failure to follow up on head injuries and fractures • Failure to follow orders for CPR in cases of life threatening emergency • Failure to administer life sustaining medications (example for seizures or blood thinners)

17. THIRD MOST CITED IJ • F225 – Failure to thoroughly investigate allegations of resident abuse • 2009 – Cited 9 times (2.8% of homes) • 2008 – Cited 5 times (1.2% of homes) • 2007 – Cited 2 times (.6% of homes)

18. FAILURE TO INVESTIGATE ABUSE • Staff continue to work with residents after allegations of verbal or physical abuse without investigation or reporting • Residents assault other residents without investigation or reporting • Non consensual sexual fondling without investigation or intervention

19. FOURTH MOST CITED IJ • F314 - Failure to prevent pressure ulcers and provide treatment to promote healing and prevent infection • 2009 – Cited 4 times (.9% of homes) • 2008 – Cited 3 times (.6% of homes) • 2007 – Cited 1 time (.3% of homes)

20. FAILURE TO PREVENT OR TREAT PRESSURE ULCERS • Failure to routinely assess skin to discover wounds / recognize infections / treat pain • Failure to notify physician and obtain orders for wound treatments • Failure to obtain wound care medication, treatment, equipment as ordered

21. FIFTH MOST CITED IJ • F371 – Failure to Store, Prepare, and Distribute Food Under Sanitary Conditions • 2009 – Cited 2 times (.6% of homes) • 2008 – Cited 3 times ( .9% of homes) • 2007 – Cited 2 times (.6% of homes)

22. KITCHEN SANITATION • Failure to maintain food storage and preparation areas free of pests including rodents and roaches

23. OTHER IMMEDIATE JEOPARDY CITATIONS (FFY 2007 – 2009) • F441 - Failure to maintain infection control practices to prevent blood borne illnesses • F333 - Failure to secure and administer critical medications • F157 - Failure to inform the physician and family of accidents with injuries

24. WHAT TO DO IF AN IJ IS DETERMINED TO EXIST • Survey team leader will notify facility immediately • Facility develops a plan to remove immediate jeopardy and begins to implement actions • If plan is implemented immediately, IJ is removed; often requires staff in-service

25. ADDITIONAL ACTIONS • Survey team exits, documents actions taken by facility to remove IJ • Survey is sent to facility within 10 days • Facility receives revisit based on acceptable plan of correction

26. THANK YOU! • Mary Fleming, Director of Survey • Phone 405 – 271-9444, ext. 57215 • Fax 405 – 271 - 3442