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Food For Thought | |
NCP Training
Don't forget to attend one of the conference calls next week: Oct. 25, 26, 27 at either 7 am or 7 pm. Make sure you have your policy and procedure, revised assessment form, PES guides, and the power point presentation on your computer.
CEU Opportunity:
Abbott Nutrition Health Institute is offering this continuing education program: "Strengthening Outcomes in the Aging Population: Collaborative Teams as the Vital Link Between Nutrition and Sustained Recovery" The program is offered for only $25.00 for 5.5 CEUs! Program Date: Tuesday, November 1, 2011 from 10 am to 4:30 pm available in San Francisco and simulcast in LA and San Diego.
Check here for registration information and agenda.
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| Food Funnies | |
In honor of Halloween coming up this month, I feel the need to make appropriate jokes:
What do thirsty ghosts and goblins drink on Halloween?
Ghoul-Aid.
Got a food Funny? email it to Judy
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Contact the Editor | |
Please send your RD News comments, suggestions & questions to Judy Morgan, MBA, RD
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Issue: 114 |
October 20, 2011 |
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Greetings!
This issue brings you the newest surveyor guidance on F322 Feeding Tubes, and reminders on our NCP training and another CE opportunity. |
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Tube Feeding Survey Alert | |
CMS announced revisions to surveyor guidance for F tag 322 Feeding Tubes effective November 30, 2011.
What does this mean to Nutricopia RDs?
It means that tube fed residents will be more closely reviewed in your community's survey. Are you ready to weather the scrutiny?
The focus of the surveyors will be to:
- Identify whether the resident's clinical condition warrants feeding tube placement (unavoidable),
- Determine if the resident's rights/wishes were considered in the decision,
- Identify if the tube feeding is utilized in accordance with current standards of clinical practice, and
- Determine if an ongoing review of resident's ability to resume normal eating is conducted.
In addition, surveyors may conduct an in-depth review of written facility protocols for tube feeding administration, infection control, meeting nutritional and psychosocial needs, and prevention and treatment of potential complications.
Deficiencies in this F tag will be at severity level 2 (D, E, F) or higher due to the potential for more than minimal harm. The RD will be instrumental in helping the community stay in compliance. The facility is in non-compliance if they failed to do one or more of the following:
- Assess nutritional status and need; identify a clinically pertinent rationale for tube feeding,
- Identify nutritional needs and ensure that the tube feeding meets those needs,
- Address the nutritional aspects of enteral feeding and the management of the feeding tube and prevention of complications; or
- Use and monitor feeding tube per facility protocol and clinical standards of practice and provide services to attempt to restore normal eating skills or identify and manage complications.
Take note that if a deficiency in F322 is cited, it may lead to more review and possible citation of F325 Nutrition if it has been determined that facility failed any of the 1st 3 items!
Read the guidance for complete language and details.
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| RD Tip |
What can you expect in survey?
Surveyors may interview the RD regarding when to assess the resident, how to determine what formula is appropriate, how the nutritional needs are determined, how to determine if the tube feeding meets the nutritional needs, and what interventions were in place to try to optimize food intake prior to the decision to tube feed.
RD documentation for assessment, provision of nutritional needs and monitoring the resident's potential for resuming normal eating will be reviewed. Physician orders, MAR, Intake & Output records, MDS section K Nutritional Approaches and Percent Intake by Artificial Route will be reviewed to determine if all are matching and accurate for tube feeding orders including flush. Care plans will be reviewed for monitoring of potential complications such as aspiration, social isolation, GI symptoms and tube problems.
What are the next steps?
- Use the Nutricopia Worksheet for Enteral Feeding Orders (P&P #470) as a guideline for chart audits.
- Check for matching orders, pump settings, MAR, I&O, and look at the formula being infused for accuracy
- Audit Enteral and Nutrition care plans for rationale for use of feeding tube, and monitoring for complications
- Check for Advance Directive, POLST, etc. to support resident rights/wishes
- Check for periodic swallow evaluation, Physician/IDT documentation or reassessment of the continued need for the tube feeding
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| Dear Dietitian | |
We can help the facility be proactive and survey ready. Let your Administrator and DSS know that you will check the residents on enteral feedings to assure compliance with the revised surveyor guidance. If you identify things that need immediate correction, discuss with the Administrator and Director of Nursing; a more in-depth QA may be needed. Let your supervisor know if you do not feel you have time to accurately and thoroughly review the residents on tube feedings each month so we can offer some solutions for help.
Judy Morgan, MBA, RD
Editor |
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