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Ftag of the Week – F658 Services Provided Meet Professional Standards

This week’s “Ftag of the Week” is F658 Services Provided Meet Professional Standards, which is part of the Comprehensive Resident Centered Care Plans regulatory group under the updated Requirements of Participation (RoPs). F658 requires that the care and services provided by the facility are provided according to accepted standards of clinical practice.

The regulation requires that if a negative or potentially negative outcome for a resident is determined to be related to the facility’s failure to meet these standards and the surveyors determine that a deficient practice has occurred, the facility should be cited under both F658 as well as the appropriate area where the concern was identified. F658 has been cited at least 10 times at an Immediate-Jeopardy level on survey under the new LTCSP, more than a dozen times at an Actual Harm level, and hundreds of times at a lower scope/severity, so it’s worth paying attention to. Surveyors are reviewing the following criteria:

  • If the services provided or arranged for by the facility that are defined in the resident’s comprehensive care plan reflect accepted standards of practice. If the facility provides information on an outdated standard of practice used in the facility that a surveyor is concerned about, the surveyor is required to provide evidence of a more up-to-date standard/widely used practice that is supported by recent clinical literature.
  • If the references for standards of practice used by the facility are up to date and accurate for the services that are being provided
  • If the facility failed to provide or arrange for services/care that should have been provided with acceptable standards of quality

Some areas where this has been cited include failure to provide basic life support (IJ), failure to follow professional standards of nursing practice for an unresponsive resident who had a hypoglycemic episode (IJ), administration of an excessive dose of an antipsychotic (IJ), failure to meet professional standards of practice for medication administration related to insulin (IJ), and failure to provide oxygen to a resident in respiratory distress (IJ).  Citations in these areas, which are all high-risk clinical service areas, indicate, in many instances a lack of monitoring of a facility’s associated system to ensure standards of practice are being adhered to on a routine basis. If you are not monitoring system/protocol compliance on a routine basis, you should be.

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