All-Cause Harm Prevention in Nursing Homes

The Centers for Medicare & Medicaid Services (CMS) and the Quality Innovation Network National Coordinating Center collaborated on a new change package related to prevention of all-cause harm in nursing homes. The Office of the Inspector General (OIG) in a 2014 report stated that 59% of adverse and temporary harm events that occurred during a skilled nursing facility (SNF) stay were preventable, which is referenced in the Change Package. A second 2014 OIG Report cited in the Package found that nursing facilities only reported 53% of abuse or neglect violations in 2012. OIG issued an “early alert” in August 2017 finding that CMS does not have adequate procedures in place to ensure potential abuse or neglect incidents in SNFs are identified and reported according to requirements. A new report (with an expected publication date of FY 2018) in which the OIG plans to determine the prevalence of potential abuse or neglect in both in-patient and out-patient settings is also expected to be released. It is clear that facilities need to be focusing on abuse, neglect and harm prevention.

Appendix A of the Package includes information on priority areas for preventing all cause harm, including:

  • Addressing staffing
  • Knowing the residents, their needs and areas of risk and including them in the care planning process
  • Preventing, identifying and addressing gaps in care
  • Promoting excellent multidisciplinary team work
  • Providing tangible leadership engagement with staff and residents
  • Ensuring excellent, competent and available care is provided onsite

The Change Package includes suggested interventions in Appendix B, including:

  • Providing leadership to establish a culture of providing safe, quality care
  • Engaging the resident and representative/family in care so they receive desired and safe care
  • Supporting staff commitment, interdisciplinary teamwork and communication to prevent and mitigate errors and reduce resident injury and/or harm
  • Continuously learn and improve organizational approaches to quality and safe care

The Change Package to prevent harm (adverse events, abuse and neglect) for nursing home residents can be downloaded here. A complimentary webinar related to this change package will be held on January 24, 2019 at 3pm EST. Registration information and more details can be found here.

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