Ftag of the Week – F688 Increase/Prevent Decrease in ROM/Mobility (Pt. 1)

Our next CMSCG “Ftag of the Week” is part of the Quality of Care regulatory group, F688 Increase/Prevent Decrease in ROM/Mobility. There are three parts to this regulation, along with a significant amount of documentation and care planning expectations. Let’s start with the regulatory requirements and then, of course, we will review the definitions provided at F688.

F688 – Regulatory Requirements

Per Appendix PP of the State Operations Manual, a nursing home must ensure that:

• a resident who is admitted without limited range of motion (ROM) does not experience a reduction in ROM unless his/her clinical condition demonstrates that a reduction in range of motion is unavoidable
• a resident with limited ROM is provided appropriate treatment and services to increase range of motion or prevent further decrease
• a resident with limited mobility receives appropriate assistance, equipment and is provided services to maintain or improve his/her mobility with maximum practicable independence unless a reduction in mobility is demonstrably unavoidable.

It’s important to be aware that while we think of ROM and mobility as physical concerns, surveyors are also guided to review the impact of the mental and psychosocial aspects of improving/maintaining or preventing avoidable decline in a resident’s ROM/mobility.

 Let’s move on to the definitions.

Definitions

“Passive ROM” – Movement of a joint through the range of motion with no effort by the patient

“Active Assisted ROM” – Occurs when muscles surrounding the joint are used to perform the exercise, but some assistance is required, either by using a piece of equipment or help is provided by the therapist

“Mobility” – Includes all types of movement, which, for the purposes of this regulation, refers to walking, movement in bed and transfer from a bed to chair. Movement may occur with or without assistance and either with or without an appliance.

“Muscle atrophy” – wasting or loss of muscle tissue

Policies Needed

The Interpretive Guidance (IG) for F688 covers several areas, but we’ll begin with the section that addresses required policies. The IG states that the facility, in collaboration with the Medical Director, Director of Nursing and PT/OT consultant, as appropriate, must develop resident care policies which cover specific concerns. Your P&P should address:

• Restorative treatment/services
• Rehabilitative treatment/services
• Equipment use
• Equipment cleaning
• Equipment storage
• Who may provide specific treatments and modalities, in accordance with State law and/or practice acts

In Part 2 of our “Ftag of the Week” for F688 ROM/Mobility, we will review assessments and the associated Interpretive Guidance – and see how it all comes together on survey.