Next up on the CMSCG Blog “Ftag of the Week,” we will be looking at F694 Parenteral/IV Fluids. CMS Compliance Group Clinical Consultant Mary Quinn is lending some additional clinical expertise to this regulation.
F694 – What’s Required
According to the regulation in Appendix PP of the State Operations Manual (SOM), parenteral fluids must be administered consistent with professional standards of practice and in accordance with physician orders, the comprehensive person-centered care plan, and the resident’s goals and preferences. The intent of this regulation is to ensure that any resident who receives parenteral fluids receives them in accordance with professional standards of practice for safety and that there is ongoing support of the resident during treatments.
Remember – there is no requirement that a nursing home must offer intravenous therapy but if these services will be provided by an outside contractor, the facility is required to inform each resident before or at the time of admission, as well as during his/her stay about these services if they are offered in the facility.
Definitions
“Parenteral fluid” is the delivery of fluid or medication through an intravenous, subcutaneous, intramuscular, or mucosal route to maintain adequate hydration, restore and/or maintain fluid volume, reestablish lost electrolytes, or provide nutrition which includes Total Parenteral Nutrition (TPN).
“Intravenous (IV) therapy” is the administration of parenteral fluids or medications through an IV catheter to treat a condition.
IV Therapy
There are several options for how nursing home residents may receive IV therapy. These include:
- Providing IV therapy either directly or under contract with individuals to provide the services. Individuals providing these services must be qualified, trained and competent in accordance with professional standards of practice, licensure and State practice acts/laws.
- If a resident needs and agrees to receive IV therapy but the facility does not provide these services onsite, the facility must assist the resident with the transfer to another facility or with the relocation to another setting (e.g. private home, or residential/assisted living facility) of his/her choice where IV therapy can be provided.
If the facility offers IV therapy, it must develop and implement policies which are based on professional standards of practice and which address:
- Preparation
- Insertion
- Administration
- Maintenance and discontinuation of an IV
- Prevention of infection
There are a lot of areas in which poor practice can lead to a citation on survey. In the next part of our CMSCG Blog Series on F694, we’ll look at key areas related to IV therapy requirements.