Quality of Care Flashcards
When must a resident be offered an influenza immunization shot?
483.25-n-
Between OCTOBER 1 - MARCH 31st
Medication Error Rate needs to be _____ or less.
19.901-13-
5%
- Must round down – if rate is 4.6 it is a rate of 4% — this round down is only effective if it results in a 5% deficiency.
- Medication error can also be when: DR. orders are not followed, label is not followed, and pharmacists rules are not followed.
- Failure to “FLUSH” a gastric Tube (before&After) would be counted in the error rate.
- PRN medications not administered are not part of the 5% calculation
What are the ADL’s
- Both- 483.25-19.901
(i) bathe, dress, and groom;
(ii) transfer and ambulate;
(iii) toilet;
(iv) eat; and
(v) use speech, language, or other functional communication systems.
What is the facility to do when a resident is unable to preform an ADL?
-Both-
A service must be provided services to assist, or DO the ADL. (IE. CNA shave, brush teeth, dresses a resident)
The basic philosophy of Quality of CARE is?
-Both-
If you are able to walk in, you should walk out after being a resident of a SNF. Either Maintain, or improve ADL’s. (Unless Clinically unavoidable)
What are the 11 measures of Quality of Care.
-Both- 1-ADL's 2-Pressure Sores 3-Urinary Incontinence 4-Range of Motion 5-Mental and psychosocial functioning. 6-Naso-gastric tube 7-Accidents 8-Nutrition 9-Hydration 10-Special Needs 11-Unnessary drugs
What is an Unnecessary drug?
-Both- 1-a DRUG in excessive dose 2-without adequate monitoring; or 3-without adequate indications for its use; or 4- presence of adverse consequences
What is the general Rule for use of Antipsychotic drugs?
-Both-
If on these type of drugs must try and generally reduce and or use behavioral interventions.
-Texas-Pediatric-
If a Facility takes on 5 or more children under 26 lbs how many nurses must be dedicated to the care of those children?
19.901-14-
1 Nurse
-Texas-Pediatric-
If a Facility takes on children and the number of children are less than 5 where should the rooms be located?
19.901.-14
As close to the nurses Station as Possible.
-Texas-Pediatric-
For the Respiratory Care of Children what are the three basic rules?
19.901-14
1-Group rooms together
2-Vent Equp. must ID to the ROOM and or CHILD
3- must have a safe RATIO of respiratory therapist to residents
-Texas-Pediatric-
What is considered respiratory therapy staff ?
19.901-14
1-RRT -registered respiratory therapist
2-CRT-certified respiratory therapy technician
3-a LN whose primary function is respiratory care
-Texas-Pediatric-
If the facility cares for NINE or MORE children with tracheostomies what is the ratio of REQUIRED RESPIRATORY STAFF?
- 901-14
1: 9 24 hours a day. 1 staff to Nine Pt. 24 hours a day
-Quality Assurance DADS-
How does the Priority for visits happen?
19.910
Facilities with the a history of resident care Tags, are moved to the top of the list
-Quality Assurance DADS-
After a an annual or follow-up survey or inspection how many days before a rapid response team may come into your facility?
19.911
60 days
What is true about influenza and pneumococcal immunizations?
483.25-n-
1- Before offering must have documentation of side effects and benefits.
2- Must be offered, and must be in clinical record.
3-Physician does not need to sign off on them-(Fed: 483.40(b)(3) (*F386))
-Quality of Care-
Facility MUST ensure they provide residents with care for what SPECAIL SERVICES?
-Both- (A) injections; (B) parenteral or enteral fluids; (C) colostomy, ureterostomy, or ileostomy care; (D) tracheostomy care; (E) tracheal suctioning; (F) respiratory care; (G) foot care; and (H) prostheses.
How often should someone be moved if they have a pressure soar?
APX PP 314
Every Two hours.
Depending on Type of soar
As far as Quality of CARE of the facility goes, who is MOST at RISK for Pressure ULCERS?
Apx:PP 314
New Admit patients, They are HIGH RISK for the first 2-3 Weeks
What is a “DEPENDENT” position?
when a resident is seated with her or his feet on the floor
What is breakthrough pain?
episodic increase in (flare-up) pain
**someone whose pain is generally being managed by his/her current medication regimen
When may an indwelling catheter be used?
Only when there is a VALID medical
-Acute or chronic urinary retention
IS URINARY incontinence is NOT a normal part of aging.
No.
As far as the “AGING” process goes it is not normal.
** many different reasons why many of the ELDERLY are incontinent
**Urinary incontinence is a SYMPTOM of a condition.
What is the most common type of urinary incontinence among the elderly?
APX. PP F-315
Urge Incontinence
Stress Incontinence is the 2ed
What is the time frame for an indwelling catheter use?
14 days,
After the 14th day there needs to be appropriate indicators that justify the cath.
14th day need justification on 30th day need to be taken out.
What is the rule of thumb for changing an indwelling catheter?
Apx. PP F-315
Once every 30 days
**Because bacteriuria is nearly universal, on the 30th day
*14th day need justification on 30th day need to be taken out.
What is the test to show someone has a UTI?
Apx.PP F-315
There is no one test that POSITIVELY ID’s that a UTI is present.
There is only high probabilities of UTI based on several different tests. **
** Bacteriuria in the urin….
What are some signs of psycho-social adjustment is present?
Apx. PP F-319 Impaired verbal communication Social Isolation Sleep pattern disturbance Spiritual Distress Inability to control BEHAVIOR Potential Violence SAME response to ANY Stressor
What are some treatments for Psyco-social adjustment.
Apx. PP F-319
opportunities for self-governance;
systematic orientation programs;
arrangements to keep residents in touch with their communities, cultural heritage, former lifestyle,
religious practices;
maintaining contact with friends and family
What are some clinical reasons that produce psyco-social reactions, that often are mistaken for DEPRESSION?
Apx. PP F-319 Metabolic Diseases Endocrine Diseases--Thyroid-- Central Nervous System Disease (CNS)--Tumors/MS/CHF Others--pancreatic--anemia Restraints
How often should a Resident BE WEIGHED?
Apx.PP F-325
1-Admission/Readmission (BASELINE)
2- Weekly for the first 4 weeks after admission
3-Then monthly after the first 4 weeks.
What is significant weight loss?
Apx. PP F-325
1-month - 5%
3-month- 7.5%
6-month-10%
** anything more than these WT loss intervals are “Severe weight loss” Ex: 1-month 6% weight loss is severe.
What is the agency that is resposible for DRUG LABLE requirement that manufacturers include within the medication labeling warnings about adverse reactions and potential safety hazards identified both before and after approval of a medication, and what to do if they occur
Apx. PP F-329
FDA
What is GDR? (medications)
Gradual Does Reduction –
Part of the regulation that says medications (especially psychoactive) should be Tempered as time goes on.
**The purpose of tapering a medication is to find an optimal dose or to determine whether continued use of the medication is benefiting the resident
** this evaluation id done by the pharmacist
Adverse consequences (in drugs ) increases with ___ and ____?
1-The NUMBER of Medications
2-Number of Medications taken of a cretin CLASS ( anticoagulants, diuretics, antipsychotics, anti-infectives, and anticonvulsants).
Ex: Meaning , don’t take two different types of diuretics.
If the pharmacist notes any irregularities, to whom does she make the report to?
Apx.PP F-329
1-Attending Physician
2-DON
