• Today we’re focusing on F686, F687, F689, F690, F694, F695, F697, F699, and F700 on quality of care.
• Look for additional updates each week through October.

• Updates guidance to reflect frequency of completion of risk assessments.
• Includes clarification for determining if skin damage is a pressure injury/pressure ulcer.
• Outlines requirements to prevent infection.

• Adds new language to address proper infection prevention and control practices for foot care equipment.

• Adds components related to electronic cigarettes or e-cigarettes.
• Adds components on safety for residents with substance use disorder (SUD).

• Clarifies that the regulation is specific to bowel incontinence not bowel management.

• Adds components on assessing intravenous (IV) therapy sites, assessing the continued need for an IV, and components related to professional standards of practice for cleaning.

• Clarifies that guidance for mechanical ventilation only applies to facilities offering this care.

• Adds language regarding use of opioids within the current opioid crisis.
• Recommends resources for use of opioids.
• Provides guidance on assessment of resident with history of addiction.
• Offers guidance on opioid side effects and overdose prevention.

• Provides definitions associated with culturally competent and trauma-informed care, key elements of noncompliance, and investigative summary and examples of non-compliance.

• Clarifies inclusion of the “use” of bedrails in addition to installation.
• Adds links to alternatives to bedrails.
• Clarifies removal requirements.

• Examine/update existing policies to ensure e-cigarettes/devices are included.
• Examine/update existing assessments related to smoking to ensure residents are assessed for their ability to safely handle electronic cigarette devices.
• If care and services are offered for residents with SUD, ensure staff are educated on assessing residents for risk of leaving facility without notification, appropriate intervention development, substance use in the facility to include signs and symptoms of use, and overdose.
• Ensure staff are educated on adding/updating care plan interventions addressing plans to monitor and supervise residents with SUD.
• Ensure staff are knowledgeable about signs and symptoms of overdose and ways to address emergencies related to substance use.
• Examine/update policies that define the mechanisms and procedures for assessing or identifying, monitoring, and managing residents at risk for elopement (to include those with SUD).
• Evaluate/update current policies and/or procedures related to IV therapy to ensure they include frequency of assessment of IV catheter sites and related factors, procedure determining and documenting continued use for IV when not being used for IV fluids or medications, and adherence to professional standards to include use of appropriate antiseptics to scrub ports, connectors, and hubs.
• Examine/update policies related to pain management to ensure they include the need to assess residents for history of past addiction or opioid use disorder and related treatment to implement strategies to adequately address the resident’s pain (which may include continuation of medication-assisted treatment, non‐opioid pain medications, and non-pharmacological approaches).
• Examine current policies and/or procedures to ensure processes exist for identifying patterns/requests for pain medication that could be an indicator of drug diversion, procedure for assessing, documenting and managing side effects of opioid use, and procedures for addresseing opioid overdose prevention (naloxone).
• Examine existing policy and/or process for identification of cultural preferences, history of trauma assessment, and triggers which may cause re-traumatization.
• Identify residents who are trauma survivors, have history of trauma, and identify triggers which cause re-traumatization.
• Use approaches that are culturally competent and/or are trauma informed.
• Evaluate care plans for trigger identification and culturally competent and/or trauma-informed approaches.
• Educate staff on cultural competency and trauma-informed care.
• Evaluate existing process for determining if bedrails are appropriate to ensure that prior to installation or use, appropriate alternatives have been assessed. For facilities with beds that have bedrails pre-installed, establish a process for determining whether the beds, including mattresses and rails are appropriate and safe for the resident.

• Trauma Informed Care Training
• Behavioral Health and Trauma Informed Care
• Trauma Informed Care: How Do I Start?

• Refer to Appendix PP-State Operations Manual.
• Register for training on these changes on the CMS Quality, Safety & Education Portal (QSEP) – Driving Healthcare Quality webpage.
• Access the Action Brief: 483.25 Quality of Care.