NAB NHA Exam Compiled Cards

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long version formula of FTE

# of positions x # of days/week X 20%

formulas for FTE

# of positions x (1.4) ||assumed position is for 7 days a week

minimum wages

$7.25

speech/language

(Speech Language Pathologist (SLP)) improve auditory comprehension, speech production, expressive behavior

Monitor and evaluate resident satisfaction

(ask them) quality of care and life. numerous methods involving both staff and outside resources

co-mingling

(cannot do) resident's funds must never be included with or in any way.

What does the Rehab program consist of?

(carried out on written order of physician. Team role)||a. first step is to assess-part of team role|b. identify needs, set goals|c. select treatment modalities, implement|d. certain resident activities are rehabilitative, though done by ACTIVITY DIRECTOR|e. facility must provide space and equipment when outside resources do not furnish

battery backup

(if no generator) for fire, life safety, alarm system; all entrances and exits. NO waiver.

What are the duties of a social worker? (7)

(not specified by CMS)||Standards of practice include:|1. member of interdisciplinary team|2. social history|3. community resources-have complete file|4. family counseling-especially at admission (not psychotherapy)|5. discharge planning- must begin at admission|6. advance medical directives (living will) - at or before taking admission- know wishes of resident (means making health related decisions) most widely used means to lessen conflict between profession ethic and resident wishes. |7. auditing- regular reports from SW (conference or written) include number of residents being counseled. Review community file. ||

Visually Impaired residents

(same services as hearing impaired)|Environmental considerations: no glare, indirect lights, use of color.||

transfer agreement

(written) with one or more hospitals. include transfer procedures, records. EXCEPTION document if no hospital will sign.

What is required in reference to Dental Services? (3)

*1. 24 hour emergency care - acute pain, damaged tooth|*2. routine inspection, cleaning, filling|*3. payment: SNF not required to pay for Medicare resident; may charge||- prompt referral, appointment, transportation|- poor dentition a major factor in malnourishment|- charges may be made to Medicare, private pay residents. Medicaid requires facility proivde emergency and routine care - not required to pay for services not reimbursed.

Bladder and bowel problems are a physical/emotional problem. What are three effective practices to address them?

1. prompted voiding|2. physical exercise- pelvic floor exercise, walking, calisthenics, and|3. Kegel Exercise by which sphincters are stengtherned. Proper hydration. Must provide needed assistive devices.||

lower break-even: do 3 things -

1. reduce fixed costs, (mortgage)|2. increase prices where possible,|3. lower variable cost

How does the PPS Medicare assessment compare to medicaid assessments? (3)

1. same MDS 3.0 is used as for medicaid|2. 66 RUGS (Resource Utilization Groups) that determine the level of payment on each Medicare Part A resident (case-mix)|3. MDS 3.0 is electronically transmitted to the State Medicaid Agency - same as for MDS for Medicaid. State computers tied in with CMS mainframe computers in Baltimore|

what are the 7 components that are mandatorily addressed for developing and operationalizing polices and procedures

ombudsman involved in

1. services that could adversely affect health, welfare, safety, or rights|2. facility notify of survey noncompliance findings|3. state notify of any action against facility.|4. must have access to residents; records only with written consent.|give resident the name, address, phone number of ombudsmen.|fed and state notify when give facility waiver.|state notify of urvey and allow to sit in on an exit interview, suggest residents and families to interview

Technique to performance evaluations

1. supervisor complete form and interview employee|2. both supervisor and employee complete form then interview. employees tend to under rate self.

factors in setting up employee compensation programs are:

1. supervisory duties|2. level of authority|3. knowledge required|4. necessary skills

what is the purpose of performance evaluations?

1. to help an employee to improve work performance|2. evaluate effectiveness of policies and procedures. |

legislative issue

1. work with state health care associations and state and other health care groups|2. keep local legislators informed of LTC needs and issues.|3. know applicable bills and let legislators know possible opposition.|4. contact all members of legislative committees that will handle LTC bill. do not wait until committee meets and try to educate them

ACTIVITIES

1.INVOLVE COMMUNITY in and out of facility| 2.PARTICIPATION may refuse|

what are some unacceptable practices for FOOD STORAGE? (4)

1.prolonged storage|2. too much exposure to light|3. prolong cooking in large volume of water.|4. precooking to attain soft texture.

How much inventory is needed on hand for emergency supply

3 days supply of perishables|7 days suppy of staples||(these are standards of practice. an administrator should anticipate the type of catastrophe his/her facility may suffer and plan accordingly. the 3 and 7 day SOP MAY not be sufficient. Please check your state requirements for state-specific regulations)

numbers to know for AR

What are the required visits for the MD/DO?

30 days/first 90 days|every 60 days thereafter||up to 10 weeks late is o.k. next visit must be counted from regularly scheduled date.

Wheelchair passage

32" bathroom doors||36" elsewhere

look back period

4 quarter previous year - if paid 50k or more, MUST deposit via ELECTRONIC TAX DEPSOIT SYSTEM (EFTDS). advantage of EFTDS: reduces errors, makes corrections easier, acknowledges recipt in 48 hours.

standard work week -

40 hours and 8/80

key to communication is listening

40% of the time. |active listening - hearing message and the feelings behind it.|

injury/illnesss rate

8.5%

Residents Rights: TELEPHONE - ACCESS

ACCESS to private use of telephone - both auditory and visual in-so-far as pssible| telephones in occupied offices and nurses station do not qualify.| equipment required to accommodate hearing impaired and wheelchair bound residents. | cordless and cellphones sometimes valuable

How must ownership be accessible to residents?

Accessible to residents to read in 24 hours, excluding weekends and holidays; |Copy in 2 working days

End of Year

All inventories are valued. Supposed to use cost when purchased or current cost, whichever is less.

What kind of patients are unable able to train for bladder/bowel problems?

Alzheimer's

where is the comprehensive plan of care developed/revised from?

Assessments

What is Heavy Care?

Assistance with:|-Transfer/mobility|-Toileting|-eating|||INSTRUMENTAL ADLs require more physical and mental abilities.

perpetual inventory

BEST. know amount on hand and cost based on use at all times. tighter control.

Sanitation: what does HACCP stand for?

Hazards Analysis Critical Control Point||(traces how, when, where contamination can occur)

What are the symptoms for anti-psychotic drugs?

Head jerking |Fly-catcher tongue (tongue swells and loses control, too long will become chronic)||||Report it to DON

OPERATING BUDGET

INCLUDES DETAILS OF ATINICPATED REVENUES (INCOME) BY SERVICE, AND ANTICIPATED EXPENDITURES BY CATEGORY. ||HELPS TO CONINUOUSLY STUDY AND CONTROL FINANCES|||(ROAD MAP TO FUTURE)

CAPITAL BUDGET

INCLUDES REAL ESTATE, BUILDINGS, QUIPMENT, USALLY LIMITING FACTOR AS RE-COVERAGE FROM EXPENES TAKES LONG TIME, ||MEDICARE COUNTS $5000 OR MORE AS CAPITAL IF ITEM HAS USEFUL LIF IN RXCESS OF 1 YEAR (PREVIOUSLY $500 OR MORE)

What are the parameters for unplanned weight loss?

INTERVAL SIGNIFICANT LOSS SEVERE LOSS|1 month 5% greater than 5%|3 months 7.5% greater than 7.5%|6 months 10% greater than 10%

What content and format does CMS require? (9)

Storage of drugs

Internal and external must be in separate areas

Unions: Things you CAN'T do (SPIT)

Threaten to fire, demote|Iterrogate - question if for or against, attend meetings, or sign card|Promise raise, promotion or other benefit|Surveillance - may not watch to see who attends meetings, discusses union and passes out literature on his own time. | Administrator cannot attend union meetings| Supervisor speaks for union - do not fire. Clarify Facility stand on unionizing.

staffing requirements for DON

Must be an a registered nurse. May serve as charge nurse only when 60 or fewer residents. Must have a RN 8 consecutive hours a day/ 7 days per week unless have a waiver.

What is required of medical records (4)?

Must be:|Complete |Accurate|Accessible|Organized

Pharmaceutical services

Must have policies And procedures covering all aspects of drugs

Medication error

Must not have 5% or MORE. |Residents free of significant medical errors. |

How activities accommodate handicapped?

Must provide adaptive equipment so can participate.

Medicaid billing

NH bills a fiscal intermediary chosen by the state. Nursing homes bill electronically on Form UB04 (failure to bill timely may result in forfeiture of that payment.

Medicaid -

Title 19 program for medical assistance to the medically indigent - based on medical need.

Physician/resident relationship

To be promoted by staff, how to talk to the doctor

What is the purpose of PLAN, IMPLEMENT, EVALUATE nursing services?

To maximize residents health potential, eliminate excess disability

Governing body/administrator relationship

NHA only person reporting directly to GB, usually through the chain of command, e.g. regional director, VP of operations, etc. Represents his/her staff in best light-accurate, objective, factual. Reports to GB as requested - census, personnel, financial reports, regulation changes. (keep fully informed, otherwise grapevine gets to them.)

MBWA

NHA regularly visits all departments and observes performance and environment. sends out strong messages:||- interested, available|- expects quality|- monitoring|- provides opportunity to:| - reinforce good work| - prevent some problems| - enhance communication

delinquent accounts

NHA should take active role||letters, phone calls, personal visits. The longer it takes, the less you will collect. when all else fails, may need to turn account over to collection agency or an attorney. before you do, suggest family take out loan and pay you - pay loan monthly

Union activities

NLRA purpose |1. define and protect employee and employer rights|2. encourage bargaining|3. eliminate harmful practice

Election

NLRB may call election when 30% sign cards.|50% plus one who cote determine outcome of election||i.e 100 vote | 50%| 26 determine outcome|

Can you refuse to admit an AIDS patient?

What are the 2 types of tube feedings?

Nasogastric|PEG tube (better tolerated because it is inserted into the stomach rather than through the nose)|

(NFPA)

National Fire Protection Association ||established LSC

NPI numbers

National Provider Identifier||in addition to facility's NPI, physicians providing services must be included on the UB04

Rehab Program - What are the needs of the elderly

Needs of elderly - may require special services such as PT, OT, ST, mental health, mental retardation-especially due to CVA's, falls, structural surgery..

LIFO

New stock used first. Inflation makes value of remaining goods less than those just used.

note on ratio analysis:

a current ratio of 1:1 indicates the facility can pay its debts and perhaps have a surplus. at first glade a ratio of 2:1 appears much better. however, there may be too much money tied up in current assets that are not liquid. in this case, a quick or acid test may be better. a quick ratio of 2:1 means the facility has adequate assets to meet its obligations with a surplus that can be possibly invested until needed.

INTEGRATED BUDGET

a document that projects all capital and operating costs, as well as all revenues, and consolidates this information

What kind of rehab is need for post-acute phase CVA residents and what is the goal?

PT, OT, ST||GOAL: attain fullest potential of physical, mental, psychosocial well being.|

Medication control

Primarily for protection of resident- also to prevent illicit use, meet government regulations.

Standing order

Procedure staff follows under specific circumstances. Differs from PRN which usuall refers to individual.||I.e immunizations

Security

Proper storage (lock and key), limit access procedures.

What are the 4 roles of the resident/family council administrator?

Provide space|Provide material|Provide resorce person - meeting by invitation only.|Implement recommendations when possible

Quality Assessment and Assurance Committee (PI/QI)

REQUIRED

Governing Body

REQUIRED by CMS, whether sole proprietorship, partnership, or corporation

Legal Liability

RESPONDENT SUPERIOR- EMPLOYER IS RESPONSIBLE FOR WORK ERRORS OF EMPLOYEES WHEN ON DUTY. VICARIOUS LIABILITY - MAY BE RESPONSIBLE FOR NON-CONTRACT WORKERS WHILE PERFORMING DUTIES IN THE FACILITY. | - PROPERLY TRAINED. NEVER ALLOW EMPLOYEE ON JOB UNTIL FULLY TRAINED . LIABILITY INSURANCE.

What is the RN's role in MDS assessments?

RN must certify COMPLETENESS (not accuracy)|must be coordinated by an RN. No waiver.

What is the preferred treatment for contractures?|

ROM (range of motion)|Splint - if flexed - to help prevention

What is included in the discharge summary? (4)

Recap of residents stay|Final summary of status|Post d/c plan|Must be completed 90 days after discharge.

RDA's for Dietary Mangement

Recommended Dietary Allowances of vitamins, minerals, calories, proteins, etc.

Polypharmacy

Refers to those patents who are on 9 or more medications, including vitamins.|Standard of practice is for the consulting pharmacist to identify these patients to their attending physician at least annually.

Automatic stop order

Required on drugs not limited to time and number of doses. Nurse call MD before last dose. Not a recommended practice in nursing homes

Sexuality|

Resident right to privacy.|Consensual nature

Marreed labeling

Return to pharmacy

Who makes up QI/PI

DON, designated MD/DO, at least three other staff members

INS

Immigration and Naturalization Service

Corporation

Directors and officers must act within the authority granted them - usually in bylaws and articles of incorporation. Can be held liable for any unauthorized actions.

Dementia

Impairment of mental powers due to organic causes

Role confusion -

GB members usually successful in another field. Not have same, clearly defined solutions

What category of drugs does medicaid usually pay for? (part d)

Generic drugs

Safe Harbor Rules

Get regulations from OIG. Governs reimbursement under Medicare/Medicaid. Not violate Anti-kickback Statute. involves investors, space and equipment rentals, personal services, management contracts, referral sources.

Anti-psychotic drugs

Give only for specific diagnosis, documented diagnosis.|

In regards to nursing, what plans should be made to address emergencies?

Have plans posted at nurses stations:|- regular physician|- back-up physician|- transfer to ER|- special plans for cardiac cases||(review procedures regularly)

HCP

Hazard Communication Program ||Mandated by OSHA

LSC, ANSI/ADAAG, and CMS

**- building materials - fire-rate according to number of stories. 2 hour and 1 hour rating|**- sprinklers - new buildings have automatically activated by smoke/heat|- exits - no room more than 100 feet from exit. Lighted exit signs of specific size. |- walls extend continuously to roof deck of next floor. wall finish must meet flame-spread requirements ( have certificate of this)|- furnishings - curtains and carpet must meet fire rating|- rooms - CMS requirements - 4 residents to room MAX. 80 sq ft/resident (multi-resident room), 100 sq ft for single occupancy.

staff

advisory, recommend, teach. cannot enforce decisions- consultants.

misconceptions in the aging process

aged normally decrease in intellectual functioning; normally cannot care for selves. May lead to being treated as infantile - TO BE AVOIDED.

depreciation

all assets costing $5000 or more and used more than one year are depreciated. allocation of costs of tangible assets over a specified period of time. cause of depreciation is decrease in value due to use, obsolescence, action of elements...

deposits

all funds received should be deposited the same day they are received. Person receiving funds should not make up bank deposit slip - second chance to lose funds

receipts

all funds received should be receipted and immediately recorded in proper accounts - first opportunity to lose money.

marketing attitude.

all marketing oriented to meeting consumer needs. number one goal; starting point

OBRA: ownership

all participating facilities file Disclosure of Ownsership. FOR CMS (1513). If party has 5% or more ownership, show|1. name and address|2. relationships between any two owners|3. any named person's 5% or more interest in any other participating facility||annual update by administrator

documentation

all received, all withdrawn documented with receipts and/or signatures

accelerated depreciation

allocates larger amounts of depreciation in the early years of an asset's assigned life. DOUBLE-DECLINING is the type that allows applying the doubled rate each year. SUM-OF-THE-YEAR'S_DIGITS is another accelerated method that has high depreciation charges in the early years of an asset's life. PRODUCTION -UNIT, SERVICE-HOURS and others are not often used.

amortization

allocation of costs of non-current, intangible assets over a specified period of time. also, of debt-monthly payments

Residents Rights:survey results

allowed to examine survey results and plan of care. HAVE READILY AVAILABLE (make part of admission)

Residents Rights: grievance and complaints

allowed to voice complaints regarding care and treatment. No discrimination or reprisal. Promptly investigate and resolve all complaints. Post names, telephone numbers, etc. of advocacy groups. Surveyors will ask residents how staff responds.

purpose of organizing

allows for growth and expansion; seeks to reduce friction and unsought consequences.

What is the generic substitution for Xanax?

alprazolam

ratio analysis

analyzes strength and profitability, and efficiency of operations. done by determining relationships between certain items in balance sheet and earnings statement, and pairs of items of different statements

use discounts

and full credit period-helps with cash flow

timing of change

announce before start, allow time to adjust, get off chest. ask for reactions, promote discussion - how affects you?||avoid 2 words: effective immediately

what kind of patients are pre admission screening targeted towards? (PASSAR)

any applicant on a PSYCHOTROPIC DRUG, or a history of mental illness or mental retardation, must be screened by an agency selected by the state medicaid agency.

define job evaluation

appraisal of a job of by application of standards in order to rank or rate jobs. used to determine pay levels

current liabilities

are debts usually due within one year,such as FICA taxes, FWT, notes payable and dividends

Intangible assets

are non-physical, such as COPYRIGHTS, patents and GOODWILL

corporations

are required by state to have Articles of Incorporation that specify officers, board, membership.

What is Light Care?

assistance with GROOMING and DRESSING

what is the purpose of developing and operationalizing polices||

assuring that the facility is doing all that is within its control to prevent abuse and neglect.

How often should PI/QI ( Performance improvement /quality improvement) meet?

at least quarterly

payroll accounting: records

attendance and payroll. |Wage & Hour says keep at least 3 years.|May keep employee earning record.|

functional

authority over a function (hiring, purchasing..) but not over person who carries it out. used in larger organizations.

documentation - personnel records

available to Medicare/Medicaid and other government agencies. No federal law that employee see reord; most states have such laws.

journal

book of original ENTRY. CONTAINS al financial transactions in chronological order. tells where to post debits and credits.

What is the generic substitution for Thorazene?

chlorpromazine

multiple sclerosis

chronic, progressive, involves central nervous system||Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord (central nervous system).

lien

claim or charge on property for payment of obligations

What is the purpose of the DEA?

Define job

collection of tasks that can be performed by an employee.

limited liability corporation ( LLC)

combines characteristics of CORPORATIONS AND PARTNERHSIPS. more flexible management. profit and losses can be allocated regardless of how stockholders are invest in the company.||IRS will attach owners assets when corporation does not remit payroll taxes.

sudden increase in cost

compare to same dates in prior years, see if cyclical.

earning statement

compares revenues with expenses incurred to produce income. reflects PROFITABILITY. ALSO CALLED PROFIT AND LOSS STATEMENT. |

What is the timing for a comprehensive plan of care to be completed?

complete in SEVEN days after assessment. (Max: 21 days after admission)

ledger

complete listing of all accounts and their balances, payable and receivable

safety and infection control program -

complete procedures for all staff to follow best infection control. committee may be desirable.

Chart of Accounts

completel list of all categories in the ledger - may include number - receivables and payables - like table of contents.

mortgage

conditional transfer of title on property by a borrower to a lender to secure payment of a debt or loan

purchasing

consolidate purchasing by |a. standardize both products and vendors well before purchasing,|b. centralize purchasing so all department heads do not purchase, |c. minimizing number of staff who can purchase. have strict purchasing procedures, and negotiate with vendors

communicable

contagious

AP statement

contains balance from last statement date, dates and amounts of payments, dates and amounts of new purchases, and new balance. Also contains age of amounts due. Do not pay by statement.

regulated waste

contaminated sharps, blood, pathological waste, etc. Have written procedures for handling.

fiscal year and budgeting

corporations choose any 12 months. partnerships generally use calendar year. sole proprietorships use calendar year.

energy

cost appear too high, best to hire maintenance engineer to do energy audit, set up program for ONE person to audit - save enough first year to cover fees

nursing costs

cost of drugs $0.60 ppd. 100 beds with 90% occupancy. how much do you expect to spend in a 20 day month||100 beds x 90% occupancy = 90 pts|90pts x $0.60 cost ppd = $54.00 total cost/day|$54.00 total cost/day x 30 days = $1620.00

Health Care Fraud and Abuse COntrol (HCFAC)

created as part of HIPAA in 1996. the office of Inspector General (OIG) and Department of Justice (DOJ) authorized to fight fraud. Resulted in significant saving already.

What Act created the DEA?

created by Comprehensive Druge Abuse Prevention and Control Act of 1970

What food groups cause allergies?

dairy products most frequent; seafood. |Odor of some foods may cause anaphylaxis within 60 seconds. ||Dietary personnel must know about food allergies-check trays and servings carefully.

value of break-even analysis

dcan study volume of service and expenses in integrated manner; expenses more closely controlled; decision on expansion can be carefully considered; easy-to-read report summarizing date contained in various income statements

Long-term liabilities

debts not due for a period usually more than one year, such mortgages, bonds, and property liens.

liabilities

debts or obligations owed.

EEOC: veterans

disabled Vietnam veterans

Parkinson's

disorder of the brain that leads to shaking (tremors) and difficulty in walking

malignant

disposed to cause harm, suffering, or distress deliberately; causing harm or suffering/cancerous

straight-line depreciation method

distributes the same dollar amount of depreciation to expenses each year during the asset's assigned life. (required by medicare)||cost - salvage value|________________||assigned life

garnishments

do not fire unless it meets federal standards

performance evaluation extra points

do not overemphasize negative features. cover positive, too. |documentation: signatures and dates

adjusting entries

done by accountant if administration is concerned with PROFITABILITY. also done for discounts on purchasing, for uncollectable bills,and at the end of the year. | a. adjustment in basic bookkeeping is done in journal| b. error notedin audit is adjusted in ledger

staffing requirements for CNAs

each state must maintain a registry which includes name, address, SS #, DOB, record of training and competency evaluation completed, (name and date of program), documentation of any act of neglect, abuse, or misappropriation property.

double-entry accounting

each transaction has equal debits, equal credits

dividends

earnings distributed to owners

retained earnings

earnings not distributed to stockholders, limited, or IRS will tax.

advantages of methods:

easier to access computer data, makes comparisons, etc. ||most budgets now prepared by central office in chain organizations, may ask for administrator input. some have administrator develop budget, send to central office, which negotiates with administrator. family owned facilities still depend on administrator to develop budget.

delegation

effective when lowest person in echelon who is authorized and capable is making a given decision. key to effective management.

Where are MDS assessments reported?

electronic reporting to state Medicaid agency of ALL assessments.

advertising

emphasize unique aspects of your service. false advertising - such as "we meet and exceed all state an federal standards" is prime ammunitions for lawyers

What effects do drugs have on aging?

more sensitive to drugs|discharge from body changes| urine| perspriration | feces| breathing||a. side effects a risk factor. Tag records of residents who exhibit side effects|b. multiple medications (4 or more) - compatibility

methods

most chain organizations have computerized financial management. local facility computers linked with MAINFRAME COMPUTER IN CENTRAL OFFICE

management types

most effective now considered to be TQM and MBWA

Arteriosclerosis

most frequent metabolic deficiency. ||a general term that refers to the loss of elasticity and thickening of arteries.

What are the reasons for complaints?

most residents want to go home. Also, most family members have no resolved feelings about placement.

Bylaws

mostly by corporations. Rules to govern corporation itself. Not too specific. Tells WHAT cop oration will do.Includes duties of Board, officers, committees. Prepared by corporate members. Used as basis for writing policies and procedures for each unit of corp. Tells HOW activities to be carried out. Usually prepared by administrator, and approved by board.

normal physical changes in the aging process (6)|

Medicare Therapies

must be given 5 times weekly ; can be a comination of the therapy

What is required of computer codes and written signatures?

must be readily available and maintained under adequate safeguards.

Deposit less than 50k

must deposit in bank by the 15th of next month, unless total is less than $2500, then can remit to IRS quarterly. may use electronic or hardcopy depositing.

What is required by nurses when doing assessments?

must do comprehensive, accurate, standardized assessment for each resident's functional capacity in the five ADLs.

How must you keep records of PI/QI?

must document at actions, continuing record. DH'S (Department of Health and Human Services) and State-no required disclosure-just ensure they are kept (compliance)

OBRA: lab, radiology, other diagnostic

must have agreement with qualified sources

grievances (employee)

must have or employees feel no one cares. explore all employee complaints, give feedback. invites organized labor without it.

readmission

must have written policy. must readmit to first available semi-private room shared by a member of same sex.

menus for dietary management

must meet nutritional needs according to Food and Nutrition Board of Research Council, NRC (national Academy of Sciences) State determines retention.

AR audited

must show that made an effort to collect money before putting on bad debt

NLRB

national labor relations board

gross profit

net sales - cost of goods

Denial Letter

new regulations mandate that a 2-day notice is given to the resident/legal representative prior to discharging from Medicare Part A

principals of reciprocal action

no change can occur in any unit of an organization without affecting all other departments directly or indirectly||(don't ask why: employees get defensive. "i understand you were late, what are the reasons"

no change

no change in any unit until all others evaluate impact

charges

no charges to personal account for items paid by medicare/medicaid

S corporation

no corporate tax, except some long-term capital gains. profits or losses claimed on individual tax returns

keep revenue cost in balance

no deficit budgeting

EEOC: Handicapped REHABILITATION ACT OF 1973.

no discrimination if employer receives federal funsd; no discrimination in hiring or use of facilities by handicapped in programs using federal funds. Also requires Affirmative Action in federally-funded programs.

What is the purpose of EEOC

no discrimination in employment and use of facilities

What are the intervals for meals?

no longer than 14 hours between evening meal and breakfast||16 hours with substantial snacks and o.k. from resident's counsil||(snacks must meet RDA's)

Threshold

no more than 1/2 inch on entrance and exit doors, except exterior sliding door can be 3/4 inch in height

are there any specifications for workers in dietary, housekeeping, laundry, and maintenance?

no specifications. a director of environmental services preferred to be over the last three departments

Exit Interview

includes resident and ombudsman. define areas not in compliance (not by Tag Number). ||PURPOSE: to inform facility of observation and findings. findings written and discussed (284) surveyors must revisit for deficiencies with a scope and severity rating of "G" or higher. They have the option on all citings below the "G" level. ||DOUBLE G's: CMS imposes denial of payment when provider is cited for actual harm deficiency, corrects, but is cited again within 9-15 months.

what does failure to distinguish between normal and abnormal changes in the aging process result in?

infantilizing residents which leads to regression

nosocomial

infections that occur after admission

Directing (leading)

influence of employees todo their work according to stander - who?when? how? invoves leading, motivating, communicating, giving instructions, goal setting, decision making, representing, coordinating, managing conflicts.

written communication preferred when:

info must pass thru several mgt. levels|employees not well trained|involves significant change |provides guidelines of long duration|supervisor tends to forget what has told employees

newsletters*

inform public of facility services, inform residents/family of comment resources. send to agencies, civic organizations, local government, health care organizations.

equities

interest in or claims upon assets by the owners ||capital stock + retained earnings

overall goal

interpret facility to public and public to facility.|bonds and involve th two in an interrelationship. | a. earn respect and pproval of community.

corporation

not generally liable for business debts, except payroll taxes. best for owner's protection against liabilities of business.|

stereotyping residents

not possible; aged to different

timing of notices (4)

notice given 30 days before transfer/dicharge unless:|- safety of residents endangered|- health of residents endangered|- resident has urgent needs for immediate transfer|- not resident in faciliy for 30 days

environmental design

now part of all new construction. Must be designed to provide most attractive, comfortable, usable environment. | a. landscaping - all grounds, nursing home sign.| b. choice of colors.| c. room size- too small?, adequately designed?| d. medical records storage| e. parking - inconspicuous| f. functional equipment - not just fancy.

departments in budgets

involve department heads in budgeting for own units. promotes cooperation.

cost mangement

involves sensitivity analysis-purpose is to ancticipate changes in variable costs and to plan containment.||Due to increased competition, changes in reimbursement, more regulation

contract for personal services

involves the offer of money, consideration, acceptance. Spell out duties, authority, time, remuneration, ESCAPE CLAUSE, other terms

capital

is a term meaning funds to be used in business. Real esate, buildings and certain equipment can be included under certain conditions. |

Vendor's statement

is basically a history of account - balance of last billing, added bills for service, payments made, current balance, and age of account. DO NOT pay by statement - pay only by invoice

book value

is cost of a depreciable asset less accumulation depreciation ||depreciable asset - depreciation

What is the purpose of resident rights?

is for residents to have autonomy and choice, to the extent possible, over how they wish to live and receive care. Facility must practice and promote rights.

employee centered management

is interested in needs and interests of employees. promotes positive work atmosphere, improves performance. (TQM and MBWA)

reimbursement rate

is set by CMS based on the 53 RUGs (case mix). 2 sets of rates: metropolitan and rural

hematoma

it is a collection of blood outside of a blood vessel. it occurs because the wall of a blood vessel wall has been damaged and blood has leaked into tissue where it does not belong.

Americans with Disabilities Act

job description set up to show essential and marginal tasks - may not ask if have handicap

performance evaluations

job or performance based - evaluate on basis of goals and procedures for individual employees job. do not compare with each other.

Discharge

just cause according to state employment security is misconduct. Absenteeism is not considered misconduct.

Resident funds

keep all who request it (in writing)

savings

keep as much money in savings as possible - make your money work for you. maintain only enough in checking to cover day- to-day cost. this is usually determined by corporate financial persons.

how does dietary monitor and evaluate resident satisfaction

number and type of meals, cost; obtain weekly reports on # of meals, types, income, etc.

turn-over rate

number of times an item is replaced during the year.

Who uses the Emergency Medication Kit?|

nurses

late fees

nursing homes may charge reasonable fee

EEOC: Age

over 40

Line

over all under one's direction - hire, instruct, monitor, discipline, fire

Administrator's role in Financial Mangement

owners hold administrator responsible for proper financial management of facility. Varies according to type of ownership. chain organizations may do budgeting, payroll, group purchasing - administrator may have little input. Smaller organizations usually have CPA to supervise accounting, make financial reports, handle payroll, etc.

define job assignment

pacific assignment of duties (usually written)

wage and hour division

part of Dept of Labor - Fair Labor Standards Act

educational institutions

participate in HS career days, involve student groups (social studies classes, clubs). inform of what nursing home industry involves

Duty of obedience partnership

partner owes his partners a duty to act in obedience to the partnership agreement on all business decisions. Personally liable if does not.

staff recognition: organizational

pay increases, benefits, recognition, praise, awards, promotion. Controlled by facility.|

Employee compensation

pay scales related to level of authority, training required, supervisory duties, skill|. ||Key to good pays system is to start with fair wage standard - prevailing wage paid by other facilities.

pre-employment tests

personality, interest, ability, work sample- must be done by qualified examiners. READING test by use of application. Personality and interest test not usually good predictor; ability test and work sample can be. No test given that has adverse impact on minorities or women (title VII)

how is covered in ADA?

physical, mental or psychological disability, obese, AIDS victims, and others.||

Who prescribes therapeutic diets and who approves them?

physician prescribes|dietitian approves

Who must be contacted of a Change in Condition

physician|family/legal rep|||Reassessment required if signiciant

budget

plan expressed in numerical terms that is a forecast of revenues/expenditures for fiscal year. also budget other resrouces - allocating staff, space, equipment, supplies

budgets

plan expressed in numerical terms that outline expected results

strategy

plan of action used to meet goals. marketing program lists strategies in sequence to be carried out, who , when, etc.

FIRE CONTROL

planned program with local firemen who learn facility layout, hookups, cutoffs..

Staff Development :Facility-wide program

planned, have responsible person or committee, supported by administrator; provide space, time, materials, trainers, and monitor results

marginal return

point at which revenues equal expenses, the break-even point

barriers in organizational communication

poorly worded -use language of receiver|inattention - tune out and think of something else|transmission barriers- noise, poor hearing, stuttering, etc.|distrust of sender|fear of consequences|poor retention - 30% or less is retained|premature evaluation - give answer before problem is presented|upward communication barrier- filtering out some info before passing it along|over/under - more than need to make decision.

eligibility for Medicaid

possess no more than a home, car, and other resources up to an amount set by the state and approved by CMS.|

medical exams

pre-employment physicals only after job offer. Physician only gives findings, no recommendation or decision on employment.

Alzheimer

pre-senile dementia due to atrophy of frontal and occipital lobes, progressive deterioration, chronic, interferes with social and emotional function.

Resident Activity Director (RAD): Therapeutic Recreation Specialist

preferred: licensed or registered, if applicable, or eligible for certification as a TRSor an activities professional by a recognized accrediting body; or is a OT or OTA; or in a social or recreational program withing the past 5 years. 1 of which was full time in a patient activities program in a health care setting.

Purpose

primary focus on obtaining goals |offsest uncertainty and change|develop economical operations, and|facilitate control|

Duties

primary: to investigate and resolve complains made by or on behalf of LTC residents. An ombudsman is an individual who protects and promotes the rights of individuals before, during, and after a placement into a NF, adduct care home, or other assisted living. the service is offered at no cost to the client and is confidients|

Resident Rights: notice

prior to or at admission must notify (and document) residents of their rights (federal and State) in language they understand. Also, eligibility for Medicare and Medicad and basic rates.

Residents Rights: Privacy and confidentiality of self and records

privacy with whomever wishes- private room not necessary. Visual privacy at least by curtains. PRIVACY OF BODY DURING CARE AND TREATMENT

Other billing

Process of Financial Management

process of ensureing materials and other resources are bought and used efficiently and economically; attain goals.

materials security

program of purchasing, receiving, storage, issuing, inventorying. Administrator monitor

risk management

program to reduce occurrences (incidents) that may lead to action damaging to facility and its reputation. economic loss through tort action -civil suit. primarily to protect facility, but also to protect residents, staff, and visitors.

Occupational Safety and Health Administration (OSHA)

programs OSHA falls under U.S. Department of Labor

ombudsman

programs required. Includes state advocacy agencies for MI and MR. established by Older Americans Act of 1965, as amended.

Quality of Life

promoted by care and environment that ENCHANCE |-dignity|-self-determination|-participation|-notice before roommate change|-etc.||(culture change: i.e. family style dining, etc.)|

Staff recognition

promotes job satisfaction and MOTIVATES. Stimulated by own needs and rewards:

what services must the rehab program provide?

provide or arrange for through outside resources

Omnibus Budget Reconcilation Act of 1987 (CMS)

provides Gederal Care Guidelines (42CFR) for all nursing facilities that are certified

FMLA of Feb 1993

provisions- leave without pay must be granted| 1. leave must be granted to fathers in case of newborn child;| 2. leave granted for placement of child for adoption;| 3. leave granted to care for spouse, child, or parent with serious health condition| 4. UP TO 12 WEEKS PER YEAR; DOES NOT HAVE TO BE ALL AT ONCE. | 5. ELIGIBILITY- MUST HAVE WORKED 1,250 HOURS DURING THE PAST 12 MONTHS, INCLUDES PERSON, WORKING PART-TIME. (AT LEAST 60%)| 6. Employer qualifies if it employs at least 50 people for at least 20 weeks per year.

mental health specialist

psychiatrist, psychologist, SW, etc. counseling, psychotherapy

written program

public relations program should be written. show the role of employees, residents, ramify, volunteers, and administrator in improving relationships within facility (staff/residents, staff/family, staff/staff, staff/community)

What are the purpose of assistive devices for eating and who provides them?

purpose: to maintain or improve ability to eat|provided by: facility|

What is the generic substitution for Quinidex Extentabs?

quinidine sulfate

EEOC: Title VII

race, religion, sex, national origin

cytotoxic

radiation, chemotherapy, immuno-suppressants

What is the difference between reality orientation and validation therapy?

reality orientation - date, location, next holiday|validation therapy - going back to their reality - not forcing reality

staffing (HR)

recruiting, interviewing, hiring, training, promoting, demoting, terminating, retiring employees. (terminate early in week)

earnings

refers to generated revenues, or income. Gross erarnings are total revenues or income

staffing requirements for dietitian

registered by ADA, or qualified by education, training, experience as approved by state| Dietary Manager - certified by board of Dietary Managers as a Certified Dietary Manger (CDM)

What role can an PA/NP/clinical nurse specialist play in place of the physician?

require visits in SNF after the initial visit may alternate between the physician and the pa/np/clinical nurse specialist

emergency power

required by CMS if have life support equipment, state may require all. supply power to: (LSC) alarm system, life supports, nurse's station, med. prep area, boiler room, communications (call system). CMS omits resident call system, BUT says follow LSC|| power transfer- 10 seconds| cranked weekly| tested full load 30 minutes/month| document

Electronic billing

required. can bill at any time - usually monthly as must have invoices from vendors such as the therapies, labs, etc.

demand billing

resident has the right to have facility bill Medicare for services even though the facility has determined he/she is not qualified. CANNOT BILL OTHER SOURCES UNTIL DETERMINATION OF CLAIM IS MADE BY THE INTERMEDIARY.||

who participates in the comprehensive plan of care?

residents and family participate.||(promotes cooperation. ask CNAs & housekeepers to join.)

employing supervisors

resumes done by professionals, don't oversell job; tell some problems, give scenarios and ask how would handle; first impression not always best

Residents Rights: personal property

retain and use personal possessions so long as it does not hinder staff function; infringe on rights or other residents; or threaten health and safety| VALUE to residents. something to share.| LOSSES be documented and fully investigated| LABELED, proper storage provided|

accrual basis

revenue/expenses recorded when incurred. Medicare REQUIRES

net earnings (net profit)

revenues - expenses

cash basis

revenues/expenditures recorded when actually received or paid out, except for depreciation expense.

**three steps in correcting errors:

review how work was to be done - begin with mutual agreement.|point out error|indicate remedy

Auditing and reporting

review program regularly - check all equipment, accident log, maintenance log, infection control measures, security practices, reports of theft.||conduct and observe drills wil firemen||review documentation ||ask each employee "duty?"

Authority

right to act or require action of others- instruct, approve/disapprove, veto action, change action, reward/withold.

Residents Rights: Residents Funds

right to manage own financial affairs, to deposit funds with facility. request in writing

Residents Rights:Mail

right to uncensored, unopened mail-sending and receiving | a. ACCESS to stationary and stamps| b. PROMPT MAILING within 24 hours-and receing-the day it is delivered to facility.

discipline and Counseling

rules of behavior must be clear and understood; penalties must be equally clear||purpose is to change employee behavior to acceptable and improve work performance

EEOC: pregnancy

same benefits as all other employees. Sick Leave.

Fairness and consistency

same penalty for same error

activities

self-determination and participation. can choose activities, schedules, and health care constant with interests, assessments, and plan of care. includes sleep, being awakened at night, eating schedule, clothes, grooming, visitation, short leaves, free time||1.

involuntary seclusions (abuse)

separation from others, or from rooms (dining room)

Functions of Managers (supervisors): Planning

setting goals, establishing PPR's, programs, budgets, etc. that determine what, how, when, where and by whom work is to be done. CENTRAL TASK is planning as it permeates all other functions.

Residents Rights: married couple

share room if both consent. not required to provide for unmarried couples. must prvide requested privacy for visitors of opposite sex. cannot deny intimacy when facility policy is followed.

What are contractures?|

shortening or shrinkage of musles, tendons, etc., by persistent flexion or distortion of a joint- especially in arthritis and tendonitis

check stubs

show gross pay, medicare, SS, FWT (other authorized withholding), amount of check, totals year-to-date.

ratio analysis: current or working capital

shows excess of current assets over current liabilities. expressed as 1.5:2. creditors interest in this ratio.||i.e. 25k/50k = 1.2

statement of changes in financial position

shows flows of funds into and out of the business. derived from and ties together b, c, and d in single report.

chart of organization

shows lines of authority and communication, formal organization.||hierarchy. top to bottom

Immigration and Naturalization Form 1-9

since Nov 1989. Every employee must have one on file.

focus on improving

skills and quality of output. concerned with productivity, safety, cost, resident satisfaction. how can improve quality of work, and their knowledge and skills.

physical abuse

slapping, hitting, pinching, kicking, pushing, pulling hair, handling in rough, angry manner

normal psychological changes in the aging process|

slowed memory retrieval|problems handling change|forgetfulness|DEPRESSION WHEN ADMITTED|resistance to change

cash-flow statement

sometimes used to show cash receipts and disbursements leading to net change in cash in a given period. provides information to plan for short range, cash needs or able to pay obligations promptly

rules

specific, authoritative guides that require an action be taken or not taken. allows no flexibility in decision making. employees can use no judgment, so should have few as possible.

Accounting

standards established by accountants and boards - GAAP. Nearly all facilities now use computerized.

Who provides the content shown on MDS assessments?

state

procedures

step by step means by which tasks are performed. allows less flexibility in decision making

EEOC: Sex

substantially equal work, equal pay

balance sheet

summarizes assets, liabilities, and stock holders' equity. reflects SOLVENCY. made up at ANY TIME

Accounting records: account

summary of changes in assets, liabilities, stockholders equity, revenue, expense. each account given titles that describes nature of item included (equipment; utilities, auto expense...)|

programs

summations of goals, PPR's, budgets, work and space assignments, and resources.

accumulated depreciation

the total depreciated take to date on a depreciable assets

provider's bill

they bill the SNF for any covered service. ||ADVANTAGE - helps to reduce fraud as SNF will only pay for services actually rendered

operating expense

those incurred in normal operations of business - salaries, benefits, utilities, materials, rents, etc.

drug abuser

threat- narcotic key

define job classification

titles of jobs, ruse, aide, secretary

remitting withholdings

to IRS Medicare, SS, FWT via bank deposits

frequent reports

to administrator on amounts on hand

reason for budgets

to determine reasonable costs and plan cost control

GB listen

to employee complaints but refer them to supervisor or NHA. Inform NHA

What is the administrator's role in PLAN, IMPLEMENT, EVALUATE nursing services?

to ensure that the newest geriatric knowledge is available to properly trained staff, and there is suitable environment.

What is the goal of social services?

to help MAINTAIN or IMPROVE each resident's ability to meet everyday physical, mental, and psychosocial needs.

What is the goal of the rehab program?|

to help each person live at fullest potential possible for that individual - walk again, feed self, toilet, etc.|

What is the purpose of pre admission screening?

to prevent inappropriate placement. |admit only if needs skilled care

Personnel Records: purpose

to provide factual information for making objective personnel decisions. Not required by CMS, but by Wage & Hours, EEOC, INS, state, etc.

purpose of human resources

to provide quality resident care with efficiency and economy. MUST:||1. Employ qualified person for each position.|2. Create a POSITIVE WORK ENVIRONMENT

net worth

total assets - total liabilities

How do you configure the cost of raw food ppd?

total cost|_____________||# resident days||||(i.e. 100 residents x 30 days = 3,000 divide INTO $15,000)

gross income

total income from all services. Also, capital gains, interest on bonds, workers' compensation insurance benfits

basis of worker's comp premium

total payroll, claims experience, risk class, & some other legal requirements

Negotiating

use of give and take in solving problems. not a win/win situation. Get Employee ideas and build on them. useful for contracts with HMOs, consultants, and labor unions.

scalar chain

used almost entirely. || 0| I|__|I I|0 0

When are CAAs utilized?

used when a particular problem is noted at admission such as incontinence, constipation, bedsores, etc.

What is the what is the equation for weight PERCENT LOSS?

usual weight - actual|_________________ ||usual weight |||(usual weight = weight over lifetime; family knows)||do not use ideal body weight

purpose of communication

usually CHANGE - schedule, procedure, new skill, further training. |

define job specifications

usually same as job descriptions

aging account

value of aging account is two fold:||1. reminds resident his account is an arrears and needs attention, and|2. it helps you estimate actual amounts you can expect to collect.

bookkeeping

very mechanical, recording of business transactions.

evaluating effectiveness of policies and procedures. Are they:

does lower back injury and job dissatisfaction have significant correlation

yes

What is restless leg syndrome

|Restless leg syndrome is a disorder in which there is an urge or need to move the legs to stop unpleasant sensations. Symptoms: RLS leads to sensations in the lower legs that make you uncomfortable unless you move your legs.|||||-causes night walkers. unknown origin.|-treatment very diverse-medications, exercise, hot showers, heating pads, etc. |-difficult to control

Unity of command

employee has only one supervisor insofar as possible. need clear authority lines - promotes job satisfaction, teamwork.

goals or objectives

end results or product toward which all effort is directed||a. short range|b. long range|c. goal oriented needed||(These SHOULD STIMULATE action)

zero-based

evaluated costs and benefits of all activities in comparison to alternative expenditures, rank and chose from alternatives in term s of how they fit overall priorities

reporting/investigating abuse

every incident. documentation must include: who, nature of abuse, where, when, whether addressed immediately. report to proper sate authority with FIVE WORKING DAYS

working capital

excess of CURRENT ASSETS/CURRENT LIABILITES. |A measure of company's ability to pay bills.

What is a Kegel exercise?

exercise muscles that support bladder.

capital expenditure

expenses of increasing book value of facility assets.

retained earnings

explains changes in retained earning tha occur between balance sheet dates

glaucoma

eye pressure 16-18, cannot cure, can control||Glaucoma refers to a group of eye conditions that lead to damage to the optic nerve, the nerve that carries visual information from the eye to the brain.||In many cases, damage to the optic nerve is due to increased pressure in the eye, also known as intraocular pressure (IOP).|

best form of organizational communication

face to face - as secure immediate feedback by expressions, questions..

surety bond

facility bond or assurance approved by DHHS, at least to cover all resident funds. may have alter nature assurance.

Notice of Transfer/Discharge

facility must notify resident and family member before hand in writing. include in notice and in clinical record:|- reason|- effective date|- location to which transferred/discharged|- right to appeal|- full information to Medicaid agency, ombudsman, and proper advocacy agency

wanders and elopement

facility must plan, due to liability||assess possibilities before and at admission. ||plan includes notifying doctor and family, setting up monitoring program, installing door alarms, advising all staff.||DOCUMENT||wristbands that trigger door alarms are not restraints (i.e. wander guard, code alert, magnetic locking doors, etc)|

Residents Rights:acess and visitation

facility provide immediate access 24 hours per day to:| a. REPRESENTATIVE OF CMS OR STATE, resident's physician, ombudsman, and advocacy reps. immediate family and other relatives may visit as resident desires. | b. FACILITY MAY ESTABLISH guidelines for "reasonable acess" by assigning location of visit, not allowing disturbance of other residents - make these available to resident and family in writing.

Staff Development: orientation

facility, staff, personnel policies and procedures (handbook). documentation

benign

favorable

use of news media

featured articles. negative rumors - work with reports

penalties

fine up to $10,000 and up to 6 mos in prison

Dietary in-services

fire control and infection control are required programs. |Other programs taught but not mandated include food portioning, food prep and temperatures. ||effective when employees are capable of learning and motivated; and when ADMINISTRATOR support program

define job analysis

first step is to identify |1. tasks|2. knowledge, skill, behaviors needed. |Best person to help determine is the employee. use to develop job description.

fixed expense

fixed expense remains constant without regard to volume of business||i.e. mortgage payments, leases, taxes

Medicare re-qualify

for another 100 days if there is a 60 day break in skilled services. this does not mean the person has to be discharged from nursing home, nor does it mean just because they were discharged from the nursing home that the spell of service has been broken.

Category 3

for cases of immediate jeopardy (level 4 deficiencies)|-temporary manager appointed|-terminated of provider agreement and/or|-CIVIL MONEY PENALTY OF $3,050 TO $10,000 PER DAY OF NONCOMPLIANCE|||||(QIS Survey being implemented in all states incrementally)

alarm devices

for wanders and elopers

restraints

free from restraints used for discipline or convenience. must be for treatment. discipline means to punish behavior; convenience means to control behavior or maintain residents with least staff effort

Resident Rights: exercise rights

free of interference, oercion, discrimination, or reprisal. Facility can encourage to participate undocumented care plan program.

Abuse

free of verbal, sexual, physical, or mental abuse, corporal punishment, involuntary seclusion

storage

freezers and storage rooms locked

staff recognition: social recognition

from fellow work - not controlled by facility|

conveyance at death within 30 days -

funds and accounting to person or probate administrating estate.

investment

funds not used for as much as 20 to 30 days may earn most by keeping them in money market funds - they are still liquid

Strategies

general plan that focuses on long range goals. ||What will facility be like, look like, feel like, sound like, and react like, in the future

Drug and Alcohol testing

generally permissible. obtain written consent of applicant. paid for by facility.

Superior/subordinate relationship

gives rise to jealousy and anger; trouble begins. Some people DO NOT WANT TO WORK or be told what to do.

informal organization and communication

grapevine - tends to be used and depended on more than officia communication; tends to be believed and acted on. CANNOT destroy. learn to use.||offset by open, frequent, official communication. supervisors trace rumors.||coffee cliques and other informal groups talk about work, procedures, changes, how they will react. undue influence on performance

result in continuous quality improvement (CQI)

greater job satisfaction, motivation, teamwork, growth of staff.

operating profit

gross profit - operating expenses

organizing

grouping activities and people, assigning roles, delegating authority. Setting up department, shifts, work teams.

sexual abuse

harassment, coercion, assault

Residents Rights: records

has right to inspect and purchase copy of all records

Residents rights:Medical care and treatment

has right to refuse to be admitted to facility. Choose own physician.|A. refuse treatment-discuss alternatives first.|B. inform in advance of care an treatment-total health status, prognosis.|C. Informed consent.|

computerized information

learn basic terminology. value- provides quicker, more accurate, greater amount of information for decision making. especially useful in financial management, inventory control, etc.MIS needed in nursing homes| a. online survey certification and reporting (OSCAR) system. All NH's must input assessment and care plan information. surveyors use in planning focus of survey.| b. extensively used in accounting, assessment, care plans.| c. internet - much information for NH survey results| d. FAX| e. voice response| f. e-mail

partnership

legally liable for business debts

sole proprietorship

legally liable for business debts

closely held corporation

less shareholders, most are 5 or less, less formal organization.

level of deficiency

level 1 - NO actualy harm with potential for minimal harm; minor negative impact on residents.||level 2 - no actual harm with potential for more than minmal harm; EXAMPLE: medication error rate, harm of short duration as falls, a laceration, etc. - easy to remedy.||level 3 - actual harm that is not IJ. A negative outcome that has compromised resident's ability to maintain or reach highest level of functioning. EXAMPLE: pressure sore of urinary tract infection occurring after admission.||Level 4 - IJ. Immediate or corrective action necessary because noncompliance in one or more requirements has caused or is likely to cause serious injury or harm, impairment, or death. EXAMPLE: nurse call system not functioning, severe staffing shortages.

staffing requirements for charge nurse

licensed nurse on each tour of duty unless have a waiver (waivers for medicare facility granted by CMS; for medicaid, by state)

What 2 entities establish nursing practices and principles?|

licensing boards|code for nurses||Administrator should report unethical practice to appropriate board.|

Financial Statements: trial balance

list of all accounts and their balances, except account with zero balance. made at an y time, used in preparing other statements

define job description

list of duties, level of authority, distinguishing features of work, special requirements as standing, stooping, lifting, and qualifications-required license, training, etc.

bank statement

lists balances at beginning of month, deposits, checks paid, bank charges, interest, daily balances, and ending balance. RECONCILE immediately upon receipt monthly

Employee counseling

low affect ( soft voice), be specific, listen, no hasty dision, accept feelings, no criticism. Non-directive; draw out information.|

purpose of controlling

maintain harmony between plans and work performance. ||purpose of correcting erros is to improve work performance.

INVENTORY CONTROL

maintain proper levels to reduce working capital needs

what is the difference between mediation and arbitration?

mediation: third party tries to get parties to agree||arbitration: opposing parties agree to abide by decision of the arbiter. ||

Accounts Receivable: reimbursement sources

medicaid|medicare|private pay|managed care|long-term care|||83% of residents pay in part or in whole by Medicaid/Medicare

abnormal psychological changes in the aging process|

memory loss |delusions|HALLUCINATIONS|dementia|sudden behavior change often due to mild strokes

economic order quantity (EOQ)

method helps on when and how much to order. balances cost of reordering and carrying cost, and risk of running out. Must consider shrinkage, spoilage, and theft.

remedies: category 1 remedies for "d" and "e" deficiencies

directed POC|state monitoring|directed in-service

Staff Development: content for facility wide program

what is required when changing MDs? (3)

- new history |- New orders|- written releases from prior MD

organization communication

- process of tansmitting information among two or more people. occurs when message received with understanding.

What must the facility ensure for Hearing Deficit & Balance?

- proper treatment and assistive devices|- appointments|- and transportation to specialists.||Facility does not provide services and hearing aids, but ensure availability.

What are some symptoms of depression in the elderly?

-Being more confused or forgetful.|-Eating less. |-Not bathing or shaving as often. Visitors may notice smells of urine or stool. Clothes may be dirty and wrinkled.|-Not taking care of the home.|-Stopping medicines or not taking them correctly.|-Withdrawing from others. Not talking as much, and not answering the phone or returning phone calls.|

What are the duties of an MD?

-Implementation |-Coordination||of resident care policies|

What are the conditions for FAXING?

-Physician should have signed and retained the original copy of the order|-facility should have photocopy of the faxed order since FAX fades over time|

risk factors

-administration - PPRs, staff qualification, follow-up of complaints, accidents, insurance...|-nursing - restraints, PRN orders, medications, lack of proper assessment and care plan. #1 are of concern|-environment - LSC, ANSI, ADA, OSHA - poor security and preventive maintenance, inadequate safety and infection control. Housekeeping safety.|-Dietary-infection control, spoilage, food taste and appearance, garbage disposal.|-tools for developing good program:| proper plans for each dept| adequate insurance| training| documentation| quality assurance and assessment| monitored by NHA (MBWA)

When is it necessary to isolate an AIDS patient?

-bleeding or bloody discharge, or |-contagious disease. |||(Must follow universal precautions; if you follow universal precautions then you are fully able to care for AIDS residents)

guidelines to correcting (4)

-correct first error, soon as possible, in private|-objective, specific, factual-no exaggeration|-make no excuse, be serious|-do not threaten that will watch to see|

what does the Uniform MDS (minimum data set) communicate?

-describes resident's present level of functioning in four activities of daily living (ADLs)|-potential for improvement or regression. ||(use instrument specified by state and approved by CMS.)

Duties of leaders. duties are diverse. they include:

-goal setting - points teh way. good planner|-decision making - high priority, as it includes problem solving. makes decisions when needed - no - procrastination. uses his/her authority.|-giving instruction - types: specific or general, formal or informal, written or oral. Gives instructions of type staff best responds to.|-Listening - problems of staff, residents, families, and public. Good at crisis intervention. |-Representing - his staff in best light.|-Coordinating- People have different approach to work - slow and fast, interested or not, apply self fully or not, etc. He/She must coordinate those differences and still get job done.

Policies, Procedures, and Rules (PPR's)

1. FIRST STEP in human resource management|2. PURPOSE: provide information on what management expects of employees and what employees expect from management|3. DEFINITIONS| policies - flexible| rules - inflexible|4. EMPLOYEES HANDBOOK - simply written PPR's on personnel management. Copy for each emplyee.

leadership style

-laissez-faire - give instructions and leave alone, easy going and supportive. May work for professional staff, and for highly motivated, capable staff.||democratic- allow employee input on how things are done. majority rules. a factor in TQM. administrator must retain veto power, cannot be 1005 democratic.||paternal, sympathetic, parenting - you do your job- i'll take care of leave, raises, benefits.||autocratic- dictatorial, threatening, intimidating. no confidence in staff; he knows all. "don't care if he likes me or not-just so work gets done"||situational- leaders adapt their style at times to meet circumstances in which they are working and/or the type of employee they are leading.

What must MD supervise? (5)

-medical care |-policies on accidents/incidents|-lab radiology|-pharmacy|-quality of care

spoilage

-milk and others-make sure to rotate-FIFO

Transfer/discharge is possible when resident's:(7)

-needs cannot be met|-health is improved so she/he no longer needs facility care|-continued stay endangers safety of others|-continued stay endangers health of others|-has failed to pay for care after reasonable and appropriate notice, or|-facility goes out of business|-documentation Needs that cannot be met and health improvement is entered in record by resident's physician. Any physician can document dangers to self or others in record. staff fully document all transfers/discharges

What are the options for MD with plan of care?

-they record residents' progress and problems|-electronic signatures are acceptable|

3.GROUPS free to organize residents, families, resident/family groups.|

...

4. WORK must be part of plan of care

...

False Claims Act (Civil Ware - time law) to prevent false claims for services not rendered, double-billed, and not necessary.

...

quick or acid test relates quick assets (cash, AR) to current liabilities (creditors and owners interest in this.)||acid test ratio = quick assets| __________| | current liabilites

...

How many licensed staff members are required during dining?

Employment practices

1. Advertising (external recruitment)|2. Job Posting (internal recruitment)|3. Staff one of the best sources of applicants|4. CNA registry|5. Labor Pool - disadvantages: affects care, decreases morale, increases cost.|6. Employment agency - advantages: screens for basic job requirements|7. Application form - may not ask birthday, sex, marital status, nationality, children (arrest records), birthplace, physical size, etc.| Fill out alone in facility to test reading level| include permission to contact references|8. Most states require criminal background check on all non-licensed, non-registered staff.|9. Employment history - always check 2 references - good indicator of success is length of time on prior jobs.| verify employment dates| ask if would reemploy|10 Intervewing

What are the different forms of skin reactions? (3)|

1. diseases of skin (shingles, cellulitus, etc.)|2. reactions to medications - hives, blisters, burning|3. proper hydration- strong relation to skin condition. Pressure sores

Accountant collection rate by days delinquent

1-30 days lose 5% 30,000 uncollectable|31-60 lose 10% 20,000 |61-90 lose 25% 15,000|91-100 lose 50% 5,000

About how many residents are typically diagnosed with dementia in a facility and what is needed to address it.

1. 1/2|2. often have behavioral problems - staff needs to be trained.|

What are the Food Classes that provide RDAs?

1. 4oz meat|2. 2 cups fruit/vegetables|3. 4 servings of bread/cereal|4. 2 cups milk||(a class not eaten - alternative means to meeds needs: nutritional supplements)

What is the frequency for Medicare part A assessments? (5 different points)

1. 5 day|2. 14 day|3. 30 day|4. 60 day|5. 90 day

Counseling residents and family:

1. LIFE||L- listen: let them get it off their chest|I - Investigate: no snap judgments, threats, early recommendations|F - Feedback|E - Evaluate||2. Keep feelings under control - use low affect, soft voice, little emotions - no anger, impatience, or irritation.||3. use crisis interventions - every one loses emotional equilibrium at times and cannot think straight due to irritation, anger, or other.| a. keep quiet and let them explode.| b. when get it off their chest they usually sigh and relax| c. then can problem solve.

Psychosocial problems associated with residents in a facility (4)

1. Manifestations - sad, withdraws, mask-like expressions, crying, etc.|2. treatment - reality orientation, validation therapy, sensory training, remotivation, promote community and family contact, social worker counseling, psychotherapy-latter through outside resources|3. sudden changes in mood/behavior, (loss of social judgment, sexual activity, etc.) notify physician and family. reassess before taking action if significant. |4. mental confusion from medication-closely monitor all taking FOUR OR MORE MEDICATIONS

motivation - process by which administrators initiate and direct employee behavior

1. Maslow's needs hierarchy - needs in acending order of importance from biological (food, clothing, shelter) to self-actualization. ||2. motivation primarily internal - employees wants to be seen as capable, competent||3. well motivated employees identify with facility goals, see as their own. ||4. money seldom motivates over period of time. employees must know raises depend on performance. may motivate if sizable in terms of what accustomed to.||5. rewards - important to job satisfaction

What are some clinical approaches used to address depression in residents?

1. Medications: Lexapro, Celexa, Zoloft, Cymbalta|2. Counseling, psychotherapy|3. Activities (get involved)

policies/procedures for CNA requirements

1. NURSING home must verify that CNA is registered and is in good standing before hiring|2. RE-registration every 2 years|3. DISCIPLINE. if CNA is reported to have committed any violations of concerning abuse, neglect, or misappropriation of property, the administrator must:| - insure that it cannot happen again until the case is completed. 30 days.| - report incident to the state Medicaid complaints office.| - do a full investigation and document.|4. NEVER hire a CNA found guilty of one of these three violations.|5.NURSING hours /resident days - set by state, approved by CMS

What are the problems that result in decubitus ulcers? (4)

1. Pressure|2. Moisture|3. Hydrations|4. Nutrition|

What are Instrumental ADLs? (8)

What are the five ADLs (activities of daily living)

1. Transfer and ambulation|2. bathing, dress, grooming|3. toileting |4. eating|5. communication - language, signs, writing

Important things to know about restraints (5)

1. Use only to control harmful behavior, never for convenience, discipline, or when necessary for TREATMENT|2. Physicians orders. If resident chooses restraint it is considered therapeutic interventions - bed rail, belt for chair - informed consent ( legal representative if incapable)|3. Monitoring. Every 30 minutes, release for 10 minutes every 2 hours - standard of practice.|4. CMS's goal: restraint free.|5. Alternatives: Remove from group, walk, talk with someone, physical activity, environmental change.

objective/subjective teches used

1. attendance records, work completion, write-ups (objective)|2. supervisor's observation and opinions. (subjective)|

Things to do when Union comes in:

1. contact labor relations specialists and develop plan|2. conduct meeting and quote union promises|3. discipline on the job union activities|4. describe collective bargaining|5. union representation - speaks for employee, cannot represent self.|6. strikes - can lay off if strikes is for pay/benefits|7. card signing does not mean must join|8. tell them disadvantages of unions.

turnover - permanent

1. costs of recruiting, hiring, orienting, raining can be extremely high. Promotes research studies. |2. Other negative factors - supervisors tire of training, residents affected, poor or inadequate care.|3. Major reason - do not feel appreciated, job dissatisfaction. |4. rule - if 35% or more, in trouble. How to figure: number leaving divided by number of positions:|| # leaving | _______| # positions|5. exit interview - help pinpoint problem areas, why leaving|6. solutions - supervision, more input, training, and advancement, pay

What qualifies a Significant Change? (5)

1. deterioration in | a.TWO or more ADLs| b. cognitive abilities, or | c. communication that appears permanent.|2. loss of ambulation or use of hands to grasp small object to feed or groom|3. deterioration in mood or behavior to the point where daily problems arise, or relationship problems develop|4. deterioration of health status|5. improvement to point where care is no longer needed

Dietary Management staffing

1. dietitian full-time or as a consultant - needs knowledge of administration DUTIES. # 1 is to ensure residents' nutritional needs are met|2. dietary manager - dietetic technician or CERTIFIED by BOARD OF DIETARY MANGERS (CDM) being qualified as a member means dietary manager has basic training in food prep and infection control. Also has updated knowledge. Continuing education is required. Please note that these are standards of practice only. OBRA does not dictate minimum qualifications for a dietary manager other than he/she must be able to work collaboratively with the RD (ultimately responsible) to meet the nutritional needs of the residents.

employees biggest problem in cost management. Only solution

1. do not buy miracles items|2. request free trial on new items.|3. consider what you CAN AFFORD|4. analyze cost effectiveness - product may be good, but too expensive for what you get|5. teach staff cost control starting with budgeting|6. manage cash flow-use discounts, full credit period, work resident accounts (best way to increase cash flow), keep inventories down, sale of stock. |7. Lag-time- if receipts late, use line of credit, pledge accounts receivable, borrow from retained earnings, bank loan|8. regularly compare expenditures to see if within budget.

What are some insignificant (short term) declines that do not require reassessment? (5)

1. drug effect|2. re-dosage level|3. colds|4. symptoms associated with previous diagnosis|5. steady progress requiring assessment when stabilized

What are some important things to know about about decubitis ulcers? (4)|

1. eroded tissue due to lack of blood flow.|2. it is caused by lack of care of pressure point, turning, changing wet bed or clothing.|3. admission, if present, note size, document, take pictures|4. transfer to hospital- make color pictures when possible|

petty cash fund

1. established on imprest basis when is periodically reimbursed from general cash.|2. reconcile when run out of cash, group receipts and post to correct account, total groups of receipts and write check for that amount|3. value-conveience on things lik e postage due and small purchasse, and reduces check writing.

OSHA programs

What is required of the facility for Infection Control (F441)? (5)

1. investigate, control, prevent (think ICP)|2. have procedures for isolation, etc.|3. record incidents and corrective measures|4. be prepared to accept AIDS residents|5. care for high risk (immobilized, intrusive devices, altered immune systems, recently discharged from hospital)|

Other Disaster planning depends on location

1. main highway/railroad - chemical spills|2. factories - explosions|3. hurricanes, tornadoes, floods, wildires, snow storms, earthquakes, other natural disasters

What is the frequency for MDS assessments? (4 different points)

1. no later than 14 days after admission|2. after significant change|3. quarterly reviews|4. annually

What are the methods of interviewing?

1. non directive open ended questions; give problem and ask how handled|2. in-depth (directed) - ask specific questions|3. patterned - use list of sequential, detailed questions (some think it is more reliable)|4. know job requirements ahead of time|5. things cannot ask as may be discriminating|6. do not discuss job itself until you have information on applicant - will tailor answers to what job requirements are.|7. interview all applicants - major error is hiring first one who is well qualified|8. applicant with DISABILITY - must interview differently ( see ADA)|

survey process: tasks surveyors perform

1. offsite prep

content of personnel records

atmosphere

1. physical - pleasant buildings, rooms, surroundings, change colors.|2. social - make eye contact every time see a person and call name and smile. never ignore any person you pass in the facility. be friendly.|3. show warmth, interest in individual.|4. eden alternative

What are the 2 forms of restraints

Physical and chemical-psychoactive drugs.

Tasks surveyors perform

A. OFF-SITE PREPARATION - review CMS's Online Survey Certification and Reporting (OSCAR III and IV) system and QUALITY INDICATORS to determine areas survey is to focus on.||b. ENTRY CONFERENCE - request any records||C. Initial TOUR - may uncover new areas of concern which they list.||D. SAMPLE SELECTION AND INTERVIEWING- no longer look for light care and heavy care. Select residents according QI report. Administrator and DONs who study these reports have an insight on which residents the surveyors will be reviewing.||E. Information gathering||F. Information analysis||Exit interview||

What is AMD?

Age Related Macular Degeneration||it is a progressive eye condition that attacks the macula of the eye where our sharpest central vision occurs. it robs individuals of all but the outermost, peripheral vision, leaving only dim images or black holes at the center of vision||one in 3 has over 75 has it|regular screening|glaucoma- pressure too high

Value of Financial Management

Administrator has informatio to make decision and manage facility. Control device - measure performance against original plans.

Primary value

Administrator is charge whether she/he is present or not

Who determines what goes in the Emergency Medication Kit?

Administrator, Pharmacy, and MD

Medicare Eligibility

Anyone over 65 who is eligible for social security is eligible for Part A. Others over 65 may join and pay a premium. Certain disabled also eligible without regard to age. Everyone pays premium for Part B.

Ownership and accessibility

Belongs to facility. New owner must keep as state requires.

What is BDA?

Benign disequilibrium of Aging - Inner ear problem||Vertigo -> dizziness -> falls

What is a restraint?

CANNOT RELEASE UPON COMMAND|Cannot release self - leg, arm, hand mitts, safety ties or vests, wheelchair safety belts, bed rails||(limits access to body and environment)

Employee health and safety

CMS mandates safe and healthy environment for staff, residents, and public.|||OSHA mandates safe, healthy workplace, for employees to work in

What does CAA stand for?

Care Area Assessments

What defines a significant medication error

Causes resident discomfort or jeopardizes health and safety

Steps before administering drugs

Check MD orders|Identify drug, resident, and dosage||Pharmacist sometimes makes errors. Example, Rx Xanax, dispenses Zantac

Management

Creating and maintaing an environment within an organization that makes it possible for staff to work together toward common goals. Getting work done with and through others.

Category 2 - for deficiencies widespread with no actual harm but potential for minimum harm (f)

Denial of payment for new admits|denial of payment for all Medicare and Medicaid residents as imposed by CMS regional office|Civil money penalties of $50 to $3000 per day of noncompliance

Staff Development: training

Depends on duties- aides train in lifting, ambulating, falling, communication with residents (one of the biggest problems for CNAs)| Program not required by CMS - except for CNAs(must have 12 hours CE per year ( will look for if staff is not knowledgeable

Self adminstration

Determined by interdisciplinary team

Grievances

Plan that investigates all resident/family compaints, decides on course of action, implements, gives feed back

Who can administer drugs?

Done by |MD |RN|LPN |Medication Aide

semi-variable expense.

Dr. Allen uses this term in reference to CNA wages. For example, if a facility census drops by 5 from one day to the nest, the administrator may send an aide home to keep within budgeted HPPD numbers, thus that employee's wage may be described as a semi-variable expense.

DEA

Drug Enforcement Administration

What is required of the physician in relation to progress notes and orders?

EACH VISIT, progess notes must be:|-Written|-Signed|-Dated||Orders must be:|-Signed|-Dated||(except influenza and pneumococcal polysoccharide vaccines, which may be administered per physician APPROVED facility policy after an assessment for contraindications.)|

EEOC: sexual harassment

Employee comes to NHA, She/He should investigate, take action, document. Tort action frequent.

three basic steps in accounting

Entries- transactions recorded as they occur in the journal. tells where to post.||posting - transfer of debits and credits from journal to ledger which is charts of accounts - payables and receivables||tabulate - account balances periodically.

EEOC

Equal Employment Opportunity Commission

5 points about securing scheduled drugs

Fewer people have access to keys. |Separately locked|Firmly fixed compartments|Original container|Inventory

Unnecessary drug (4)

Excessive doses|Excessive duration, inadequate monitoring|Inadequate indication for use|Adverse consequences (reduce or discontinue)

penalties

FCA includes mandatory penalties from $5000 to $10,000 ore false or fraudulent claim, plus triple the amount of false claim and the cost of investigating and prosecuting for the claim

CASH BUDGET

FORECAST OF ALL CASH RECEIPTS AND DISBURSEMENTS. CONSIDERS SCHEDULE OF CASH INFLOWS AND PAYMENTS OF OBLIGATIONS. SHOWS AVAILABILITY OF CASH.

full time equivalents

FTEs are budgetary numbers used to determine the number of individual employees are needed to fully staff the facility without putting it in overtime situation. Today, these numbers are typically calculated by using software programs.

Informal Dispute Resolution (IDR)

Facility may request informal resolution process. Must include in writing what findings (by Tag #s) you contest-time period specified by state

POC (plan of correction)

Facility submits plan of correction showing:||a. HOW corrective action will be taken for residents affected by deficient practice.|b. HOW facility will identify other residents having potential tobe affected by the deficient practice.|c. WHAT measures or changes will be made to ensure non-recurrence.|d. HOW corrective actions to be monitored to ensure non-recurrence. No consolation can be given by surveyors or CMS.|

HIPAA

Health Insurance Portability and Accoutability Act||Ensure the confidentiality of medical records. It still being implemented and changed. |

What are the requirements of a high temp dishwasher and a low temp dishwasher?

High temperature: wash cycle 150-165 degrees F or manufacturing recommendation; rinse cycle 180 degrees||Low temperature: wash 120 degrees F and final rinse 50 ppm (parts per million) hypochlorite (chlorine) on dish service in final rinse

Span of management

What does the facility newsletter accomplish?

It is the best means of interesting residents in each other. AHCA study determlned this

Who bears the legal liability of record of ownership?

Who does thte pharmacist report irregularities to?

MD and DON

Who can receive prescriptions?

MD |RN |LPN |RPh |

How can faxed be used with prescriptions?

May be used by physician for all telephone orders except schedule II drugs. may fax these to pharmacist

What is MRSA and what does it stand for?

Methacillin Resistant Staphylococcus Aureaus||it is a bacterium that causes infections in different parts of the body. it's tougher to treat than most strains of staph because it's resistant to some commonly used antibiotics.

Duties of Corp

Mission Statement - what facility is to do (major duty)|Board establishing measurable goas|Employ agent (NHA). Required by CMS|Establishing and implementing policies and procedures. CMS says legally responsible for operations|Approve budget|Evaluate administrator's mangement|Board does not get into day-to-day operations

staffing requirements for Social Worker|

More than 120 bed facility, SW must have at least bachelors degree in social work orin human services field (sociology, special ed., rehab, counseling, psychology, etc.) PLUS 1 year supervised SW experience working with individuals in health care facility.| 120 beds or less; state sets requirement.

Confidentiality with releases

No release without consent except:|Transfer|Court order|Third-party agreement (surveyors)

Can The facility rely on volunteers?

No. Must have PPRs to cover work

Formula for medication error rate

Number of errors|----------------------|Number if opportunities||||Opportunities defined as the number of doses given plus doses ordered but not given||Best way of reucing ores is using unit dose system

Who uses the Crash Cart?

Nurses and MD||(list & inventory)

what is the content of a comprehensive plan of care?|

OBJECTIVES for highest functioning level a resident is expected to attain. |MUST BE MEASURABLE.|Plans for attaining goals must be written

OSHA

Occupational Safety and Health Administration

What should resident activities be based on?

On individual needs, interests of each resident as identified in the assessment.

Taking medications home

Only by MD order. May take home when discharged

Who is qualified to feed residents?

Only health care professionals may feed residents who need assistance with eating.||PDAs (paid feeding assistants) - work under supervision of an RN/LPN. Not to assist residents with complicated feeding problems such as swallowing difficulties and aspiration potentials.

Can residents participate in useful services

Only if in care plan.| - if does not volunteer, facility must pay them (at least minimum wage)

What are the two ways you can prescribe?

Oral |Telephone||Schedule II only in bona fide emergency; signing order

Where can controlled drug orders be faxed to

PHARMACIST only

Medicare Insurance Program

PPS

abnormal physical changes in the physical process (8)

Medicare Services PPS for SNF

Part A covers in hospital in-patient, SNF, patient teaching (self-administration of medications, ostomy care, diabetic management, and rehab - PT, OT, ST. It does not cover respiratory therapy.

duty of diligence

Partners, board members, and administrators must discharge duties in good faith, with care and prudence, i manner she/he believes is inbest interest of organization. Adminstrtaor must exercise knowledge and skill he/she professes to have as a licensee.

Who is allowed to dispense drugs?

Pharmacist ONLY||Place two or more doses in separate container and labeling||Nursing can place one dose in container

Who does the Emergency Medication Kit belong to?

Pharmacy

What are the 2 categories of Change in Condition?

Physical and Mental

What are the two roles of a pharmacist?

Review each drug regiment at least monthly||Consult on overall medictions program||(may be the same person.)

medicare consolidated billing

SNFs bills a fiscal intermediary selected by CMS. SNF bills for all ordered services given to residents, except for MD, respiratoy therapy, and emergency medical transportation. Billing includes all routine, ancillary, and capital-related cost- PT, OT, ST, lab, and x-ray test, drugs, supplies, non-emergency transpiration,etc. All these are included in th Medicare payment.|The nursing facility must pay the providers for these charges, as the nursing home is reimbursed through PPS

Employee benefits

SS, Medicare, workers comp., unemployment insurance and FMLA are required||1. other - vacation, sick, breaks, holidays, PTO, etc.|2. Most costly-usually vacation leave|3. total cost of benefits may be 25 - 40 percent of base pay|

SMDA

Safe Medical Devices Act of 1990

Destruction of DC'd

Scheduled regulated by DEA|| nonscheduled by RN

What is the defionition of a resident activity program? (4)

Social|Recreational|Religious|And other activities that promote quality of life. |Over and above activities related to activities of daily living

Who determines physician signatures

State

Retention of medical records

State determines. If not, CMS says 5 years.||Juvenile record kept according to state law- usually 3 years After attaining age of accountability

CMS and Medicaid

State has official state Medicaid agency that administers program with CMS approval.

2567

Statement of Deficiencies|referred to by its catalogue number.|Once the state sends this form to the facility it must be completed per instructions and returned to teh state agency within 10 days. the POC must be posted within the facility so anyone can review it. the facility must keep the past 3 consecutive years of POC's in-house.**

What are the required food temperatures?

Storage:|-stored at 41 degrees F or below|-(FROZEN must be kept FROZEN "solidly" according to regulations) ---> no temperature||Serving:|-hot foods LEAVE KITCHEN at 135 degrees F or above. |-cold foods LEAVE KITCHEN at 41 degrees F or below.

What is the frequency of documentation of progress?

This is determined by the facility.| Have reporting schedule to chart progress in maintaining or improving function.| Physician ecords after each visit.| Medication pass recorded as completed.

What is the role of the M.D./D.O.? (3)

They can only admit and serve as attending physician. |Back-up physician|Responsible for total programs of care

How must you approach bladder/bowel problematic patients?

Train. If unable, document why.

monitoring performance-

Use MBWA.|Accountability holds employee responsible for work assigned. should be |REGULAR - frequency depends on job itself. |INFREQUENT monitoring tends to promote feeling high performance not necessary|1. employee needs to know WHAT, WHO, and HOW will be monitored - not when...|

Payroll records

WH recommends keeping at least 3 years||(time cards: 2 years)

Must regs be communicated to MDs and between staff and MD?

YES

Is the facility required to have community programs?

Yes. Must take residents out to community activities, as well as bring community groups in.

asset

a thing of value, things owned, such as cash, equipment, real estate.

professional ethics

administrator must know ethics of practice of all staff, hold professional staff to their code. ||1. REPORT unethical practice to proper Board an/or agency|2. ETHICS in prace as relates to residents - ETHICS COMMITTEE

What are the three factors that promote positive work environment between staff and management:

a. POLICIES and PROCEDURES- clear guidelines for employees to work by. |b. SOCIAL ENVIRONMENT - people like to wrk with others (few hermits) i like the I work with: pleasant, congenial, cooperative |c. WORK ITSELF- interesting, challenging, satisfying, fulfilling - i like what i do. |

ADA job descriptions (3)

a. classify tasks as essential - ask how they would do|b. reasonable accommodations|c. penalties - depend on number of employees ( legal form of all-purpose extortion)|

value of budget

a. it expresses in financial terms the goals and programs|b. it provides criteria for evaluation of performance|c. it serves as a control device

research - do market opportunity analysis first. gives info on:

a. needs of elderly|b. nature and effect of competition|c. structure and relations of current services.|start no new service, or expand, until research shows it's economically feasible.|

purpose of internal financial controls

a. protect assets agaisnt theft and waste (safeguarding assets) - (main purpose)|b. ensure compliance with policy and procedure and Fed. Laws|c. Evaluate performance and efficiency.|d. ensure accurate, reliable data and accounting reports.

Marketing

act of offering services or product in the marketplace. managing flow of goods between producer and consumer. developing sales potential

what action is required on grievances?

act only after you know what the situation is. May need reassessment (mild CVA's and dementia)

staffing requirements for consultants, professionals

administrator must ensure all outside resources used are qualified to provide service| pharmacists| rehab therapists|

statement

bank statement should be reconciled immediately after receipt - 3rd chance to lose funds. do not allow person who makes deposit to reconcile statement - another makes deposit

Types of plans: mission

basic task assigned to an enterprise by society. In nursing homes the mission is LTC

bed-hold policy

before transfer to hospital, or granting therapeutic leave, explain:|- duration of stay under state plan|- facility policy on bed-hold periods|- written notice covering these standards

timing of budget

begin well before beginning of fiscal year- biggest error is waiting too late.

forecasting budgets

begin with overall facility utilization forecasts-average daily census, resident days by payer, anticipated changes in needs, trends in economy, employment rates.

Increment pay plan

beginning pay with regular increases-||1. seniority, merit, mixed, job-based|2. shift differentials.

privileged communication

between physician/patient, attorney/client, nurse/patient, husband/wife. NONE in child abuse cases|

billed

billed to you by invoice; know a contact person

policies

broad general statements to guide decision making and to some extent action in achieving goals. allows flexibility in judgment.

TQM

builds employee interrelationships through work teams; utilizes employee knowledge. requires open communication, trust, mutual respect among employees and management.

Payment

by numbered invoice. Every check should be backed by invoices

qualifications for COBRA

can continue coverage for up to 18 months, but must pay premium. |most recent insurance must have been under a GROUP plan|not eligible for Medicare or Medicaid or have coverage under another insurance plan

procedures for residents funds

carefully followed and documented for funds and personal valuables; otherwise facility may be responsible.

current asset

cash or other short-lived asset, i.e. A/R and CDs that are used up usually within 1 year.

investment capital

cash used to purchase real estate and equipment, and to build - used to produce operational revenues.

hepatitis B

caused by the hepatitis B virus (HBV)||symptoms of Hepatitis B are:|appetite loss|feeling tired/fatigue|nausea and committing|itching all over the body|pain over the liver|jaundice|urine becomes dark in color|stools are pale in color|

change

causes work slow-down or stoppage until employees learn how it affects them

CVA

cerebrovascular accident (stroke) may lead to paralysis

What does CVA stand for?

cerebrovascular accident|

variable expense

change with volume of business||i.e. food, medical supplies, utilities, etc. Often shown graphically.

Residents Rights:reasonable accommodations

changes that maintain unassisted functioning (furniture, adaptive equipment, GRAB BARS, safeguard for wanders, measure to reorient and re-motivate.

auditing

checking accounting records for accuracy. can have compliance audit

who is not covered under ADA?

current alcoholic and drug addicts, homosexuals, bisexuals, kleptomaniacs.

What is reverse isolation?

cytotoxic therapies (chemotherapy and radiotherapy) and AIDS when there is an outbreak of communicable disease. ||used when protecting individuals

what is the difference between delusion and hallucination?

delusion: unrealistic thoughts|hallucination: see/hear illusions

liquidity

denotes how quickly an asset can be converted to cash without appreciable loss

market opportunity

depends on demand for service, size, nature.. success depends on this|

Who makes up the interdisciplinary team?

FUTA

depositing quarterly with state workers' comp. agency & with IRS at end of year. if amount exceeds $500 for year, Federal part must deposit quarterly.|

degenerative

deterioration of tissue/organ, loses vitality

if unionized

determine in advance the essential demands and what you will do before contract negotiations. Have written plan|

percent occupancy

determined by dividing the number of possible patient days into the number of actual patient days, multiplied by 100|||actual days |_________||possible days|||(possible days = # of bed x days in month)

break-even analysis

determining break even point when income equals expenses- marginal return. |analyze variable and fixed expenses.

what is the generic substitution for Valium?

diazepam

What is a generic substitution drug?

different brand or unbranded drug substituted for a trade name drug.|must be same chemically, dosage form, but distrutibuted by different drug company, |brand name is usually capitalized

tangible assets

have physical characteristics, they can be SEEN and TOUCHED

COBRA

health insurance - protects health insurance coverage when workers change or lose job.

Why must you document grievances?

helps determine frequency, patterns.

value of 8/80

helps in scheduling payroll, etc. Scheduling-holidays, leave weekend, etc. May require much thought and innovative ideas in order to prevent overtime

Scope

how many residents involved:|- isolated: one or a limited number of residents affected; occurs occasionally in limited number of locations||- pattern: more than very limited number of residents are affected||- widespread: pervasive inf acility; systematic, affected large portion or all of the facility

Medicaid Services

include in-patient and outpatient hospital care, lab, x-ray, SNF and NF, home health, private duty nursing, dental, PT and OT, prescribed generic drugs and some other. Varies by state.

define accounting

includes bookkeeping, budgeting, reports, specials studies, auditing, designing systems

Depressed Immune Response

huge among the elderly and a major reason for an Infection Control program that includes IMMUNIZATION for everyone.

What do standard precautions prevent contact with?

human secretions -> hazardous

mental abuse

humiliation, harassment, threats, deprivation

process of organization communication

Rehabilitative (restorative) nursing

identify daily needs of residents for ||ROM|ambulation|breathing exercise ( in care plan). |||Specific MD approval not required.

What are the duties of QI/PI?

identify issues that negatively effect resident care, develop and implement plan of correction. May oversee safety and infection controls plans, pharmaceutical service.|

Residents with tube feeding

if admitted feeding self or with assistance, not fed by tube unless documented cause - now unavoidable. watch for complications: aspirations, pneumonia, diarrhea, vomiting, dehydration, etc.|

Decertifiaction of unions

if dissatisfied with union, members of union may petition NLRB for decertification election at end of contract. Never sign more than one-year contract

salvage value

if there is a salvage value, subtract from cost before depreciating.

dress requirements

if uniform required, employer must pay if cost places employee below minimum wage. |CAN BE TOLD WHAT NOT TO WEAR

who is the key person in handling employee grievances?

immediate supervisor. Can squelch, distort...

What is the major cause of bladder/bowel problems?

immobility

remedies

imposed by CMS and the state

medicare payment

in SNF Part A pays 100% of charges during 1st 20 days; resident pays co-payment from day 21-100 day. co-payment amount adjusted each january

Length of stay (LOS)

in SNF up to 100 days - as long as making progress. Must have had three day hospital stay within 30 days of discharged if it is continued care for condition that arose in original stay.

how does nursing monitor and evaluate resident satisfaction?

incidents/accidents, number of restraints, PRN orders, number of complaints

master budget

includes cash budget, capital budget, liquidity ratios, pro forma finanical statement

image building

major means of meeting goals is to sponsor fund raising event, donate proceeds to a charity - show interest in community. Tour of facility usually best method. Others:| wellness fair| be geriatric resource center| educate public officials on needs| respite care| serve on boards, committees of community organizations| speaking engagements| handling nursing home telephone

overtime

make sure you have employees properly classified - exempt vs. non-exempt. if in doubt, contact DOL

departmentalization

makes it possible for the organization to expand.**

value

makes possible plans to invest surplus and for periods when expenses exceed income

punlic relations

managing communications between organization and its many publics. difference: marketing focused on potential user, PR focus on all people.

Public Corporation

many shareholders, very structured, bylaws

medicaid - not covered

materials for personal care - tooth paste, tooth brushes, OTCs, etc. State provides full lsit of what NH must furnish residents on Medicaid.

make up

may be one person or many - there is not typical board structure in NFs

deposits under $50

may keep in petty cash, interest earning account, or non-interest earning account. |1. over $50 in interest earning accout, interest to each individual.|2. total funds within $200 of SSI (may be refered to as resource limit) notify resident in writing. |||NOTE: for med A recipients in the nursing home the regulations states for those patients the dollar amount to the interest bearing account is $100. It does give the facility the leverage to use the "$50 rule" however.

Residents Rights: research

may refuse to participate

Residents Rights: work

may refuse to perform useful service, or may do so if| a. FACILITY documents need or design in plan of care| b. PLAN SPECIFIES nature of services and if volunteer or paid| c. COMPENSATION PAID when do not volunteer-at prevailing wage| d. RESIDENT AGREES to work described in plan

Residents Rights: advanced directive

may refuse to sign

Residents Rights: transfer and discharge -

may refuse transfer from one distinct part of a facility another distinct part in order to be eligible for Medicar. No move solely for purpose of becoming eligible for Medicare. May do so if resident requests it.

pre-employment tests: content validity

measures skills, knowledge, and performance requirements

pre-employment tests: construct validity

measures traits or behaviors of people need for the job.

controlling

measuring of the work performance to determine if it follows guidelines, and correction of any errors in performance. requires good policies and procedures.

Directives/policies/procedures .|

of GB interpreted properly, whether agree or not. Let Employees gripe, but support GB

OBRA - licensed administrators

of all nursing facilities, except state may waive NHA for distinct part and swing beds.

reporting

of fires to fire marshall required in most states. also to medicaid agency

FIFO-

older stock used first. inflation results in older stock being of higher value. also reduces spoilage.

basis of budgeting

on past years' experience, historical trends, and future expectations

What is an effective SS program?

one that links:|1. social supports|2. physical care|3. environment |with resident needs. ||Administrator knows social work program is productive when resources are being utilized.

What is the scope of nurses practice?

only duties within scope of nursing practice (IVs, etc.) - defined by nurse practice act and board of examiners.

clerk

only one person should handle. have policies and procedures to provide financial controls.

verbal abuse

oral, written gesture that is disparaging, demeaning, derogatory-in hearing of resident or family|

Types of Discipline -

oral, written, suspension, docking pay

open market

ordered by court. Cannot restrict advertising health services and prices

types of rewards

organizational approval - pay increases, benefits, longevity pins, letters of recommendations, parking space, good supervisor relationship.||social environment - important. work with pleasant, cooperative employees - co-worker recognition.||work itself - interesting, stimulating, satisfying.

payback period for capital investments

original cost|__________||savings per year

timing of communication

tell assistants first, department heads, supervisors, then workers. usually several days before implementation. never tell staff at once.

define absenteeism

temporarily absent

What is the generic substitution for Seldane?

teterfendine

syndrome

the association of several clinically recognizable features, signs, symptoms, phenomena or characteristics that often occur together, so that the presence of one or more features alerts the physician to the possible presence of the others.

Auditing

the checking, reviewing, testing, and verging, the accuracy of accounting records, usually by a CPA||1. annual audits are required|2. compliance audit - is one that includes accuracy and that determines whether all business procedures were followed|3. annual cost report is required of every medicaid agency.

professional training

train AITs, interns from colleges. encourage professors to have students visit, do term paper on aging, LTC, facility operations.

occupational therapist

trained (restored). works primarily with extremities, eye/hand coordination, strength, dexterity, range of motion.

Physical Therapist

trained (usually registered) through degree program. works with all types. rehab-ambulation; heat, hydro, sound wave and other treatments; special exercise; manipulation...|

Mental retardation specialists

trained in rehab, education, etc. of MR's

Preparedness program and training

orientation of transfer/discharge

transfer/discharge a planned event; resident oriented to plan for change so it is orderly/safe. trial visit to new location, family assistance, attention to personal belonging, orienting new staff to resident's needs lessens anxiety|

Unions - bargaining

union seek to become the bargaining agent. They cannot approach employees on job; can when not on duty. ||cannot pass out literature in patient areas; can in non-patient areas

direction of organization communication-

upward, downward, horizontal (lateral) diaganonal

EEOC: Title VI

use of facilities, activities, bed assignments

Leadership NH success depends on NHA's ability and willingness to lead. Basic characteristics of leaders:

visibility- out and about in facility out in front, not office-bound. (ghost can't lead)|decisive - must use authority and be accountable for what happens.|listening - hears what people say - good communicator with everyone.|pitches in - when needed, rolls up sleeves and helps.|understanding - gives staff right to be angry, non-judgmental.|goal oriented - quality resident care is foremost. plans so all know the NH goals|Competitive - wants his/her NH to be the best|knowledge base - broad knowledge base of all NH ape rations and of total health care.

what is the administrator's role in monitoring and evaluating resident satisfaction|

visit each unit regularly, observing work being done and the environment. require regular reports from each unit of the facility.|

What is the generic substitution for Coumadin?

warfarin sodium

internal financial controls

whatever is spent must be tightly controlled, the same as for funds you receive.

most severe discipline

when abuse, under influence, fighting. ||First offense may be terminated. |||DOCUMENTATION IS IMPERATIVE

What is required of stamp signatures?

when authorized by facility management, the individual whose signature the stamp represents shall place in the administrative offices of the facility a signed satement to the effect that he/she is the only one who has the stamp and uses it.

fixed or non-current assets

will not be used up within a year||i.e. building, equipment, etc.

Problem solving approach

with supervisor let him/her vent, then egage in problem solving. how have you handled this? what went wrong? what else can you do? set time to follow up

Residents Rights: notification of change

child labor

work permit required. |if hire, get birth certificate| hours hwen under 17| no hazardous equipment (when under 17), e.g. buffer, meat slicer, no laundry work, lawnmowers, etc.

note

written promise to pay definite sum of money on a certain date usually with interest

corridors

no dead-ends (LSC)||8 feet wide (CMS)

accessible route

no incline more than 10%

Disposal

of sharps and other contaminated materials (OSHA) must have container in nursing, laundry, etc. and policy on emptying container (med carts: check levels)|

Identify risk areas

NUMBER 1 CAUSE OF NURSHING HOME FIRES ACCORDING TO THE NFPA IS GREASE FIRES IN THE KITCHEN|

reportable

accidental death, and 5 or more hospitalized (within 8 hours report)

Purpose of HCP

all chemicals are evaluated and information concerning hazard communicated to employer and employees.

the physical plant

all designed, constructed, equipped, and maintained to protect health and safety of residents, personnel, public

training and drills

all staff trained before go on job. Drill required quarterly on each shift by LSC. Document....Not ENOUGH. How many per year? documentaiotn|||Specific duties of each employee. Supervisor will question.

Training for BBP

all staff trained in how to handle| 1. blood spills and materials that may be infected, and | 2. exposure incidents

smoke detectors

approved detectors requried

Floors

at or above ground level. (LSC) |Fire rating if carpeted. (LSC)|Non-slip bath/toilet (ANSI, LSC)|Asphalt tile best

Doors

automatic fire doors; door to room closed

Right to know laws RE:

hazardous materials in some states. OSHA recognizes only in sates with OSHA approved programs

universal precautions

checked by OSHA; includes|-CDC HAND WASHING procedures. NOW recommend use of alcohol-based solution to cleanse hands (except dietary employees)|-SOILED LINENS and bedclothes means used linens.|-Contaminated linen is soiled by blood or other potentially infectious materials. Mishandling is most frequent exposure to communicable materials. OSHA requires contaminated to be containerized at location. aseptic cleaning of isolation area. |OSHA APPROVED SPILL KITT***

Preventative Maintenance definition.

checking all systems, including roof, on regular basis and documenting.||roof protects all other assets. (log or cards)

linen supply and laundry

clean linens in good condition, not ragged, stained. what resident clothing will launder?| a. monitoring costs - bulk soap, temperatures, overloading/under loading, overydrying, filters| GUIDELINES- after 10 years of use, maintenance cost usually justify replacement of equipment| b. Theft|

Includes

cleaning compounds, clorox, furniture polish, pine oil, detergents, etc. Anything with WARNING label on it.

lockout/tagout

control hazardous energy.||

requirement for rooms|

preventative maintenance

3 points of Preventative Maintenance

environmental quality - clean, attractive, home.

1. housekeeping - procedures for floors, rooms, aseptic cleaning, storage of materials, ODOR CONTROL, role in infection control, equipment care, safety|2. homelike - residents brings own belongings as long as it does not interfere with staff work or infringe on other residents' rights. de-emphasize institutional look. | a. sound - comfortable, does not interefre with hearing. background noise under resident control. Level not require staff to raise voices. consider differences in room assignments.| b. lighting - adequate for resident/staff to perform. comfortable - minimize glare, GIVE RESIDENT CONTROL.

SAFETY mandated by CMS, OSHA: Goals

1. reduce work-related illness, injury, death in staff.|2. reduce accidents, injuries among resident, families, visitors.

parking

13 FEET||cannot block sidewalk; alley for 2 cars.|The number of handicap parking places is determined from a grid issued by ANSI. It MUST BE NOTED THAT FOR EVERY EIGHT (8) HANDICAP PARKING SLOTS, ONE MUST BE VAN ACCESSIBLE.||If the facility only has one handicapped place, it must be van accessible.

Alarm systems

regulated by ANSI and LSC

local police

relationships

POSTER

required by OSHA

isolation room procedures

Doors

All 44" or more in new construction (41.5 opening)|outside doors open egress.|no locks on resident door except staff has key (LSC)||Bathroom door 32" (ANSI/ADAAG)||Fire Doors with automatic hold-open devices required in corridors||(over bed tables not required for patient)

Ventilation

All areas ventilated to outside - window, mechanical ventilation, or combination. | a. good movement (state determines| b. acceptable humidity/temperature levels (state determines)| c. surveyor rating:| A= Good movement; acceptable temp/humidity/odor levels| B= Little movement; temp/humidity/odor levels less acceptable.| C= No movement; temp/humidity/odor levels unacceptable. Residents and staff apprea distressed due to levels.

identify potential hazards

Security

Broad term that applies to protection of residents, staff and visitors, theft, etc.

LSC and other standards

Building and contact standards are set by LSC, CMS, ANSI/ADAAG - (dependent on which the state chooses) and state and local codes. ||- for handicapped|-follow which on specific state requires (ANSI/ADAAG)

Fire prevention & control -

CMS requires program, LSC gives specifics (NFPA Guidelines)

Life Safety Code (LSC)

Entire construction plan and materials meet LSC standards|||CMS requires unless have waiver or exception. CMS grants waivers on SNFs; states on NFs

entrances

Entrances - lock from outside

PERSONAL PROTETIVE EEQUIPMENT (PPE)

FACILITY MUST PROVIDE GLOVES, GOWNS, LAB COATS, FACE SHIELDS, EYE PROTECTION, MOUT PIECES, AND RESUSCITATION BAS, POCKET MASKS, OR OTHER VENTILATION DEVICES. TRAINED TO USE

Space and Equipment

Facility must provide sufficient space and equipment for dining, healthcare services, recreation and rehabilitation. ||Sufficient means enough to enable staff to provide residents with needed services as identified in the plan of care.| - space large enough to accommodate usual number that use it; must be accessible.| - accommodate wheelchairs, walkers, other ambulatory devices.| - rehab areas have exercise equipment, storage for supplies and equipment.

Waivers for Life Safety Code

If CMS finds a state fire and safety code adequately protects residents and personnel thenLSC does not apply. OLder facilities may obtain a waiver if they are and have been in compliance with an older addition of LSC as specified by CMS.||Before a nursing home may be built it must present architectural plant to State Medicaid or designated agency that approves construction. All major renovations, such as additional beds, change in utilization of space, and so on must receive approval. The state provides guidelines on what must be a approved. Upkeep and repairs do not require prior approaval.

LSC and ANSI/ADAAG

LSC accepts both standards so they are essentially all LSC standards. Administrator does not need to know EVERY standard, but must keep a copy of the "LSC Handbook" as reference. The architect who designs the facility must know and incorporate all LSC and other standards, but it is advisable for the NHA to check his building to ensure compliance.

GROUNDS and parking

Maintenance cost-mowing biggest. State decides on number of parking spaces per bed.

ANSI/ADAAG(Americans with Disabilties Act Accessibility Guidelines)

Make building available to and usable by physically handicapped, no mental (blind, deaf, non-ambulatory, semi-ambulatory, uncoordinated). ADAAG = MAKE BUILDINGS AVAILABLE TO ADA'S. |State decides whether to apply ANSI or ADAAG standards to nursing homes

Medical devices

Medical devices - "Any apparatus, implement, chanine, implant, or related article intended for use in diagnosing, treating, curing, or preventing disease or intended to affect the body's function or structure, which achieves its intended purposes without chemical or metabolic action within the body.||i.e. catheters, thermometer, pacemakers, contact lenses, hearing aides, restraints, blood glucose monitors, WCs, gerchairs, beds, infusion and feeding pumps, whirlpool suction machines.

Grating

No greater than one-half inch; openings perpendicular to travel rout, if elongated.

OSHA penalties

OSHA can FINE facilities|amounts based on severity of the deficiencies, GIVE CITATIONS and IMPRISON|CONSULTANTS - OSHA does trial run - no penalties

Pest control

PREVENTION PROGRAM BEST; use contractor and staff||no traps, poisons, sticky fly paper.||advantage - to use pest control service:||licensed and trained in use of all pesticides, how to rotate chemicals to prevent buildup of resistance. ||(close garbage bin: attracts pests)

Highest ranking person on duty in charge. Follow RACE:

R - Remove (rescue) endangered resident|A - sound Alarm|C - Contain fire (known which extinguishers to use.)|E - Evacuate if necessary (blind) or extinguish

Alarms

flashing alarms for deaf, sound alarms for blind, tactile warnings for blind to identify danger areas.

Fire alarms

flashing and audible. |connect with local fire dept, if possible|must have NFPA 71 certification of fire alarm service|

Monitoring

States decide who will monitor LSC and ANSI/ADAAG standards. the monitor may be the State Medicaid Agency, State Fire Marshall, or other. If it is an agency other than State Medicaid, the monitoring agency must coordinate its findings with the Medicaid agency.

blood born pathogens (BBP)

focused on AIDS and Hepatitis B. (OSHA)

What items must be accessible to wheelchair residents?|

WATER FOUNTAINS, telephones (non-Braille), light switches

Reporting

a. designated person - incident covered by SMDA are reported to a specified person within a specified time.|b. deaths - designated person reports deaths to FDA and the manufacturer of the device within 10 days.|c. serious injuries and illness - reported to the manufacturer, if known; if not, to the FDA within 10 days|d. Annual (summary) reports - filed with FDA inJanuary and July . Use form FDA 3375 TEST. ANNUAL REPORTS NOT REQUIRED IF NO INCIDENT. Reports include:| facility | device-serial number and//or lot number| manufacturer| incident description||Referred to as Medical Device Reports||

label must:

a. identify product|b. identify hazardous chemicals|c. contain appropriate warning|d. show name and address of manufacturer|e. sometimes pH content-7 is norm

serious illness or injury:

a. life threatening|b. results in permanent impairment to body structure or functioning|c. needs immediate medical or surgical intervention to prevent permanent illness or injury. ||extent determined by a physician

HCP Program written:

a. list of all hazardous chemicals (anything with a warning label)|b. label all chemical containers|c. prepare and distribute MSDS (any chemical)|d. develop and implement employee training

classes of fires and control

a. paper, wood-water (class A extinguisher) no more than 75' apart|b. grease, liquids-dry chemicals, hood (class b extinguisher)|c. electrical-dry chemicals (class b or c extinguisher)| B&C no more than 50' apart.| K-Kitchen extinguisher

Needlestick Safety and Prevention Act

follow OSHA standards|engineering controls - shield, retracting needles, shielded catheters, needles housed in protective covering, and jet injections. NOW required to USE SAFETY SYRINGES.|Law requires employee input on what works best.

Location

determines security needs, i.e. high crime areas

reportable incidents

events that reasonable suggest a medical device caused or contributed to a serious illness or injury, or to the deat of a resident - includes user error.

investigate

every accident, document, corrective measures - identify patterns, discuss with dept. head.

documentation

every exposure incident. facility should have "OSHA Compliance and Exposure Control Plan Checklist" in order to know if incompliance

policies and procedures

facility required to establish policies/procedures for programs of staff training, of reporting incidents, illnesses, and injuries, and of action taken.

prevention

fire-rated building material and furnishings||have designated smoking areas and monitor.

non-recordable-

if only first aid unconscious

CMS STANDARDS for infection control

investigate, control, prevent infections|set up procedure for entire program|document incidents and correctivev action|isolate infected resident|no employee with communicable diseases or skin lesions can have contact with food or residents|hand washing after each direct resident contact|handle, process, store, and transport linens in manner to prevent spread of infection

Blue Prints

keep as-built plans available for surveyors who do LSC inspection as well as for repair persons who may need prints for big jobs.

lockout device

lock (key or combination) that will hold device in safe position so it will not energize. where to keep key? maintenance person

ramps

maximum rise 30". Slope not more than 1:10

Monitored

monitored nationally the Office of Civil Rights monitors ANSI. States may assign to Fire Marshall, Medicaid Agency, other. |ADAAG is monitored by State Agency handling LSC and ANSI.

post-exposure procedures

must have written plan for evaluation and follow-up. individuals involved tested (consent may be gained-OSHA says not required)-test blood of exposed person

Employee with lesions

never works in kitchen or patient care area

document

on OSHA forms log (FORM 300***) only inventory staff, not residents. need copy of "what every employer needs to know about OSHA Record-keeping . keep records for 5 years.

Handrails

outside ramp, stairwell, bathroom required by ANSI, and specific height.||CMS requires in corridors.||ADAAG specifies all 34" to 38" in public places. |On stairwell must be 32" and MUST EXTEND 12" beyond last step. (ANSI|

programs

procedures to cover preventive measures, investigating of accidents, documentation, corrective action, reporting. committee may be useful - not required

training

staff must be trained annually on commonly used medical devices and on reporting. trained as necessary on infrequently used devices. include step by step procedure for staff to use in handling and reporting.

reporting communicable diseases to:

state agency

monitoring

the Food and Drug Administartion (FDA) monitors

Purpose of LSC

to provide reasonable degree of safety from fire.

purpose of lockout/tagout

to require employers to establish program using lockout or tagout devices on energy isolating devices and to disable equipment and machines to prevent unexpected energizing, start-up, or release of store energy in order to prevent injury.

Toilets and handrails - height

toilets (Also ADA for staff) seat **17" to 19" height;||hand rails/grab bars 33" to 36". |5% or more meet standards as determined by state and CMS||(easier to replace with handicapped toilet)

accidents

unintentional damage to object or injury to person. two causes: |(1) unsafe behavior|(2) unsafe working or living conditions

tagout device

used when evergy source cannot be locked out - tag or warning device NOT to use.

HBV requirements

vaccine offered free to all employees (OSHA)

Water

water must have backup source of supply. Temperature established by state. Automatic Control Valves. (surveyors will ask for contract) (110 degrees in GA)

smoking

written regulations, enforced. |smoking ares with non-combustible ashtrays, metal containers with self-closing lids.|Prohibited areas include resident rooms and beds, oxygen, flammable liquid storage.|proper signs posted.|supervise non-responsible.

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Violent

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