'We have to do better' on infection prevention, CMS official tells LTC nurse managers during new survey update

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Evan Shulman
Evan Shulman

OXON HILL, MD —  Nursing homes's new survey routine seems to be going smoothly, about half a year in, but infection prevention problems continue to plague the field.

That was the message Wednesday afternoon from Evan Schulman, the Centers for Medicare & Medicaid Services' deputy director for the Division of Nursing Homes, during a presentation at the American Association of Directors of Nursing Services' annual meeting.

Schulman said that infection prevention continues to be big challenge for the field, as it is the No. 1 deficiency under the new survey, just as it was using the prior process. There are upward of 3 million healthcare acquired infections each year. “It's a very, very challenging problem,” he noted.

CMS launched the new survey process for nursing homes back in November, which comes with a revised set of F-tags and further involvement from residents.

The No. 1 issue surveyors keep tripping on is handwashing, Shulman explained added. He gave the example of one facility that was cited after an employee failed to wash up or change gloves when handling fecal matter.

“Really, that basic,” he said. “We have got to do better on handwashing.”

The agency has conducted about 2,500 surveys under the new process thus far, Shulman said. When he polled the packed room, about half of the DONs indicated they had experienced the new survey at their own facilities.

No. 2 on the most-cited F-tags list was proper food storage, followed by "comprehensive care plan." Shulman reminded providers that they must incorporate residents in the development of their care blueprint.

“I don't think we should have to write a regulation to include the resident in their care planning, and I think most of you are probably doing that,” he said.

The deputy director emphasized to his sometimes skeptical audience that the new process is all about improving care for the resident — and not seeking out deficiencies.

“What's really important to remember is, the real reason why we did this is to identify the risks to residents and try to prevent them. That's the reason: To improve and protect the health and safety of the residents of nursing facilities.”

CMS has several tools to help skilled care providers prepare for the new survey process, he noted, including its Integrated Surveyor Training Website, and the agency's nursing home information hub.

Rounding out the top-five deficiencies under the new survey process are "accident and supervision" at No. 4 and "label/store drugs and biologicals" at No. 5. Four out of the top five deficiencies are the same as under the old survey process, with "quality of care" dropping down to No. 7. 

This is the third annual conference for the AADNS, with some 170 nurse leaders in attendance. The show concludes Friday afternoon.