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Compliance Monitoring Division
Clinical Web Window
The purpose of this "Window" is to create an easily accessible place where clinical issues can be presented on a regular basis. We hope that this will contribute to high quality care in the Long Term Care (LTC) continuum, will provide a forum for discussion of the regulatory approach to clinical issues and will, when possible, alert practitioners to clinical issues that may come under increased scrutiny during surveys. We will also place surveyor training resources on this site. While it is our goal to anticipate and alert providers to new clinical issues that may affect survey trends, standards for compliance continue to be based on the existing state and federal regulations. Contributors to this website will include Compliance Monitoring staff, and when available or needed, practitioners with a special interest or expertise. We invite comments, suggestions and requests that will enhance the dialogue among all stakeholders involved in LTC.
For more information regarding the clinical updates please contact:
Minnesota Department of Health
Compliance Monitoring Division
85 East Seventh Place, Suite 300
St. Paul, Minnesota 55101
Telephone: (651) 201-4101
Email: health.fpc-web@state.mn.us
Clinical Updates Index
Accidents and Supervision F323
Handouts/Training Materials for the September 17, 2007 Joint Guidance Training for Accidents and Supervision F323
- F323 - Program Information Sheet (pdf:24kb:1 page)
- F323 - Accidents and Supervision Guidance Training (pdf:248kb:36 pages)
- F323 Accidents and Supervision Guidance Training - Click on recorded sessions on left side bar
(Power Point WebEx Presentation: 13mb: 1hr 40 min)
- F323 - State Operations Manual Transmittal 27 (pdf:352kb:33 pages)
- September 17, 2007 CEU Sign-Up Sheet (pdf::24kb:1 pages)
Activities
Quality of Life Initiative for Activities F248/249 - An Interdisciplinary Approach. Toolkit - January 16, 2007
Activities of Daily Living
F312 Residents Unable to Carry Out Activities of Daily Living (pdf: 10 pages) - December 2006
F311 Activities of Daily Living (pdf: 1 page) - February 2006
Comprehensive Assessment
Summarizing Comprehensive Resident Assessment Information (pdf::40kb:5 pages) September 2007
Strategic Approaches to Improving the Care Delivery Process - May 2010
Joint Statewide Training - Dr. Steven Levenson, MD, CMD
- Module 1 - The Biological Foundation (pdf:804k/59 pages)
- Module 2 - Clinical Decision Making and Problem Solving (pdf:392k/66 pages)
- Module 3 - Basic Elements for Quality Care (pdf:115k/45 pages)
- Module 4 - RAI (pdf:309k/27 pages)
- Module 5 - Behavior, Mood, Cognition, and Delirium-Related Triggers (pdf:308k/127 pages)
- Module 6 - Nutrition and Weight Loss (pdf:376k/53 pages)
- Module 7 - Pain: Trigger #19 (pdf:429k/46 pages)
- Module 8 - Skin Care and Pressure Ulcers: Trigger #16 (pdf:188k/38 pages)
- Module 9 - Falls and Fall Risk (pdf:211k/49 pages)
- Module 10 - Reducing Avoidable Hospitalization (pdf:100k/83 pages)
Coordination Hospice & Nursing Home Services
Coordination of Hospice and Nursing Home Services (pdf:40kb:5 pages) April 30, 2009
Diabetes
Minnesota Department of Health Diabetes Program
Dignity
Nursing Home Surveyor Training Resources - December 2005
A training resource for surveyors regarding reviewing dignity during the nursing home survey process.
End of Life (F309), Advance Directives (F155), Feeding Tubes (F322/F321)
Statewide Phonecall January 16, 2013 Agenda
March 18, 2013 Phone Call Agenda (pdf: 74kb/3 pages)
CMS Nursing Home Guidance Revision:
End of Life (F309)
http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-12-48.pdf
Department of Health F309 Webex. First click on this link, Second click on "recorded sessions" on the left side of the page, and Third click F309 Webex. This Webex is meant to be viewed with the F309 Script and Handout.
F309 Webex Script (pdf: 74kb/17 pages)
Advance Directives (F155),
http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-13-16.pdf
Department of Health Webex. First click on this link, Second click on "recorded sessions" on the left side of the page, and Third click F155 Webex. This Webex is meant to be viewed with the F155 Script and Handout.
F155 Webex Script (pdf: 68kb/17 pages)
Feeding Tubes (F322/F321)
http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-13-17.pdf
Department of Health Webex. First click on this link, Second click on "recorded sessions" on the left side of the page, and Third click F322 Webex. This Webex is meant to be viewed with the F322 Script and Handout.
F322 Webex Script (pdf: 68kb/14 pages)
CMS QIS Survey Forms on CMS Website:
https://www.qtso.com/qisforms.html
See: Critical Elements for Hospice and/or Palliative Care
See: Critical Elements for Tube Feeding Status
Federal Ambulatory Surgical Centers (ASC)/State Licensed Outpatient Surgical Centers
Updated Information from CMS
Please Note: It is recommended that providers check the CMS Web Site Addresses weekly for new program letters, for information regarding the State Operations Manual updates
See Program Letters - http://www.cms.hhs.gov/SurveyCertificationGenInfo/
Federal Regulations
http://www.cms.hhs.gov/transmittals/downloads/R56SOMA.pdf
Federal Reporting Procedures
Please see June 2011, Provider Statewide Call
Federal Infection Control Surveyor Worksheet
Worksheet (pdf:240k/ 15 pages)
Minnesota State Regulations
https://www.revisor.mn.gov/data/revisor/rule/current/4675/4675.pdf
Training Documents
Appendix L, Ambulatory Surgical Centers Comprehensive Revision (ppt:1mb/ 36 pages)
Infection Control Program (ppt:958k/ 36 pages)
Flash Sterilization
http://www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter09_55.pdf
Food and Drug Administration
Food and Drug Administration Publication for Health Professionals
http://www.fda.gov/
This is a site that may be useful as a bookmark.
Publication provides information to healthcare professionals to enhance communication of new drug safety information, raise awareness of reported adverse avents, and stimulate additional adverse event reporting.
Acetaminophen Alert – February 6, 2004
This is the first in a series of periodic clinical updates FPC will make available
to practitioners in LTC.
Health Care Reform/Affordable Health Care Act
Health Care Reform/Affordable Health Care Act - Leadership Summit April 26, 2010
(pdf:772k/44 pages)
Infection Control
http://www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter09_54.pdf
Revisions to Appendix PP - Interpretive Guidelines for Long-Term Care Facilities, Tag F441 Infection Control (Transmittal 55 - December 2, 2009 (pdf:479k/ 38 pages)
F441 Infection Control Training Handouts - November 12 & 13, 2009
- Agenda (MSWord/1 page)
- 12 Steps to Prevent Antimicrobial Resistance Amoung Long-Term Care Residents (pdf:51k/ 2 pages)
- Safe Infection Practices - Diabetes (pdf:118k/ 2 pages)
- Infection Control Evaluation Form (MSWord/ 1 page)
- CMS F441 Infection Control Guidance Overview - Session I (PowerPoint:1.4 MB/ 52 pages)
- CMS Infection Control Program Slides - Session III (pdf:199k/ 11 pages)
- Link to QIS Electronic Forms and Worksheets (CMS web site) --See Infection Control & Immunizations, Dining & Kitchen/Food Service
- Guideline for the Management of Antimicrobial Resistant Microorganisms in Minnesota Long-Term Care Facilities
http://www.health.state.mn.us/divs/idepc/dtopics/infectioncontrol/ltcguideline.html - MRSA Resources
http://www.health.state.mn.us/divs/idepc/diseases/mrsa/index.html - Minnesota Reportable Disease Poster
http://www.health.state.mn.us/divs/idepc/dtopics/reportable/rule/poster.html
Nutrition and Food Sanitation
A Statewide video conference training session will be conducted the morning of October 3, 2008. The following handouts pertain to this training. MDH will be implementationg these guidelines on October 20, 2008.
- Agenda for October 3, 2008 - Training for Nutrition and Sanitary Conditions: Implementation of Revised Federal Guidance October 3, 2008
- Revisions to Appendix PP "Interpretive Guidelines for Long-Term Care Facilities" Tags 325 (Nutrition) and F371 (Food Sanitation) (pdf:570K/ 58 pages)
- Handouts 1-5 - F325 (Nutrition) (MSWord: 8 pages)
- Handouts 1-9 - F371 (Food Sanitation) (MSWord: 11 pages)
Converted PowerPoint files for October 3, 2008 presentation. See Information Bulletin 08-10.
- Sanitary Conditions (F371) Surveyor Training: Interpretive Guidance; Investigative Protocol (pdf:74k/ 30 pages)
- Nutrition (F325) Surveyor Training: Interpretive Guidance; Investigative Protocol (pdf:70k/ 29 pages)
- Evaluation Form for F325 and F371 Video Conference (MSWord: 2 pages)
- Locally-Grown Produce is approved source if the food is not processed.
See http://www.health.state.mn.us/divs/eh/food/fs/localgrown.html
Pain Management/F309
Advancing Excellence in Nursing Homes: Implementation Guide Improving Pain Managementhttp://www.nhqualitycampaign.org/files/im/3&4_Pain_TAW_Guide.pdf
Agenda - Minnesota's Call to Action - F309 Quality of Care: Pain Management and End of Life Issues (pdf:12k/ 1 page)
Implementation Guide: Goals 3 and 4: Improving Pain Management (pdf:215k/ 19 pages)
42CFR 483.25 (F309) - Quality of Care Changes to Interpretive Guidance (pdf:146k/ 31 pages)
Cam Basics (pdf:181k/ 5 pages)
Stage II - Critical Elements for a Resident Who Receives Dialysis Treatments (pdf:114k/ 17 pages)
Stage II - General Critical Element Pathway (pdf:83k/ 10 pages)
State II - Critical Elements for Hospice and/or Palliative Care (pdf:92k/ 12 pages)
State II - Critical Elements for Pain Management (pdf:89k/ 11 pages)
CMS GRID (pdf:269k/ 1 page)
Managing Individuals With Pain in LTC (S. Levenson) (pdf:251k/ 42 pages)
Transmittal 41 - Revisions to Appendices P and PP (pdf:995k/ 45 pages)
F309 Scenarios - MDH Letter (pdf:79k/ 4 pages)
Becoming Well Within Minnesota (pdf:90k/ 2 pages)
Training Scenarios and Questions for Pain Management (pdf:15k/ 1 page)
Pressure Ulcers
A Physician's, Practitioner's & Clinician's Reference Guide for Pressure Ulcer Prevention & Treatment - March 2005
Printable Brochure. May be downloaded and copied back to back. (pdf: 2 pages)
Pressure Ulcer Questions and Answers - September 28, 2005
This listing of frequently asked questions and answers was compiled by Stratis Health in response to Minnesota providers' questions
related to pressure ulcers.
Pressure Ulcer/Non-pressure Ulcer Follow-up Training - January 2006 (Powerpoint Presentation)
CMS Regional Office Long-Term Care Provider Associations Meeting - Pressure Ulcer Power Point Training - August 2007
Quality of Life
-
Quality of Life and Environment
- http://www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter09_31.pdf
- http://www.cms.hhs.gov/transmittals/downloads/R48SOMA.pdf
- Power Point Quality of Life and Environment Tag Changes - March 20, 2009
-
Food Procurement and Self Determination and Participation
- http://www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter09_39.pdf
- Minnesota Culture Change Coalition http://www.mnculturechange.org/
- Pioneer Network http://www.pioneernetwork.net/
- Locally-Grown Produce is approved source if the food is not processed.
See http://www.health.state.mn.us/divs/eh/food/fs/localgrown.html
Range of Motion
F317/F318 Range of Motion - June 2007 (pdf 3 pages)
Root Cause Analysis
Presentations: Updated July 2010
- Root Cause Analysis: Understanding the Regulatory Perspective (Powerpoint Presentation/ 2mb)
- Root Cause Analysis - The Process (ppt:775k/24 pages)
- Root Cause Analysis - Laying the Groundwork (ppt:1.4mb/52 pages)
- Root Cause Analysis - Beginning the Investigation (ppt:1.17mb/21 pages)
- Root Cause Analysis - Next Steps (ppt:438k/9 pages)
- Root Cause Analysis - What's in it for you? (ppt:629k/16 pages)
- Root Cause Analysis - Developing Action Plans (ppt:477k/15 pages)
Handouts
- Case Study: RCA Exercise - Medication Error (pdf:35k/ 1 page)
- RCA Tracking Tool Template (pdf:33k/ 2 pages)
- Sample forms/Worksheets: Burns Manor (pdf:2.16mb/ 12 pages)
- Sample falls data collection/RCA tools: St. Michael's (pdf:46k/ 3 pages)
Unnecessary Medications F329
Paginated materials extracted from CMS Transmittal 22- Pharmacy Training - January 2007
Dr. Steve Levenson Power Points: Medications F329 (pdf 23 pages) - July 2007
Dr. Steve Levenson F329 materials for September 6, 2007 phone conference (4:30 to 6:30 pm)
- F329 Documentation Templates (MSWord:55kb:6 pages)
- Inappropriate Medication Editorial (pdf 2 pages)
Urinary Incontinence
Urinary Incontinence and Catheters - September 12, 2005
Documents, forms and information provided for a joint MDH and provider video
conference training session on urinary incontinence and catheters.
