Microsoft word - top tag drill down report 03_2008

O regon Seniors and People with Disabilities

Top Tag Drill Down Report
Original 1/10/08 rev 3/08
The total number of phrases or key words is greater than the number of instances as a
tag may contain multiple issues.

Nursing Facilities

F 0309 - Provide necessary care and services…
30 cites for the 10/1-12/31/2007 quarter
14 – lack of monitoring or assessment or Dr notification for change in condition
11 – failure to follow care plan for falls, skin breakdown/pressure or positioning
10 - lack of, or inadequate bowel and/or catheter care
10 - failure to follow physicians orders for medication or treatment ( insulin,
Haldol, Avonex, prn pain meds)

28 cites for the 07/1-09/30/2007 quarter
The 28 citations were scattered over so many issues that to trend them or lump
them together would be difficult.

27 cites for the 04/01 – 06/30/2007 quarter
9 - failure to follow physicians orders for medication or treatment
9 - lack of, or inadequate bowel and/or catheter care
7 – lack of monitoring or assessment or Dr notification for change in condition
3 – failure to assess or treat for pain
3 – failure to follow care plan/Dr orders for weights and meal/fluid management

29 cites for the 01/1-03/31/2007 quarter
8 – lack of or inadequate bowel and/or catheter care (most experienced pain or
hospitalization)
5 – lack of or inadequate diabetic or insulin monitoring and administration
4 – failure to follow physician orders or care plan for Oxygyn and/or respiratory
care
4 – failure to prevent or care plan for skin breakdown
3 – failed to prevent or manage pain
3 – failed to follow orders for meal / nutrition monitoring
2 – failure to notify physician of significant change
2 – fall prevention and care plan
22 cites for the 10/1-12/31/2006 quarter
15 – Failure to follow physicians orders for medication or treatment
(includes meds, (insulin, Atenelol, Haldol) diet and hydration, and device use,
(foam boots, positioning pads and contracture devices).
9 - Lack of pain management, treatment for on-going pain or unassessed pain
3 – Failure to care plan or provide care for Residents on hemodialysis .
CBC Citations

C 232 - Abuse Reporting and Investigation: Facility

5 cites for the 10/1-12/31/2007 quarter
3 – no investigation for incidents and incidents with injury
2 – incomplete investigations
2 – no preventative measures or interventions for future
C 260 - Service Plan: General

8 cites for the 10/1-12/31/2007 quarter
7 – not reflective of resident needs (i.e., unaddressed and unassesed pain,
weight loss, dietary, restraints)
4 – service plans not done or not complete
3 – no updates of service plan since admit but change in needs(6 mo, 7 mo, 1 yr)
C 270 - Change of Condition and Monitoring

3 cites for the 10/1-12/31/2007 quarter
2 – no assessment or follow-up or intervention for residents w/ falls
3 - no monitoring for pressure sores, weight loss or health status
C 280 – Resident Health Services
6 cites for the 10/1-12/31/2007 quarter
3 – RN not notified of health issues, MD not notified
3 – no assessment of worsening health conditions
2 - no delegation records for delegated tasks
C 290 - Resident Health Srvc: On- and Off-Site Health Srvc
2 cites for the 10/1-12/31/2007 quarter
3 – failure to coordinate with Home Health

Source: http://www.ohca.com/news_currents/docs/041508ncK.pdf