F323 is the federal tag that is often cited at actual harm or immediate jeopardy. Have you received any citations at actual harm under this tag in recent years? If so, when was the last time you reviewed the language in the regulation?
I know it's probably a great cure for insomnia, but the regulation is pretty clearly written. And although there is some room for interpretation, it's a great guide to help improve your accident prevention program. Think about it: how can you meet the challenge if you don’t know what the rules are?
A Quick Look at the F323 Regulation
Let’s look at a few highlights of the F323 regulation. It states:
“The intent of this requirement is to ensure the facility provides an environment that is free from accident hazards over which the facility has control and provides supervision and assistive devices to each resident to prevent avoidable accidents.” This includes:
- Identifying hazard(s) and risk(s). This is key—if you aren’t aware of a hazard, how can you protect the resident?
- Evaluating and analyzing hazard(s) and risk(s). We do a great job gathering data but aren’t always great at analyzing it to assist in developing appropriate preventive interventions!
- Implementing interventions to reduce hazard(s) and risk(s). When was the last time you reviewed a care plan and validated that interventions are in place?
- Monitoring for effectiveness and modifying interventions when necessary. Back to the QAPI committee, are the interventions working?
Monitoring Your Interventions
Is your safety committee actively identifying, evaluating and analyzing, implementing interventions, and monitoring the effectiveness of these interventions? These are basics, the language we are judged by. They should be included in your monthly QAPI committee meeting.
Here are a few definitions to think about:
- Accident refers to any unexpected or unintentional incident which may result in injury or illness to a resident. This does not include adverse outcomes that are a direct consequence of treatment or care provided in accordance with current standards of practice (e.g., drug side effects or reactions).
- Avoidable Accident means that an accident occurred because the facility failed to:
- Identify environment hazards and individual resident risk of an accident, including the need for supervision
- Evaluate/analyze the hazards and risks
- Implement interventions—including adequate supervision consistent with a resident’s needs, goals, plan of care, and current standards of practice—in order to reduce the risk of an accident
- Monitor the effectiveness of the interventions and modify the interventions as necessary in accordance with current standards of practice
- Unavoidable Accident means that an accident occurred despite facility efforts to do the above.
Think about the process—PDSA, Fishbone—it really doesn’t matter as long as you have a process. The language above gives you the framework to review with your QAPI committee. Ask the questions, Are we following these steps? Are we monitoring effectiveness? What are we doing with our data?
Know Your Regulations
The argument can be made that a facility has done everything humanly possible to prevent an accident and is still cited at harm level. Know your regulations, know what steps you can take to avoid citations (History of Past Non-Compliance) or challenge a citation received (Informal Dispute Resolution).
Consider printing copies of the F323 regulation and share it with your QAPI committee. Leave copies in the breakroom, hold employee meetings, and include discussions regarding this regulation. Use real-life examples of challenging residents—these are always a great way to get your caregivers involved in identifying opportunities for improving outcomes.
Stay tuned for future articles on History of Past Non-Compliance and Informal Dispute Resolution. And remember, if you don’t know what the regulation says, you can’t prevent citations. Go to the CMS website for regulation information.
Next Steps
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