Nutrition & Foodservice Edge Magazine - September/October 2023 - 20

FOOD AND NUTRITION CAN TRIGGER AN IMMEDIATE
JEOPARDY IN A CMS SURVEY
and seek direction. In some cases, the CMS Regional Office
(RO) is also contacted for confirmation. Surveyors then must
immediately notify the nursing home administrator and
deliver the completed IJ Template.
REMOVING IMMEDIATE JEOPARDY: THE
REMOVAL PLAN
The facility must complete a " removal plan " which:
1) identifies the residents who have suffered, or are likely
to suffer, a serious adverse outcome as a result of the
noncompliance;
2) specifies the action the entity will take to change the
process or system failure to prevent a serious adverse
outcome from occurring or
recurring; and
3) indicates the date the action will
be complete.
The removal plan differs from a
plan of correction because the
facility does not have to correct
all noncompliance - just the
noncompliance contributing to the
serious harm.
* Failure to provide adequate nutrition and hydration
resulting in malnutrition.
* Withholding nutrition and hydration without advance
directive.
* Lack of potable water supply.
* Unsafe dietary practices resulting in high potential for
foodborne illnesses.
THE REMOVAL PLAN
differs from a plan of
correction because the
facility does not have to
REGULATORY AND BEST PRACTICE
GUIDELINES
As noted earlier, the CMS State Operations Manual
Appendix PP - Guidance to Surveyors for Long Term Care
Facilities is the primary resource
used by surveyors in determining
compliance. Within Appendix PP
are examples provided to surveyors
for Severity Level 4 Noncompliance
related to food and nutrition such as:
F692
The State Agency, or the survey
team in consultation with the SA,
determines whether, if implemented
appropriately, the removal plan will
remove the Immediate Jeopardy. To
remove IJ, surveyors must determine onsite that the nursing
home took immediate action to prevent a serious adverse
outcome from occurring or recurring and no resident is
currently experiencing serious injury, serious harm, or
serious impairment; and/or serious injury, serious harm,
serious impairment, or death is not likely.
correct all noncompliance-
just the noncompliance
contributing to the serious
harm.
Assisted nutrition and hydration:
Examples of Severity Level 4
Noncompliance: Immediate Jeopardy
to Resident Health or Safety include
but are not limited to:
* Repeated, systemic failure to
assess and address a resident's
nutritional status and to implement
pertinent interventions based on
such an assessment resulted in continued significant or
severe weight loss and functional decline; Repeated failure
to assist a resident who required assistance with meals
and drink resulted in or made likely the development
of life-threatening symptom(s), or the development or
continuation of severely impaired nutritional status;
If the plan is not fully implemented, the IJ will continue until
the removal plan is fully implemented and the likelihood
of serious injury, harm, impairment, or death no longer
exists. Offsite desk/telephone review for removal of IJ is not
permitted.
Some key IJ triggers related to food and nutrition while not
conclusive include:
* Improper feeding/positioning of an individual with
known aspiration risk.
* Food supply that is inadequate to meet the needs of the
individual.
* Dietary restrictions or downgraded diet textures, such as
mechanical soft or pureed textures, were provided by the
facility against the resident's expressed preferences and
resulted in substantial and ongoing decline in food intake
resulting in significant or severe unplanned weight loss
with accompanying irreversible functional decline to the
point where the resident was placed on hospice; or
* The failure to provide an ordered potassium-restricted
therapeutic diet resulted in evidence of cardiac
dysrhythmias or other changes in medical condition due
to hyperkalemia.
20 NUTRITION & F OOD SER VICE EDGE | SEPTEMBER-OCTOBER 2023
Nutrition & Foodservice Edge Magazine - September/October 2023

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