Schaab Consulting: Inspecting Nursing Homes

Tuesday, March 31, 2009

Inspecting Nursing Homes

For nursing homes to be a part of Medicare and Medicaid, Congress has certain requirements nursing homes must meet. The state governments are working with the Centers for Medicare and Medicaid Services (CMS) to perform health and fire safety inspections and investigate complaints of nursing homes.
Certified nursing homes must meet 180 regulatory standards to protect nursing home residents. These standards include medication, food preparation, abuse, etc.. The team is made up of trained inspectors, including 1 RN. These inspections take place at least once a year – more frequently for poor performance. The inspections make sure the nursing homes are performing at “minimum” standards. The quality of nursing homes can change (for better or worse) in a short amount of time. These changes occur when a nursing home’s administrator/ownership changes or when the home’s finances suddenly change.
Bottom Line: A passing grade still leaves room for concern.

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Susan Schaab RN,BSN,CLNC

Owner Schaab Consulting with over 2 years experience assisting attorneys with medical cases.

RN, BSN with over 20 years experience in both hospital and ambulatory care settings

Clinical expertise in Obstetrics, Newborn ICU, Plastic Surgery, and Ambulatory Surgery

Administrative expertise as Compliance Officer, Laser Safety Officer; creating and reviewing Standards of Care; developing Policies and Procedures

Review, Organize, Analyze, and Summarize the medical record
Case Consultation including: Medical Malpractice, Personal Injury, Literature Research

Sample Report

Mary Smith
Smith & Associates
1701 Main St
Bozeman, MT 59715

Dear Ms. Smith:

Pursuant to our conversation on January 14, 2007; I have completed my review of the medical records for Dave Jones. The medical records reviewed to date are from St. Mary's Health Care, Bridger MT from admissions 5/03/2006, 5/07/2006, and 6/19/2006.
Mr. Jones was admitted to St. James on 10/17 for gastrointestinal bleeding from undetermined source. His history was significant for appendectomy complicated by peritonitis with a small bowel resection. He was evaluated by CT scan of the abdomen (unremarkable), Merkel's scan (evidence of bleeding but location not apparent), colonoscopy (difficulty visualizing entire bowel do to less than ideal prep). Mr. Jones's hematocrit and hemoglobin dropped to a low of 24.4 (normal 42-55) and 8.4 (normal 14-18) respectively. Dr. May deemed it necessary to perform exploratory laparotomy with small bowel enteroscopy [visualizing the bowel directly with a scope]. Considering the low hematocrit and continued bleeding this was a reasonable surgery. Although Dr. May did not find a specific site for the bleeding there was evidence of bleeding at the level of anastomosis [reconnection] of the small bowel.
On October 26, 2007 Mr. Jones was noted to be febrile and his abdominal incision was red with drainage. Dr. May followed the standard of care by opening the incision, culturing the drainage, and ordering wet to dry dressing changes. He also prescribed appropriate antibiotics for methicillin resistant staph aureus [MRSA]. Mr. Jones seemed concerned that this occurred in his room and not under sterile technique. The wound was contaminated so it was impossible to debribe under sterile circumstances. It is within the standard of care to open incisions in non-sterile environments. MRSA is not uncommon in hospitals, and is now found frequently in the community. It is possible Mr. Jones entered St. Mary's Hospital already colonized by MRSA.
Although Mr. Jones has experienced very traumatic and unfortunate complications to his GI bleeding, I find no evidence of malpractice or negligence on the part of Dr. May or St. Mary's Health Care. My opinion is based on the review of the available records and may be supplemented upon further review of records.
Thank you for the opportunity to review this case. Please call if I can be of further assistance or if you have any questions.

Schaab Consulting