Nursing: CMS CoP Standards for Hospitals 2022

Webinar Details

Speaker

Laura A Dixon

Industry

Nursing

Speciality

Nursing

Available

All Days

Duration

120 Minutes


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Description

There were multiple changes to the hospital nursing chapter of the conditions of participation (CoPs) in 2021. However, many of those changes are still awaiting interpretive guidelines and survey procedures. In late 2021, CMS made changes to the section in response to the COVID-19 pandemic for “hospital at home” facilities. 

CMS CoP Nursing Standards for Hospitals 2022 Update will discuss the often-cited areas of the CoP manual involving nursing care: plans of care, staffing, policy changes, when an RN is required in an outpatient department, documentation, supervision, nursing leadership, cms verbal orders, antibiotic stewardship program requirement and more. 

CMS has issued deficiency reports which include which are the most problematic standards for hospitals. The nursing services have been cited over 6,300 times according to the most recent report. CMS CoP Nursing Standards for Hospitals 2022 is a must-attend program for any chief nursing officer, clinical nurse or nurse supervisor, or person interested in ensuring compliance with the CMS hospital conditions of participation in nursing.

Other changes in the past to this section include timing of medications, standing orders, soft wrist restraints, and restraint reporting, plan of care, cms verbal orders, blood transfusions, IV medication, compounding, BUD, antibiotic stewardship program, safe injection practices, self-administration of medications and drug orders.

Every hospital that accepts Medicare and Medicaid reimbursement must follow the CMS (Center for Medicare and Medicaid Services) Conditions of Participation (CoPs) and it must be followed for all patients. This program will cover the nursing services section in the hospital CoP manual. Facilities with Deemed Status accredited by the Joint Commission, Health Care Facility Accreditation Program, CIHQ, and DNV Healthcare must also follow these regulations.

CMS CoP Nursing Standards for Hospitals 2022 will also reference other important sections that all nurses should be aware of that are outside the nursing services section. Such sections include the revised discharge planning standards, medication standards, revised history and physicals, visitation, restraint and seclusion and grievances, and privacy and confidentiality. CMS issued the privacy and confidentiality memo, safe injection practices memo, humidity memo, and insulin pen memo.

Learning Objectives

  • Recall that CMS has a section on nursing services that every hospital must follow even if accredited
  • Describe the three different timeframes for which all medications must be administered
  • Discuss that nursing care plans are a frequently cited area by CMS
  • Recall that CMS verbal orders must be signed off and must include both a date and time

Agenda

  • Introduction into the CMS hospital CoPs
  • General information on CMS including online access and email contact for CMS to ask questions
  • CMS deficiency reports and problematic standards
  • Final changes under the Hospital Improvement Rule to nursing            
  • CMS 3 Worksheets
  • CDC resources on preventing healthcare-acquired infections (HAI)
  • CMS memos of interest
    • Infection control breaches
    • Texting
    • Ligature risks
    • Legionnaire’s
    • Safe injection practices
    • Humidity in the OR
  • ISMP safe injection practices
  • Non-Discrimination, Interpreters, and section 1557
  • Nursing Services and 24 hours services
  • RN on duty – recent update
  • Organizational chart and nursing
  • Chief Nursing Officer (CNO) responsibilities & requirements
  • CNO approval of nursing policies
  • Staffing and delivery of care
  • 24-hour nursing services and supervision
  • RN to evaluate the care of all patients
  • Nursing care plans
  • Changes to the plan of care
  • Agency nurse requirements
  • Medication administration
  • The order required for all medications
  • BUD, compounding sterile preparations (CSP)
  • Protocols, standing orders, order sets
  • Requirements for complete drug order
  • Compounding of medications
  • Three medications timing changes
  • Safe Opioid use
  • Standing orders and protocols
  • CMS Verbal orders Requirements 2022
  • Blood transfusions and IV medications changes
  • Reporting blood administration and medication errors
  • Self-administered medications
  • CAH Nursing requirements
  • 1135 Waivers for sections addressed
    • Care-at-home

Other important sections nurses should be aware of:

  • Restraint and seclusion changes
  • Grievances
  • Medication policies
  • Visitation
  • History and physicals
  • Discharge planning revised standards

Who Should Attend

  • Chief nursing officer
  • All nurses
  • Nurse managers/supervisors
  • Nurse educators
  • HIM Director and staff
  • Compliance officer
  • Chief of medical staff
  • Medical staff coordinator
  • Risk manager
  • Patient safety officer
  • Senior leadership
  • Hospital legal counsel
  • QAPI director
  • Joint Commission coordinator
  • Regulatory officers
  • Physicians
  • Education department staff
  • Board members
  • Audit staff
  • Others are responsible for compliance with hospital nursing regulations including documentation compliance.
Laura A Dixon
Laura A Dixon

(BS, JD, RN, CPHRM)

Laura Dixon | Laura A. Dixon recently served as the Regional Director of Risk Management and Patient Safety for Kaiser Permanente Colorado where she provided consultation and resources to clinical staff. Prior to joining Kaiser, she served as the Director, of Facility Patient Safety and Risk Management and Operations for COPIC from 2014 to 2020. In her role, Ms. Dixon provided patient safety and risk management consultation and training to facilities, practitioners, and staff in multiple states. Such services included the creation of presentations on risk management topics, assessment of healthcare facilities; and development of programs and compilation of reference materials that complement physician-oriented products.

Prior to joining COPIC, she served as the Director, of the Western Region, Patient Safety and Risk Management for The Doctors Company, Napa, California. In this capacity, she provided patient safety and risk management consultation to the physicians and staff in the western United States. Ms. Dixon’s legal experience includes medical malpractice insurance defense and representation of nurses before the Colorado Board of Nursing.

Ms. Laura Dixon has more than twenty years of clinical experience in acute care facilities, including critical care, coronary care, peri-operative services, and pain management.

As a registered nurse and attorney, Laura holds a Bachelor of Science degree from Regis University, RECEP of Denver, a Doctor of Jurisprudence degree from Drake University College of Law, Des Moines, Iowa, and a Registered Nurse Diploma from Saint Luke’s School Professional Nursing, Cedar Rapids, Iowa. She is licensed to practice law in Colorado and California.

Registration Options

Choose Your Options

Save $10 - [ HEALTHCPTI ]

Error Conference Exists In Wish-list.

Congrats Conference Added In Wish-list.


Need Corporate Discount ?


  • * For more than 6 attendee call us at +1-800-803-7592 or mail us at cs@conferencepanel.com
  • * For Check and ACH payment call us at +1-800-803-7592 or mail us at cs@conferencepanel.com
  • * Click to download the Order Form
Laura A Dixon
Laura A Dixon

(BS, JD, RN, CPHRM)

Laura Dixon | Laura A. Dixon recently served as the Regional Director of Risk Management and Patient Safety for Kaiser Permanente Colorado where she provided consultation and resources to clinical staff. Prior to joining Kaiser, she served as the Director, of Facility Patient Safety and Risk Management and Operations for COPIC from 2014 to 2020. In her role, Ms. Dixon provided patient safety and risk management consultation and training to facilities, practitioners, and staff in multiple states. Such services included the creation of presentations on risk management topics, assessment of healthcare facilities; and development of programs and compilation of reference materials that complement physician-oriented products.

Prior to joining COPIC, she served as the Director, of the Western Region, Patient Safety and Risk Management for The Doctors Company, Napa, California. In this capacity, she provided patient safety and risk management consultation to the physicians and staff in the western United States. Ms. Dixon’s legal experience includes medical malpractice insurance defense and representation of nurses before the Colorado Board of Nursing.

Ms. Laura Dixon has more than twenty years of clinical experience in acute care facilities, including critical care, coronary care, peri-operative services, and pain management.

As a registered nurse and attorney, Laura holds a Bachelor of Science degree from Regis University, RECEP of Denver, a Doctor of Jurisprudence degree from Drake University College of Law, Des Moines, Iowa, and a Registered Nurse Diploma from Saint Luke’s School Professional Nursing, Cedar Rapids, Iowa. She is licensed to practice law in Colorado and California.