F695 Respirator/Tracheostomy Care and Suctioning

As we wrap up the FTag of the month series for 2023, we recap the Top 10 most frequently cited FTags on recertification surveys for 2023, according to CASPER data from November 2023.

1. F812 Food Procurement, Store/Prepare/Serve Sanitary
2. F880 Infection Prevention and Control
3. F689 Free of Accident Hazards/Supervision/Devices
4. F656 Develop/Implement Comprehensive Care Plan
5. F761 Storage of Drugs and Biologicals
6. F684 Quality of Care
7. F695 Respirator/Tracheostomy Care and Suctioning
8. F677 ADL Care Provided for Dependent Residents
9. F657 Care Plan Timing and Revision
10. F584 Safe/Clean/Comfortable/Homelike Environment

Today we will be reviewing the final Ftag to wrap up the blog series for 2023, FTag 695.

For the past five years, this FTag hasn't made it to the Top 10. So, what prompts its appearance in 2023? Consider the profile of residents admitted to long-term care – typically, they are sicker individuals with prevalent pulmonary and cardiac issues, often requiring breathing treatments or respiratory interventions upon admission. According to Appendix PP of the State Operations Manual, an examination of MDS data reveals that the most common respiratory diseases among nursing home residents are:

• Pneumonia
• Asthma
• COPD8
• Acute respiratory distress syndrome
• Lung cancer
• History of TB

In an August 2022 BMC Geriatrics article, it was highlighted that age-related factors such as frailty and immunosenescence contribute to more severe outcomes, increased hospitalizations, and higher mortality rates in the elderly when facing respiratory infections. Considering the anticipated doubling of the population over 65 in long-term care settings by 2050, the clustering of frail older residents in close living quarters amplifies the rapid spread of infections.

Measures to reduce citations in FTag 695

1. Ensure bacterial pneumonia and influenza vaccines are administered.
2. Administer TB tests upon admission.
3. Update resident care policies and procedures for respiratory care and services to include tracheostomy care and suctioning.
4. Ensure respiratory care policies are consistent with professional standards, are comprehensive and person-centered and address each resident’s goals and preferences.
5. Perform routine competency tests for all licensed nurses specific to appropriate hand hygiene and standard precaution practices.
6. Include risks for potential complications in care plans specific to unplanned extubation; aspiration and the potential for respiratory infection; nutritional complications related to tube feedings, gastric distress; increased or decreased CO2 levels; development of oral or ocular ulcers; DVT’s due to immobility: airway complications such as tracheal infections, mucous plugging and/or stenosis.
7. Consult/Contract Respiratory Therapists for staff education and ongoing skills training.

There are 12 essential components to Respiratory Care Policies. Have you ensured that all 12 components are covered in your current policies? The CMS Critical Element Pathway for Respiratory Care spans 7 pages, and it's crucial to gauge your familiarity with these requirements. Polaris Group consultants are knowledgeable and available to assist you in the development of updated Respiratory Care policies. Additionally, they can help in developing skills fairs and audits tailored to FTag 695. For further information, contact us today!