Practical Tips to Avoid F695 Respiratory Care Deficiencies

F695 Respiratory Care was the 7th most cited deficiency in standard health surveys so far for the 2024 Fiscal Year, being cited in 21% of surveys. F695 mandates that facilities must ensure residents requiring respiratory care, such as oxygen therapy, respiratory treatments, tracheostomy care, tracheal suctioning and mechanical ventilation, receive it according to professional standards, personalized care plans, and the resident’s preferences. Based upon the facility assessment and in consideration of the resident population, diagnoses, staffing/ staff qualifications, and facility resources, the facility must determine its ability to provide specialized respiratory care that meets the identified needs. This includes having sufficiently trained staff and established respiratory care policies in place before admitting residents who need respiratory services.

YTD F695 Citation Data

As you can see, F695 is most often cited with scope and severity of D (Isolated with no actual harm with potential for more than minimal harm), but there have been 11 occurrences of immediate jeopardy.  Examples of IJ level citations include:

EXAMPLE 1

The facility failed to provide respiratory care and services for a tracheostomy dependent resident according to professional standards of practice. Resident requested his tracheostomy to be suctioned. The certified nursing assistant (CNA) notified the nurse. By the time the nurse got to the room, the resident was unresponsive. A code was called, Cardiopulmonary Resuscitation (CPR) was initiated with no evidence the airway was cleared prior to providing breaths, the resident was transported to the hospital where he expired. During the survey, two residents were observed in the facility needing tracheostomy suctioning; however, staff had not responded to their requests. There was inaccurate and incomplete documentation related to tracheostomy care. Staff expressed lack of confidence and access to supplies related to care and services to residents with tracheostomies.

EXAMPLE 2

The facility failed to ensure staff were trained for emergency care of tracheostomies and provide emergency tracheostomy kits for one resident reviewed for tracheostomy care. The facility’s failure to train staff and provide emergency tracheostomy kits in the event that the resident’s airway was compromised, resulted in resident’s trach tube becoming dislodged and an emergency room visit to have tube re-inserted. In addition, the facility failed to properly store resident respiratory care equipment when not in use for resident’s C-PAP mask.

Practical Tips for Compliance with F695:

• • Pre-Admission Assessments: Before admitting any resident with respiratory needs, conduct a thorough pre-admission assessment to determine if the facility has the necessary resources, staff, and expertise to meet those needs based on the facility assessment.
  • Policy Development: Collaborate with key healthcare professionals, including the medical director, director of nurses, and respiratory therapist, to develop and regularly update policies and procedures for respiratory care that comply with professional standards. Regulatory guidelines suggest policy/procedures address, but not be limited to, the following factors:
    • • • Oxygen services
        • Respiratory exercises
        • Nebulizers and inhalers
        • BiPAP/CPAP treatments
        • Mechanical ventilation/tracheostomy care
        • Emergency care
        • Adverse reactions protocol
        • Respiratory assessment
        • Maintenance of respiratory equipment
        • Emergency power
        • Infection Control measures
        • Posting signs for oxygen in use
  • Tailored Care Plans: Create individualized care plans that reflect each resident’s specific respiratory needs, preferences, and goals. Ensure these plans are regularly reviewed and updated based on the resident’s condition and any changes in care requirements.
  • Staff Education and Training: Continuously educate and train staff on respiratory care protocols, emphasizing the importance of adhering to established policies and procedures. Include training on the use of specialized equipment and emergency response protocols.
  • Regular Monitoring: Implement a system for ongoing monitoring of respiratory care practices. Regular audits can help identify areas for improvement and ensure consistent adherence to standards.
  • Interdisciplinary Collaboration: Promote regular communication and collaboration among the care team, including doctors, nurses, and respiratory therapists, to ensure comprehensive and coordinated care for residents with respiratory needs.
  • Documentation: Keep thorough and accurate documentation of all respiratory care and services provided, including care plan updates, staff training records, treatment records and monitoring reports. This documentation can be crucial during inspections and reviews. If applicable, documentation should include:
    • • • Vital signs, including the respiratory rate;
        • Chest movement and respiratory effort, and the identification of abnormal breath sounds;
        • Signs of dyspnea, cyanosis, coughing, whether position affects breathing, characteristics of sputum, signs of potential infection, or the presence of behavioral changes that may reflect hypoxia including anxiety, apprehension, level of consciousness;
        • Instructions for the resident on how to participate/assist in the respiratory treatments as appropriate; and
        • Documentation of respiratory treatments and resident’s response post treatment.
  • Resident and Family Involvement: Engage residents and their families in the care planning process. Educate them about the respiratory care being provided and encourage their input to ensure care aligns with the resident’s preferences and goals.

Critical Element Pathway for Respiratory Care

Surveyors will use the Respiratory Care Critical Element Pathway (CMS 20081) as part of their determination of compliance with F695.

This form includes steps for:

• • • Observation of Oxygen therapy, Respiratory Aerosolized care, Breathing exercises, Mechanical ventilation or tracheostomy
    • Interview with Resident/Resident Representative/Family
    • Interviews with Staff
    • Record Review

This form is available on line (Survey Resources) and can be used by facilities as a QAPI audit tool.

Next steps! Join Proactive on September 17th for our presentation Documentation for Respiratory Care which is part of our Documentation in Depth series. Access Proactive’ s Survey Ready Toolkit for a treasure trove of auditing and monitoring tools to prepare for survey in key focus areas.