1. Kritz, Fran


Clarifications for nursing leadership and staffing are expected.


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The Centers for Medicare and Medicaid Services (CMS) has proposed updates and clarifications to the Hospital Improvement Rule, including revisions to guidance on timely response by nurses to patient needs and supervisory responsibilities of nursing leadership.


The proposed new rule, formally called Hospital and Critical Access Hospital Changes to Promote Innovation, Flexibility, and Improvement in Patient Care, was published in the Federal Register in 2016 and is expected to be finalized this summer (see Benefits of adopting the changes, the CMS states in the proposal, "would include reduced readmissions, reduced incidence of hospital-acquired conditions (including healthcare-associated infections), improved use of antibiotics at reduced costs (including the potential for reduced antibiotic resistance), and improved patient and workforce protections."


The proposed changes are important for nurses to review to prepare for implementation, according to Sue Dill Calloway, president of Patient Safety and Healthcare Consulting and Education in Dublin, Ohio, who recently led a webinar on the subject. The CMS's proposal includes new regulations as well as changes to old ones, and also creates a reminder system for existing rules for hospital conditions of participation, the regulations that set minimum health and safety standards for hospitals that participate in Medicare.


Calloway told AJN that based on her conversations with the CMS, several parts of the proposed rule contain requirements for improvements in areas that nursing "is not getting right" and for which hospitals are being marked deficient during inspections. The areas include nursing practice, CMS standards and processes (known as Quality Assessment and Performance Improvement, or QAPI), patients' rights, infection control, and medical records. Important takeaways for nurses include:


* An RN must be immediately available when needed for the appropriate care of patients in both inpatient and outpatient settings. This means facilities must have sufficient numbers and types of supervisory and staff nurses in each department or nursing unit where such patient needs might arise.


* Regulations that refer to nursing leadership include not just the chief nursing officer but also nursing department directors.


* If approved by the medical executive committee, no individual physician orders are needed for the flu or pneumonia vaccine. Nurses must make sure there are no contraindications.


* Patients and/or their representatives must be informed in a language they understand of their right to be free from discrimination and how to seek assistance at the hospital if they believe they have been discriminated against.-Fran Kritz