OASIS-Central

Q: If our agency works primarily with older patients and deals with heart issues frequently, is there anything we should be aware of about the heart failure data elements?

A: Data element M1500, symptoms in heart failure patients, asks whether a patient diagnosed with heart failure exhibited symptoms of heart failure. If so, heart failure follow-up (M1510) asks about actions taken in response. This is a potential  survey trap. All agencies that deal with heart issues should know about it and pay special attention.

One response for M1510 is “No action taken.” Clinicians should never use this option. If the nurse does not act in response to symptoms, the agency has not complied with the requirement in the Conditions of Participation, § 484.18 (b), to not notify the physician of changes that suggest a need to modify the plan of care. There could be associated deficiencies under skilled nursing (Conditions of Participation, § 484.30), including failure to initiate appropriate rehabilitative procedures, revisions to the plan of care, physician notification, and coordination of patient care (Conditions of Participation, § 484.14(g)).

Agencies should review with nurses and therapists the symptoms of heart failure and stress the importance of following up on any signs. Most importantly, completion of M1510 should be monitored and there should never be any time a clinician checks “No action taken.”