Thursday, May 19, 2016

ICF/IID: Privacy During Medication Pass and W130

It several parts of Texas privacy during medication pass has become a focus issue in the ICF/IID homes during surveys.  Recently one home was cited for giving medications at the dinging room table and the tag used was W130.

W130 does deal with privacy and specifically states "ensure privacy during treatment and care of personal needs".  That seems straight forward enough, but if someone wants additional clarification, the guidelines for surveyors provides the following:
"Clients must be provided privacy during personal hygiene activities (e.g., toileting, bathing, dressing) and during medical/nursing treatments that require exposure of one's body.

People not involved in the care of the client should not be present without their consent while they are being examined or treated.

Whenever possible, the facility should be sensitive to clients’ preferences for same sex care in private situations. "

The above clarifies that privacy during certain activities is required.  However, some facilities are receiving citations for giving oral medications in front of others.  W130 was written because the medications were provided in front of others.   It could be argued that the section of the guideline stating that "People not involved in the care of the client should not be present without their consent while they are being examined or treated" means that a privacy should be maintained during oral medication pass as well.  However, it would be more likely that this statement is referring to an examine or treatment with a physician or nurse that requires "exposure of one's body" in some specific way such as removing a shirt, pants, etc.  It could also be assumed that the "treated" part of this guideline also refers to when there is "exposure of one's body" as stated in the previous sentence.  The case could be made that treated also refers to an oral medication pass, but I think this point could be argued on the basis that there was no "exposure of one's body".

Looking at the guidelines, it is hard to equate taking a pill with "medical/nursing treatments that require exposure of one's body".  The only example noted in the deficient practice was that the individual took his medications in front of others.  It was not noted whether he objected or wanted the other people around or not.

Had the facility been prepared for an Informal Dispute Resolution (IDR) in Texas, it might have been the time to move forward with one.  The use of W130 for an oral medication seems to be a stretch at best, but had it been connected to a discussion of the medications, then it might have been clear what the problem was in this instance.  For example, if the individual took a specific medication for cancer treatment, then his privacy would have been violated had staff discussed what the medication was used for in front of others at the table.    The final result was that the facility administration really had no idea what was done wrong, but wrote a Plan of Correction (POC) all the same and submitted it for review.  The facility will likely clear a follow up visit and move forward.  It would be logical to assume that if this trend continues, private providers are going to be forced to strongly consider the IDR process.

Source: Page 53:   ICF/IID Standards