In addition, the death must be reported by phone to CMS no later than the close of business following knowledge of the death. Staff must document in the patient's medical record the date and time they reported the death to CMS.

Hospitals will need to revise their policies and procedures on restraint and seclusion to add this requirement. During the mandatory restraint training that is also required by the new regulations, this information should be discussed.

Of course, The Joint Commission has a National Patient Safety Goal to make sure the patient is not misidentified by using two identifiers.

The nurse should make sure the medications are administered in this time frame. If the medication is ordered at 9 a.m., then a nurse could give it between 8:30 and 9:30 a.m., but not between 8 and 10 a.m.

Q: Our hospital owns a critical access hospital (CAH) and I was wondering whether the three new CMS regulations regarding discharge appeal rights, restraint and seclusion, and history and physicals apply to critical access hospitals.

A: There is only one of the three new regulations that apply to CAHs. CAHs have a separate condition of participation (CoP) that applies to them. The only one that applies is the Medicare Discharge Appeals Rights. This rule becomes effective July 1, 2007. This means that upon admission a Medicare or Medicare Advantage patient has to be given the new revised form called "the IM form" or important information under Medicare. It must be given within two days of admission and signed and dated by the patient. The patient must be given a copy of what they signed within two days of discharge so the information is fresh in his or her memory. If the patient thinks he or she is being prematurely discharged, he or she has the right to contact the state QIO. Then the patient must be given a third notice called the detail notice. While the new regulations apply to CAHs, it does not apply to the swing bed patients.

Q: What does CMS say about agency nurses?

A: CMS called agency nurses non-employee nurses. The requirement for agency nurses is contained under tag number 207. The federal regulation requires that agency nurses must follow the hospital's policies and procedures. The director of nursing service (often referred by most hospitals as the chief nursing officer or VP of Patient Care Services) must provide for the adequate supervision and evaluation of the clinical activities of non-employee nursing personnel that occur within the responsibility of the nursing services.

The director of nursing and the hospital are responsible for making sure that the agency nurse knows the policies and procedures in order to be able to follow them. The agency nurse must be adequately supervised. This supervision and evaluation of the clinical activities of each agency nurse must be conducted by the hospital employed RN. This means the hospital needs to evaluate these nurses. The hospital cannot just rely on the agency to conduct an annual evaluation of the agency nurse.

The interpretive guidelines contain information that must be provided to the agency nurse as part of his or her orientation. Orientation can be done as live presentation, though video tapes, or through self assessment learning packets that are provided to the agency. CMS does not dictate how this is to occur. They have to be oriented to the hospital and the unit, emergency procedures, nursing services policies and procedures, and safety policies and procedures.

CMS requires an RN employed by the hospital to observe and evaluate the agency nurse in theses areas. They must have a current license, and their clinical activities must be evaluated and must be adequate.