CMD Risk Assessment & Mitigation 3 — Questions and Answers
Question 1: A nursing home Medical Director receives notification of a resident-to-resident altercation resulting in injury. Under federal reporting requirements, to whom must this event be reported within 24 hours?
- The Joint Commission
- The state survey agency and the Long-Term Care Ombudsman (Correct answer)
- CMS central office only
- The resident's primary care physician only
Correct answer: The state survey agency and the Long-Term Care Ombudsman
Federal regulations (42 CFR 483.12) require facilities to report allegations of abuse, neglect, or exploitation to the state survey agency and the Long-Term Care Ombudsman within 24 hours.
Question 2: In risk stratification for pressure injury prevention, which combination of factors places a resident at HIGHEST risk?
- Ambulatory status, good nutrition, mild cognitive impairment
- Bedbound status, malnutrition, incontinence, and sensory impairment (Correct answer)
- History of prior pressure injury without current immobility
- Mild dehydration with full mobility
Correct answer: Bedbound status, malnutrition, incontinence, and sensory impairment
The combination of immobility, malnutrition, incontinence, and sensory impairment creates compounding risk factors that dramatically increase pressure injury likelihood.
Question 3: Which element of a facility's QAPI program specifically requires staff to analyze aggregate data trends rather than only individual events?
- Performance Improvement Projects (PIPs)
- Systematic Analysis and Systemic Action
- Governance and Leadership element
- Feedback, Data Systems, and Monitoring element (Correct answer)
Correct answer: Feedback, Data Systems, and Monitoring element
The Feedback, Data Systems, and Monitoring element of QAPI requires facilities to collect and analyze aggregate data to identify trends and systemic patterns.
Question 4: A Medical Director wants to reduce polypharmacy-related adverse drug events in high-risk residents. Which systematic approach is MOST evidence-based?
- Stopping all medications for residents over age 85
- Conducting comprehensive medication reviews using criteria such as the Beers Criteria (Correct answer)
- Switching all residents to generic formulations
- Limiting prescriptions to five medications per resident
Correct answer: Conducting comprehensive medication reviews using criteria such as the Beers Criteria
The American Geriatrics Society Beers Criteria provides evidence-based guidance for identifying potentially inappropriate medications in older adults, enabling systematic deprescribing.
Question 5: During a mock survey, surveyors identify that the facility lacks documented evidence of immediate corrective actions following a sentinel event. What risk does this primarily represent?
- Increased risk of staff turnover
- Regulatory non-compliance and potential for recurrent harm (Correct answer)
- Reduced Medicare reimbursement rates only
- Loss of accreditation from a voluntary accreditation body only
Correct answer: Regulatory non-compliance and potential for recurrent harm
Failure to document and implement immediate corrective actions following a sentinel event represents regulatory non-compliance and leaves systemic vulnerabilities unaddressed, risking recurrence.
Question 6: A Medical Director is tasked with reducing elopement risk in a memory care unit. Which environmental modification provides the MOST effective first-line mitigation?
- Increasing the number of resident activities
- Installing secured exit alarms and door delay systems (Correct answer)
- Eliminating all outdoor access for residents
- Reducing visiting hours to limit door traffic
Correct answer: Installing secured exit alarms and door delay systems
Secured exit alarms and door delay systems are the most direct environmental controls to detect and prevent elopement attempts in memory care units.
Question 7: A risk manager presents data showing that 70% of adverse events at a facility occur on night shifts. Using a systems-thinking approach, which contributing factor should the Medical Director investigate FIRST?
- Individual night shift staff competency levels
- Staffing ratios, supervision availability, and clinical support resources during night hours (Correct answer)
- Resident behavioral patterns that worsen at night
- Equipment availability on the night shift only
Correct answer: Staffing ratios, supervision availability, and clinical support resources during night hours
A systems-thinking approach prioritizes examining structural and organizational factors—such as staffing, supervision, and resource availability—over individual blame as root causes of shift-specific adverse event clustering.
CMD Risk Assessment & Mitigation 3
A nursing home Medical Director receives notification of a resident-to-resident altercation resulting in injury.
Under federal reporting requirements, to whom must this event be reported within 24 hours?