SMQT Nursing and Physician Services 5 — Questions and Answers
Question 1: A facility contracts with a telemedicine physician to fulfill all required physician visit obligations. Under current CMS guidance, this arrangement:
- May be acceptable if the state permits telemedicine visits to satisfy face-to-face requirements (Correct answer)
- Is never acceptable because visits must always be in-person
- Is fully acceptable under all CMS conditions without state-level consideration
- Is acceptable only for the initial admission visit
Correct answer: May be acceptable if the state permits telemedicine visits to satisfy face-to-face requirements
CMS has recognized telemedicine visits may satisfy physician visit requirements, but acceptability depends on applicable state law and the visit meeting required evaluation standards.
Question 2: A surveyor finds that the facility's charge nurses routinely change the frequency of wound dressing changes based on clinical observation without a new physician order. This practice is:
- A deficiency — treatment changes require a new or modified physician order (Correct answer)
- Acceptable if the charge nurse is an RN exercising clinical judgment
- Acceptable if the original order included nurse-discretion language
- A deficiency only if the change results in a wound worsening
Correct answer: A deficiency — treatment changes require a new or modified physician order
Nursing staff may not unilaterally modify treatment parameters established in physician orders without obtaining a new or revised order from the physician.
Question 3: During record review, a surveyor notes a resident's care plan lists 'prn physician visits as needed.' What is the problem with this approach?
- It does not satisfy the required scheduled minimum visit frequency under 42 CFR §483.30 (Correct answer)
- PRN visits are prohibited in nursing facilities under federal law
- It is acceptable as long as the resident is clinically stable
- It is acceptable if the attending physician approves the arrangement in writing
Correct answer: It does not satisfy the required scheduled minimum visit frequency under 42 CFR §483.30
Federal regulations mandate minimum physician visit frequencies on a scheduled basis; a prn-only approach does not meet this requirement regardless of resident stability.
Question 4: A nursing facility surveyor observes that licensed nurses are documenting assessments they did not perform, signing off on tasks completed by unlicensed aides. This constitutes a deficiency in:
- Nursing services — falsification of medical records and improper delegation (Correct answer)
- Physician services — inadequate physician oversight of nursing
- Resident rights — failure to disclose care practices
- Staffing — inadequate RN coverage
Correct answer: Nursing services — falsification of medical records and improper delegation
Nurses who falsify documentation by signing off on assessments they did not perform violate professional and regulatory standards for nursing services.
Question 5: Which of the following best demonstrates a facility's compliance with requirements for physician services during an emergency when the attending physician is unavailable?
- A documented on-call physician arrangement that was activated and resulted in timely evaluation of the resident (Correct answer)
- The nurse documenting attempts to reach the physician over four hours
- A family member consenting to treatment in lieu of physician authorization
- The Director of Nursing making the medical decision pending physician contact
Correct answer: A documented on-call physician arrangement that was activated and resulted in timely evaluation of the resident
Compliance requires both a written on-call arrangement and evidence it was activated and resulted in timely physician evaluation when needed.
Question 6: A physician's order reads 'continue current medications.' A surveyor would find this order problematic because:
- Orders must specifically identify each medication, dose, route, and frequency to be valid and safe (Correct answer)
- Continuation orders must be signed by the medical director, not the attending physician
- Such orders are only valid for 30 days before reauthorization is needed
- The order is acceptable as a standing order if the medications are listed in the MAR
Correct answer: Orders must specifically identify each medication, dose, route, and frequency to be valid and safe
Blanket continuation orders lacking specific medication details fail to meet standards for clear, individualized physician orders and create medication safety risks.
Question 7: Under SMQT standards, which situation would represent an adequate response by nursing staff to a change in a resident's condition?
- Promptly notifying the attending physician, documenting the assessment, and implementing ordered interventions (Correct answer)
- Waiting until the next scheduled physician visit to report a non-life-threatening change
- Notifying family first and awaiting their instructions before contacting the physician
- Documenting the change and monitoring without physician notification unless symptoms worsen
Correct answer: Promptly notifying the attending physician, documenting the assessment, and implementing ordered interventions
Nursing staff must promptly assess, notify the physician of significant changes, document findings, and implement ordered interventions to meet quality of care standards.
SMQT Nursing and Physician Services 5
A facility contracts with a telemedicine physician to fulfill all required physician visit obligations.
Under current CMS guidance, this arrangement: