The Center for Medicare and Medicaid Services (CMS) has recently released the newly revised nutrition and sanitation regulations and investigative guidelines to surveyors.  Slated to become effective September 1, 2008, the intent of F 325 ( previously F 325 and F 326 ) is that the resident maintains, to the extent possible, acceptable parameters of nutritional status and that the facility provides nutritional care and services to each resident; appropriately recognizes, evaluates and addresses the needs of every resident, and provides a therapeutic diet that takes into account the resident’s clinical condition and preferences, when there is a nutritional problem.
In addition to identifying residents with significant weight losses of > 5% in 1 month, > 7.5% in 3 months, and 10% in 6 months and providing appropriate assessments, interventions and plans of care, CMS is requiring interventions addressing gradual, unintended, progressive weight loss ( as well as gain ) over an extended period of time.  This continued, progressive, and unintentional weight loss/gain may not fit into the above percentage guidelines, however, can have negative effects on the resident’s health and well-being.  The intent of the new guidelines is to ensure that the facility provides the care and services to detect and address potential nutritional problems before weight loss/gain occurs or other nutritional concern presents such as poor appetite, decreased functional ability to feed self, and impaired cognition in order to maintain acceptable parameters of nutritional status to the extent possible given the resident’s clinical condition.  Care and services are to include:

• assessing the resident’s nutritional status and the factors that put the resident at risk of not maintaining acceptable parameters of nutritional status;

• analyzing the assessment information to identify the medical conditions, causes and/or problems related to the resident’s conditions and needs;

• defining and implementing interventions for improving nutritional status that are consistent with the resident’s needs and goals, and within recognized standards of practice, or, explaining adequately and fully in the medical record why the facility could not or should not do so; and

• monitoring and evaluating the resident’s response or lack of response to interventions, and revising or discontinuing the approaches as appropriate or justifying the continuation of current approaches.

The Interpretive Guidelines clarify areas such as assessment, care planning and interventions related to nutritional care for nursing home residents.  The investigative protocol explains objectives and the procedures surveyors will use for their investigations.  Deficiency categorization provides severity guidance for the determination of the correct level of severity of outcome to residents from the deficiencies found with Tag F 325. 
Review and Print full Advance Guidance document of F 325