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The Centers for Medicare and Medicaid (CMS) have a classification for crisis situations in which the health and safety of individual(s) are at risk. This classification is called Immediate Jeopardy (IJ).

CMS developed guidelines for surveyors of nursing homes and hospitals to use to help determine if the circumstances they are seeing pose an Immediate Jeopardy to a patient or resident’s health and safety. The guidelines assist Federal and State Survey and Certification personnel and Complaint Investigators in recognizing situations that may cause or permit Immediate Jeopardy in a nursing home or hospital as well as to almost all other certified Medicare/Medicaid entities. The surveyors can apply these principles and guidelines to all types of surveys and investigations: certifications, recertifications, revisits, and complaint investigations. The main goal of having these guidelines is to help the surveyors and investigators identify and prevent serious injury, harm, impairment, or death.

CMS has provided some definitions for the surveyors.

Immediate Jeopardy is defined as a situation in which the provider’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.

Abuse is defined as “The willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish.”

Neglect is defined as a “Failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness.”

In order to determine if there is an IJ situation, the nursing home and hospital surveyor or survey team will keep in mind that only one person needs to be at risk. They will also consider that serious harm, injury, impairment, or death does NOT have to occur before considering Immediate Jeopardy. Harm can come from both abuse and neglect and psychological harm is as serious as physical harm. The serious harm, injury, impairment or death may have occurred in the past, may be occurring at present, or may be likely to occur in the very near future as a result of the jeopardy situation. In other words, a situation that can cause any of the problems above may or may not be currently happening, but if there is a potential for it to happen, that can constitute an IJ situation. Harm does not have to occur before the surveyor or survey team can consider or call IJ.

In order to call an IJ, the nursing home and hospital surveyor or survey team must also consider if the facility either created a situation or allowed a situation to continue which resulted in serious harm or a potential for serious harm, injury, impairment or death to individuals and if the facility had an opportunity to put corrective or prevention measures in place. During the investigation the surveyor/investigator will investigate and answer the following questions: Who was involved? What harm has occurred, is occurring, or most likely will occur? When did the situation first occur? Where did the potential/actual harm occur? Is it an isolated incident or a facility-wide problem? Why did the potential/actual harm occur?

In the next post I will discuss the triggers for IJ.

Keep safe and be informed!

JL

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