Care Planning: The Road Map for Individualized Resident Care
|
|
- Virgil Shaw
- 5 years ago
- Views:
Transcription
1 Care Planning: The Road Map for Individualized Resident Care Kathy Sanders RN, RAC-CT, DNS-CT Sanders Consulting 1 Disclaimer The Care Planning: Care Planning: The Road Map for Individualized Resident Care was developed as an educational program and reference for long-term care staff. To the best of our knowledge, it reflects current federal regulations and practices. However, it cannot be considered absolute and universal. The information contained in this workshop must be considered in light of the individual organization and state regulations. The authors disclaim responsibility for any adverse effect resulting directly or indirectly from the use of the workshop material, from any undetected errors, and from the user s misunderstanding of the material. 2 Disclaimer Continued The authors put forth every effort to ensure that the content, including any policies, recommendations, and sample documents used in this training, were in agreement with current federal regulations, recommendations, and practices at the time of publication. The information provided in this training is subject to revision based on future updates and clarifications by CMS. 3 1
2 Objectives The learner will be able to: Describe the relationship between the RAI process, the care plan, and quality resident care Discuss the relationship between the MDS, CAT s, CAA s and the care plan Discus the role of critical thinking in the care planning process List the components of an effective care plan Define interim care plan Give an example of an I Format care plan 4 Introduction The care planning requirements reflect the facility s responsibilities to provide necessary care planning that results in care and services to attain or maintain the highest practicable physical, mental and psychosocial well-being for the resident. 5 Introduction Care planning fosters quality resident care by: Facilitating communication among the Interdisciplinary Team (IDT) members Providing staff with consistent information about the resident's problems, strengths, and needs Instructing staff on how to meet the individual resident s needs Allowing updates and revisions according to the resident's changing needs Including the resident s voice and choice 6 2
3 RAI Process Design Assessment (MDS 3.0) Decision Making (CAAs) Care Plan Development Care Plan Implementation Evaluation 7 Care Plan Development The care plan must aim to address the following: Prevent avoidable decline Manage risk factors Address resident strengths Evaluate treatment objectives and care outcomes Respect the resident s right to refuse treatment Offer alternative treatments Use an interdisciplinary approach Involve the resident, family, or other resident representative Involve direct care staff in the process Use current standards of practice CMS s RAI Version 3.0 Manual, Chapter 4 8 Resident Assessment Instrument (RAI) Process The RAI Process consists of three basic components: The Minimum Data Set (MDS) Version 3.0 The Care Area Assessment (CAA) Process The RAI Utilization Guidelines 9 3
4 Links in the(rai) Process The critical link between the MDS 3.0 and care planning results from two key areas: Care Area Assessments Care Area Triggers 10 What are the CATs? Care Area Triggers or CATs are the triggering mechanisms of the MDS 3.0 They are specific response options that serve as indicators of the twenty care areas that affect nursing home residents. When information entered into the MDS 3.0 triggers a response, additional assessment and care area review is required. 11 What are the CAA s? The Care Area Assessment (CAA) Process is guided by professional standards of practice and regulatory requirements. It is designed to guide the IDT through the comprehensive assessment of a resident s functional status. 12 4
5 CAAs There are 20 CAAs Delirium Visual Function Activity of Daily Living (ADL) Functional/Rehabilitation Potential Urinary Incontinence and Indwelling catheter Psychosocial Well-Being Behavioral Symptoms Falls Feeding Tubes Dental Care Psychotropic Medication Use Cognitive Loss/Dementia Communication Pain Return to Community Referral Mood Sate Activities Nutritional Status Dehydration/Fluid Maintenance Pressure Ulcer Physical Restraints 13 Using the CAAs CAAs are required for the following comprehensive clinical assessments Admission Assessments Annual Assessments Significant Change in Status Assessments Significant Correction of Prior Full Assessments CAAs may also be used at any time, not just when an assessment is due, to provide in-depth review of a care area condition to assist with development of a care plan 14 Critical Thinking The Bridge from Assessment to Care Planning Collecting assessment data in itself is not sufficient to develop an effective plan of care Understanding the relevance of the data to the specific resident s situation is essential 15 5
6 Critical Thinking The Bridge from Assessment to Car Planning Definition of Critical Thinking: The intellectual process of reasoning, of logically analyzing all available data Purpose of Critical Thinking: To explore a situation, phenomenon, question, or problem to arrive at a hypothesis or conclusions about it that integrates all available information and can, therefore, be convincingly justified (Kurfiss, 1988) 16 Critical Thinking Critical thinking includes: Integrating all available information and eliminating irrelevant information Using reasoning processes Exploring a situation to arrive at a hypothesis Logically analyzing data Arriving at reasonable conclusions about the resident s status, needs, problems, and strengths in order to create an effective plan of care 17 Critical Thinking The care plan is driven not only by identified resident issues and/or conditions but also by a resident s unique characteristics, strengths, and needs. A care plan that is based on a thorough assessment, effective clinical decision making, and is compatible with current standards of clinical practice can provide a strong basis for optimal approaches to quality of care and quality of life needs of individual residents. MDS 3.0 Manual pages 4-9,
7 Critical Thinking A well developed and executed assessment and care plan: Looks at each resident as a whole human being with unique characteristics and strengths; Views the resident in distinct functional areas for the purpose of gaining knowledge about the resident s functional status (MDS); Gives the IDT a common understanding of the resident; Re-groups the information gathered to identify possible issues and/or conditions that the resident may have (i.e., triggers); Provides additional clarity of potential issues and/or conditions by looking at possible causes and risks (CAA process); 19 Critical Thinking Develops and implements an interdisciplinary care plan based on the assessment information gathered throughout the RAI process, with necessary monitoring and follow-up; Reflects the resident/resident representative input and goals for health care; Provides information regarding how the causes and risks associated with issues and/or conditions can be addressed to provide for a resident s highest practicable level of wellbeing (care planning); Re-evaluates the resident s status at prescribed intervals (i.e., quarterly, annually, or if a significant change in status occurs) using the RAI and then modifies the individualized care plan as appropriate and necessary. MDS 3.0 Manual pages Critical Thinking Following the decision to address a triggered condition on the care plan, key staff or the IDT should subsequently: Review and revise the current care plan, as needed; and Communicate with the resident or his/her family or representative regarding the resident, care plans, and their wishes. MDS 3.0 Manual pages
8 Critical Thinking The overall care plan should be oriented towards: 1. Preventing avoidable declines in functioning or functional levels or otherwise clarifying why another goal takes precedence (e.g., palliative approaches in end of life situation). 2. Managing risk factors to the extent possible or indicating the limits of such interventions. 3. Addressing ways to try to preserve and build upon resident strengths. 4. Applying current standards of practice in the care planning process. 22 Critical Thinking 5. Evaluating treatment of measurable objectives, timetables and outcomes of care. 6. Respecting the resident s right to decline treatment. 7. Offering alternative treatments, as applicable. 8. Using an appropriate interdisciplinary approach to care plan development to improve the resident s functional abilities. 9. Involving resident, resident s family and other resident representatives as appropriate. 10. Assessing and planning for care to meet the resident s medical, nursing, mental and psychosocial needs. 23 Critical Thinking 11. Involving the direct care staff with the care planning process relating to the resident s expected outcomes. 12. Addressing additional care planning areas that are relevant to meeting the resident s needs in the long-term care setting. MDS 3.0 Manual pages 4-10 If you read through Chapter 4 of the RAI 3.0 Manual, the word individual is repeated over and over Not just with the Care Planning, but also with the CAAs. 24 8
9 Care Plan Development The process of the RAI assessments is the foundation of care planning in long-term care The full RAI Process is designed to result in a plan of care that guides ALL levels of the resident s care givers. 25 Care Plan Development The Holistic View: The facility is responsible for addressing all needs and strengths of residents regardless of whether the issue is included in the MDS or CAAs [42CFR483.20(b)] 26 The Holistic View The RAI Version 3.0 guides the nursing home team to view residents as individuals who consider both quality of care and quality of life as significant and necessary. The RAI components promote a resident-valued emphasis. The interdisciplinary approach influences the resident s experience of care by impacting work practices of the team. A holistic focus helps the IDT generate individualized, person-centered/directed plans of care that guide day-to-day care for residents 27 9
10 Care Plan Development CMS has defined six general care planning areas it considers useful for nursing homes: Functional Status Rehabilitation/Restorative Nursing Health Maintenance Discharge Potential Medications Daily Care needs 28 Care Plan Development Functional Status Functional status limitations are identified using the MDS and CATs All conditions requiring intervention must appear on the care plan once reviewed in the CAAs process The conditions identified by the RAI should be clearly linked to problems addressed on the car plan. 29 Care Plan Development Rehabilitation/Restorative Nursing Assess and care plan potential for all types of rehab needs Assess and care plan for risks and complications Be alert to the need for referrals 30 10
11 Care Plan Development Health Maintenance Monitoring of disease processes that currently are being treated Include stable and unstable conditions that need monitoring If the resident is taking medications for conditions, regular monitoring of edema, vital signs, blood glucose, etc., should be care planned Terminal care Special treatments such as dialysis or ventilator support 31 Care Plan Development Discharge Potential Assess at admission, annually, and PRN In some cases assessment for discharge potential may need to be completed with each MDS Focus on what needs to be done in order for the resident to be safely and successfully discharged 32 Care Plan Development: Medications Care Plan should include: Intent for the use of the medication Non-Pharmacological approaches Goals or expected outcome for the resident How to monitor the resident s progress relative to those goals What actions to take when the progress is not as expected 33 11
12 Care Plan Development: Medications Care Plan should include: Potential adverse consequences that appear in FDA Black-Box Warning Resident may be particularly susceptible to May be rare May have sudden onset May be irreversible Impact physical function Impact psychosocial status Other possible effects Action to take if adverse consequences occur 34 Care Plan Development: Medications Sedatives / Hypnotics Include other interventions, such as sleep & hygiene programs, implemented before and while using these drugs Methods for monitoring for adverse consequences Gradual dose reductions Timing and method What to look for in terms of possible adverse consequences associated with tapering of the particular medication 35 Care Plan Development Daily Care Needs Daily care needs that are specific to the resident and are out of the ordinary must be addressed on the care plan Nursing home staff must use their professional judgment when making these decision It is imperative to talk to direct care staff on all shifts to determine the individual resident care needs for that shift
13 Care Plan Development In developing the holistic care plan, utilize all available assessment data. In addition to the RAI Assessments, other assessments may include: Admission Nursing Assessment Hydration, I&O, Fall Risk Assessment, Risk for skin breakdown, Restorative Assessment and other nursing assessments Hospital H&P All ancillary department assessments: SS, Activities, Dietary, etc. Lab & X-ray reports Discussion with resident and family 37 Care Plan Development: Interdisciplinary Team Approach The care plan must be prepared by an interdisciplinary team that includes the attending physician, an R.N. with responsibility for the resident, and other appropriate staff in disciplines as determined by the resident s needs, and, to the extent practicable, the participation of the resident, the resident s family or the resident s legal representative. [42CFR483.20(k)(2)] 38 Care Plan Development: Interdisciplinary Team Approach Professional disciplines, as appropriate to the resident, must work together to provide the greatest benefit to the resident. The mechanics of how the IDDT meets its responsibility to develop an interdisciplinary care plan are at the discretion of the facility. Face-to-face care plans meetings are not required. The physician must participate, and may arrange for alternative methods of providing input, such as one-on-one discussions and conference calls
14 Care Plan Development: Interdisciplinary Team Approach Resident and family participation The nursing home must assist residents to participate The nursing home must provide enough time to information exchange and decision making The nursing home must make an effort to schedule care plan meetings at a convenient time of the day for residents and their families. The resident has the right to refuse specific treatments and to select among treatment options before the care plan is implemented. 40 Care Plan Development: Interdisciplinary Team Approach While federal regulations affirm the resident s right to participate in car planning and to refuse treatment, the regulations do not create the right for a resident, legal surrogate or representative to demand that the facility use specific medical intervention or treatment that the facility deems inappropriate. Statutory requirements hold the facility ultimately accountable for the resident s care and safety, including clinical decisions. [42CFR483.20(k)(2)] 41 Care Plan Components Although federal regulations do not prescribe a specific care plan format, regulations do mandate the components to be included in a care plan: Problem List / Problem statements specific to the individual Measurable objectives Measurable timetables Interventions to attain or maintain the resident s highest practicable physical, mental, and psychosocial well-being Interventions that would be required but are not provided due to resident s refusal of treatment Date of the entry, signature of the IDT member, discipline responsible for implementation 42 14
15 Care Plan Components The Problem Statement: Formulated based on critical analysis of the IDT assessments, including triggered CAAs Defines the issues specific to the resident s problem to facilitate effective goal setting and development of appropriate interventions Is NOT a restatement of the medical diagnosis, but usually defines problems arising from the medical problem. 43 Care Plan Components The Problem Statement: Disease-related problem statement: Medical Diagnosis combined with signs/symptoms exhibited by the resident Difficulty with dressing in the morning RT Osteoarthritis AEB complains of discomfort while putting arms in his sleeves and buttoning the buttons. Occasionally strikes out at staff during cares RT dementia AEB requires slow approach after simple explanation of procedures. Becomes SOB with ambulation RT COPD AEB ambulates in 15 foot increments before resting. 44 Care Plan Components The Problem Statement: Nursing Diagnosis problem statement: In practice, usually combined with etiology to create descriptive nursing diagnosis statement Confusion, acute Violence, directed at others Physical mobility, impaired
16 Care Plan Components The Problem Statement: Nursing Diagnosis problem statement: Example Acute confusion RT severe pain and effects of pain medication AEB inability to find room independently Violence directed at others RT Organic Brain Syndrome AEB slapping direct care staff while they are giving care Impaired physical mobility RT SOB related to CHF AEB unable to walk more than 15 feet without tiring, becoming SOB. 46 Care Plan Components The Problem Statement: The functional problem statement shows how: The condition is a problem for the resident, NOT how it creates a problem for the staff; The condition limits or jeopardizes the resident s ability to complete tasks of daily living; or The problem affects the resident s well-being in some way Mr. Smith cannot find his room independently Mrs. Jones slaps the face of direct care staff while they are giving personal care Mrs. Brown is unable to walk more than 15 feet because of shortness of breath 47 Care Plan Components The Problem Statement: MDS Related Problem Statements Problem statements should reflect terminology of the MDS Etiology & signs/symptoms (s/s) may be added: Memory/recall ability deficit RT severe pain & effects of pain medication AEB inability to find own room. Physically abusive behavioral symptoms RT dementia AEB slapping direct care staff while they give care. Shortness of breath with impaired physical mobility RT COPD AEB inability to walk more than 15 feet
17 Care Plan Components The Problem Statement: The functional problem statement sample for Social Services: Cognition; Mood; Psych-Well Being; Activities; Psych Drug Mr. Smith misses doing things with his wife like they used to related to RT CVA, Hemiplegia, Aphasia, as exhibited by AEB loves to play cards and is willing to learn new card games. He becomes suspicious and paranoid of his wife at times as to her faithfulness to him. He has a Dx. Of depression and is on scheduled Citalopram. 49 Care Plan Components The Problem Statement: Regardless of the working or format, the problem statement must contain enough information to ensure that interventions selected are related to the true problem Example: For a resident who fell, the problem statements below would result in different interventions: Fall climbing out of bed unassisted Slipped on urine walking to bathroom. 50 Care Plan Components: The Goal Goal: Reasonable expected outcome of care based on the content of the specified problem which provides precise objections for the resident to meet: Action-oriented Goal for the resident, not for staff Measurable Time-limited Individualized for each resident 51 17
18 Care Plan Components: The Goal According to the RAI User's manual, the goal statement should include: a subject, a verb, modifiers, and a time frame. Subject Verb Modifiers Time Frame Mr. Jones Will walk Up and down five stairs with the help of one CNA using a gait belt Daily for the next 30 days 52 Care Plan Components: The Goal Additional Example: Mr. Smith will walk 50 feet with a front wheeled walked, gait belt, and limited assist of 1 person daily for the next 30 days Subject: Mr. Smith Action Verb: will walk Modifiers: 50 ft. with front-wheeled walker, limited assist of 1, gait belt, Time Frame: daily for the next 30 days. 53 Care Plan Components: The Goal From Previous Examples: Mr. Smith will find his room independently with verbal cues within 2 weeks. Mrs. Jones will have <2 episodes per day of slapping direct care staff while they are giving care by July 22, Mrs. Brown will walk 25 feet with supervision of 1 person without s/s of SOB by August 25,
19 Care Plan Components: The Goal Reasonableness of the goal For Mrs. Jones, no episodes of slapping with 24 hours might NOT be a reasonable goal Realistic time frame: Federal regulations required quarterly reassessment at a minimum. Resident-specific assessment data should dictate how often reassessment should be done Mr. Smith might need 2 weeks of med changes, behavior modification, etc., to reach independence. 55 Care Plan Components: The Goal Each problem must have a least one goal A problem may have more than one goal If Mrs. Brown is unable to walk more than 15 feet RT SOB and hip pain, a second goal would address the hip pain. Related problems may share the same goals and approaches. 56 Care Plan Components: The Goal Example of combined SS goal getting back to Mr. Smith: 2 goals from 1 combined problem A. Mr. Smith will participate in an card game with his wife weekly by 7/28/2015 B. Mr. Smith will have no adverse drug reactions (ADR s) from the Citalopram by 7/28/
20 Care Plan Components: Interventions Interventions are: Instructions to the IDT Developed by correlating assessment data with goals of care Specific to the individual s problems, needs, strengths, and risks Interdisciplinary, with assigned accountability Consistent with the established plan of care Based on professional standards of quality 58 Care Plan Components: Interventions Vary in focus depending on desired outcome Facilitate improvement in status Prevent avoidable decline in status Provide palliative care Categories of interventions to consider include: Assessments Observations and monitoring Specific clinical approaches designed to achieve specific outcomes Resident and family teaching activities 59 Care Plan Components: Interventions Interventions are instructions to the IDT which should include concise, focused action statements of direction regarding the resident s care: Action verb: Ambulate Amount, distance, quantity, such as 15 Feet Method of to be utilized, such as with front-wheeled walker Frequency, when appropriate, such as TID. Additional clarifying information or direction, such as, with gait belt and limited assist of 1 person
21 Care Plan Communication The Care Plan is the tool for providing continuity of care: All care givers must be informed about the details of the plan initially and with any changes Goals and interventions must be communicated to all care givers consistently to ensure that everyone is working with the same outcomes in mind Resident and family must be included, and the final care plan must be discussed with the resident or the representative. 61 Care Plan Communication An effective system for consistently communicating care planning decision to everyone who needs it is essential to positive resident outcomes. It cannot be overstated how important it is to include direct care staff in the process. 62 Care Plan Time Frames Federal regulations link timing with assessments Within 7 days of completion of the initial Admission Assessment Quarterly With Significant change in status Exception: The nursing home is responsible for addressing resident s needs from the moment of admission by developing an interim care plan. [483.20(b)] 63 21
22 Care Plan Time Frames: The Interim Care Plan Initiation of Care Planning process upon admission: Utilize hospital discharge/transfer orders, SNF admission orders, initial nursing assessment. Should also include enough information about ADL status for staff to safely care of the resident Include routine care instructions to maintain or improve functional abilities until comprehensive assessment is complete. Conduct an initial CAA review for identified problem or potential problem, such as restraint, incontinence, dehydration, falls, or psychotropic drug use 64 Care Plan Time Frames: Significant Change in Status Care plan must accurately represent the care to be delivered at any given point in time. Should be re-evaluated & revised on an on-going basis to reflect changes in the resident and care the resident is receiving (RAI user s Manual, p. 2-40) Services provided or arranged must be in accordance with each resident s written plan of care. 65 Care Planning and Culture Change Culture Change is about transforming nursing homes for both residents and staff. It creates home within the nursing home through designation of neighborhoods, rather than units, with consistent assignments and resident-directed care. Care planning is a practice being influenced by Culture Change. Two newer types of care plan formats are: I Format Care Plan Full Narrative Format Care Plan 66 22
23 I Format Care Plan I Format Care Plans are the most popular of the new formats. They are: Written in the voice of the residents, actually using the individual s own statements Written so that care givers can hear the resident speaking when they read the care plan Used for cognitively impaired residents by interviewing family or surrogates to learn the wishes and life preferences of the resident Able to mesh with both the RAI s MDS 3.0 CAAs and the Quality Indicator Survey (QIS) interview processes. 67 I Format Care Plan Problem / Need Goal Approaches I am at risk for skin breakdown due to my incontinence I want to remain free of any skin problems 1. Keep me clean and dry 2. I prefer to turn every hour while I am awake 3. Do not wake me at night to turn me. 4. I do not want to wear briefs, but I will wear a smaller pad in my underwear 5. I take Ditropan for bladder spasms to cut down on leaking. 68 Full Narrative Care Plan Full Narrative Care Plans are written in paragraphs with resident-specific information that is easy to read. When read from start to finish, a full narrative care plan is similar to reading a story about the resident
24 Full Narrative Care Plan All About Me My Social History: My name is Julianne Wellington, and I prefer to be called Julia. I was born on a farm near Lewiston, NE on December 8, My parents were immigrants from Scotland. My childhood was simple and fun, and although life was tougher then, it didn t seem like it. I graduated from college and became a teacher at a country one-room school house southeast of Lewiston. I married Peter Wellington in 1948 and we had 4 children, all who live nearby. Holidays and birthdays are important to my family, and I want to participate in them. 70 Full Narrative Care Plan Communication / Memory Goal: I want to keep my mind stimulated to maintain my memory, I like eye contact, so please look at me when you speak to me. I like discussing current events, so feel free to ask me my opinion. 71 Full Narrative Care Plan Mental Wellness Goal: I want to feel like I am important and needed. I have always been very involved in my surroundings and would like to keep it that way. I sometimes get discouraged and may feel like keeping to myself. Don t take this as a problem unless it lasts more than a week or so. Don t schedule appointments or baths for me during these time.s 72 24
25 Full Narrative Care Plan Personal Care ADLs Goal: I want to do as much as I can for myself Hearing: My hearing is good 73 CAA and Care Planning Clarifications From the MDS 3.0 Manual 1. Care planning is a process that has several steps that may occur at the same time or in sequence. The following key steps and considerations may help the IDT develop the care plan after completing the comprehensive assessment: a. Care Plan goals should be measurable. b. The IDT may agree on intermediate goal(s) that will lead to outcome objectives. 74 CAA and Care Planning Clarifications From the MDS 3.0 Manual 2. Intermediate goal(s) and objectives must be pertinent to the resident s condition and situation (i.e., not just automatically applied without regard for their individual relevance), measurable, and have a time frame for completion or evaluation. 3. Care plan goal statements should include: The subject (first or third person), the verb, the modifiers, the time frame, and the goal(s)
26 CAA and Care Planning Clarifications From the MDS 3.0 Manual 4. A separate care plan is not necessarily required for each area that triggers a CAA. a. Since a single trigger can have multiple causes and contributing factors and multiple items can have a common cause or related risk factors, it is acceptable and may sometimes be more appropriate to address multiple issues within a single care plan segment or to cross reference related interventions from several care plan segments. b. For example, if impaired ADL function, mood state, falls and altered nutritional status are all determined to be caused by an infection and medication-related adverse consequences, it may be appropriate to have a single care plan that addresses these issues in relation to the common causes. 76 CAA and Care Planning Clarifications From the MDS 3.0 Manual 5. The RN coordinator is required to sign and date the Care Area Assessment (CAA) Summary after all triggered CAAs have been reviewed to certify completion of the comprehensive assessment (CAAs Completion Date, V0200B2). a. Facilities have 7 days after completing the RAI assessment to develop or revise the resident s care plan. b. Facilities should use the date at V0200B2 to determine the date at V0200C2 by which the care plan must be completed (V0200B2 + 7 days). 6. The 7-day requirement for completion or modification of the care plan applies to the Admission, SCSA, SCPA, and/or Annual RAI assessments. 77 CAA and Care Planning Clarifications From the MDS 3.0 Manual a. A new care plan does not need to be developed after each SCSA, SCPA, or Annual reassessment. b. Instead, the nursing home may revise an existing care plan using the results of the latest comprehensive assessment. c. Facilities should also evaluate the appropriateness of the care plan at all times including after Quarterly assessments, modifying as needed. 7. If the RAI (MDS and CAAs) is not completed until the last possible date (the end of calendar day 14 of the stay), many of the appropriate care area issues, risk factors, or conditions may have already been identified, causes may have been considered, and a preliminary care plan and related interventions may have been initiated. A complete care plan is required no later than 7 days after the RAI is completed
27 CAA and Care Planning Clarifications From the MDS 3.0 Manual 8. Review of the CAAs after completing the MDS may raise questions about the need to modify or continue services. Conditions that originally triggered the CAA may no longer be present because they resolved, or consideration of alternative causes may be necessary because the initial approach to an issue, risk, or condition did not work or was not fully implemented. 9. On the Annual assessment, if a resident triggers the same CAA(s) that triggered on the last comprehensive assessment, the CAA should be reviewed again. a. Even if the CAA is triggered for the same reason (no difference in MDS responses), there may be a new or changed related event identified during CAA review that might call for a revision to the resident s plan of care. 79 CAA and Care Planning Clarifications From the MDS 3.0 Manual b. The IDT with the input of the resident, family or resident s representative determines when a problem or potential problem needs to be addressed in the care plan. 10. The RN Coordinator for the CAA process (V0200B1) does not need to be the same RN as the RN Assessment Coordinator who verifies completion of the MDS assessment (Z0500). The date entered in V0200B2 on the CAA Summary is the date on which the RN Coordinator for the CAA process verified completion of the CAAs, which includes assessment of each triggered care area and completion of the location and date of the CAA assessment documentation section. See Chapter 2 for detailed instructions on the RAI completion schedule. 80 CAA and Care Planning Clarifications From the MDS 3.0 Manual 11. The Signature of Person Completing Care Plan Decision (V0200C1) can be that of any person(s) who facilitates the care plan decision making. a. It is an interdisciplinary process. b. The date entered in V0200C2 is the day the RN certifies that the CAAs have been completed and the day V0200C1 is signed. MDS 3.0 Manual Page 4-11,
28 THANK YOU Questions? 82 Information Sources Where to get more information MDS 3.0 Manual V1.15, 10/01/2017, Chapter 4 AANAC: AANAC.org State Operations Manual, Appendix P-PP, Survey Guidance to Surveyors 83 REFERENCES References: MDS 3.0 Manual V1.13, 10/01/2015 MDS Intensive Course Notes by Carol Maher RN, RAC-CT, AANAC MT, RAI Manual Contributor
29 THANK YOU Kathy Sanders RN, RAC-CT, DNS-CT Sanders Consulting 630 N. 3 rd St. Tecumseh, NE Wk: (402) Cell: (402) kathy@mdshelp.com 85 29
MDS Essentials. MDS Essentials: Content. Faculty Disclosures 5/22/2017. Educational Activity Completion
MDS Essentials MDS Essentials: Introduction to Care Area Assessments and Care Plans 4 Faculty Disclosures I have no financial relationships to disclose I have no conflicts of interests to disclose I will
More informationCritical Thinking Steps
CAA s = Critical Thinking CAROL SIEM, MSN, RN, BC, GNP Clinical Educator/Team Leader for QIPMO Critical Thinking Steps Recognition/Assessment Gather essential information about the individual Problem definition
More informationMDS 3.0: What Leadership Needs to Know
MDS 3.0: What Leadership Needs to Know especially prepared for CANPFA Ann Spenard RN, MSN History of the MDS and RAI Process The Resident Assessment Instrument (RAI) was part of a set of reforms enacted
More informationCMS s RAI Version 3.0 Manual October 2016
Presented by: CMS s RAI Version 3.0 Manual October 2016 RAI SOM CAAs MDS Resident Assessment Instrument Utilization Guidelines from the State Operations Manual Care Area Assessments Minimum Data Set Affinity
More informationADMISSION CARE PLAN. Orient PRN to person, place, & time
ADMISSION DATE: CODE STATUS: ADMISSION CARE PLAN ADMISSION DIAGNOSIS: 1. DELIRIUM 2. COGNITIVE LOSS Resident will be as alert and oriented as possible Resident will be as alert and oriented as comfortable
More informationMDS 3.0/RUG IV OVERVIEW
MDS 3.0/RUG IV Distance Learning Series January - May 2016 OVERVIEW In keeping with the success of their previous highly-rated distance learning education offerings, LeadingAge state affiliates and Plante
More informationWilhide Consulting, Inc. (c) 1
Judy Wilhide Brandt, RN, BA, RAC-MT, QCP, CPC, DNS-CT judy@judywilhide.com 909-800-9124 www.judywilhide.com Required by the Omnibus Reconciliation Act of 1987 Correction OBRA Scheduling January 2017 NC
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES
Use for a resident who has potentially unnecessary medications, is prescribed psychotropic medications or has the potential for an adverse outcome to determine whether facility practices are in place to
More informationNotes from CMS Final Rule Document Pertinent to Culture Change and Person-directed Care
Notes from CMS Final Rule Document Pertinent to Culture Change and Person-directed Care Page 594 Prepared by Cathy Lieblich, Director of Network Relations, Pioneer Network G. Benefits of Final Rule: This
More informationState and federal regulations supersede any information provided in this toolkit.
DPA Associates, Inc Toolkit author: Diane Atchinson, RN-BC, MSN, ANP, RAC-CT President, DPA Associates, Inc, Kansas City, MO E mail: diane@dpaassociates.com Clinical editor: Kathy Newman, MSW, LSCW, Consultant
More informationPain: Facility Assessment Checklists
Pain: Facility Assessment Checklists This is a series of self-assessment checklists for nursing home staff to use to assess processes related to pain management in the facility, in order to identify areas
More informationHospice and End of Life Care and Services Critical Element Pathway
Use this pathway for a resident identified as receiving end of life care (e.g., palliative care, comfort care, or terminal care) or receiving hospice care from a Medicare-certified hospice. Review the
More informationMDS 101 CHAPTER 3 Ingrid Serio Rena R. Shephard
MDS 101 An Introduction to the RAI Process CHAPTER 3 CAAs, CATs, and Care Planning Ingrid Serio RN, BSN, MPP Rena R. Shephard MHA, RN, RAC -MT, C-NE MDS 101: An Introduction to the RAI Process iii Table
More informationHome Health Eligibility Requirements
Presented By: Melinda A. Gaboury, COS-C Chief Executive Officer Healthcare Provider Solutions, Inc. healthcareprovidersolutions.com Home Health Eligibility Requirements Meets eligibility for home health
More informationRestorative Nursing: The NHA s Role and Organizational Outcomes
Restorative Nursing: The NHA s Role and Organizational Outcomes SUE LAGRANGE, RN, BSN, NHA, CDONA, CIMT DIRECTOR OF EDUCATION PATHWAY HEALTH 1 Objectives Upon completion of this program, attendees should
More informationACTIVITIES OF DAILY LIVING (ADL) DECLINE Facility Assessment Checklists
ACTIVITIES OF DAILY LIVING (ADL) DECLINE Facility Assessment Checklists This is a series of self-assessment checklists for nursing home staff to use to assess processes related to activities of daily living
More informationAANAC Education Advancement. MDS Essentials: An Introduction. Learning Objectives 3/22/2017. Education Advancement
AANAC Education Advancement MDS Essentials: An Introduction to MDS 3.0 We want to provide you with the right education at the right time in your career path Consider the following to identify your needs:
More information10/14/2014 COMMON MDS CODING ERRORS OVERVIEW OF SS/ACT SECTIONS SECTION B
COMMON MDS CODING ERRORS K AT H Y Y O S T E N, L C S W, P I P OVERVIEW OF SS/ACT SECTIONS Section B Vision, Speech, Hearing Section C Cognitive Patterns Section D Mood Section E Behaviors Section F Preferences
More informationMDS Language Impacts CAHs
MDS Language Impacts CAHs April 2014 Kerry Dunning, MHA, MSH, CPAR, RAC-CT Sr VP, Long Term Care Division GPS Healthcare Consultants Objectives To Sufficiently Understand: Medicare intent for documentation
More informationNJ Level of Care and Assessment Process
NJ Level of Care and Assessment Process CODING GUIDELINES AND LEVEL OF CARE Cheryl Hogan Division of Aging Services NJ Department of Human Services 1 5/28/2014 Goals To understand the assessment process
More informationOAR Changes. Presented by APD Medicaid LTC Policy
OAR 411-015 Changes 1 Presented by APD Medicaid LTC Policy Table of Contents 2 Service Priority OAR 411-015 Project Overview Why Are We Making These Changes Overarching Changes Changes to ADLS (each ADL
More informationMODULE T. Objectives. Dementia and Alzheimer s Disease. Dementia. N.C. Nurse Aide I Curriculum
DHSR/HCPR/CARE NAT I Curriculum - July 2013 1 N.C. Nurse Aide I Curriculum MODULE T Disease Objectives Define the terms dementia, Alzheimer s disease, and delirium. Describe the nurse aide s role in the
More informationMDS 3.0/RUG IV Distance Learning Series January - May 2016
MDS 3.0/RUG IV Distance Learning Series January - May 2016 ROUTE TO: _Administrator; _MDS Coordinator; _Director of Nursing; _Director of Accounting; _Director of Social Services; _Director of Activities;
More informationSECTION P: RESTRAINTS
SECTION P: RESTRAINTS Intent: The intent of this section is to record the frequency over the 7-day look-back period that the resident was restrained by any of the listed devices at any time during the
More informationCNA OnSite Series Overview: Understanding Restorative Care Part 1 - Introduction to Restorative Care
Series Overview: Understanding Restorative Care Part 1 - Introduction to Restorative Care Administering the Program Read the Guide View the Video Review the Suggested Questions Complete Post-Test Answer
More information483.10(b)(4) and (8) Rights Regarding Advance Directives, Treatment, and Experimental Research
483.10(b)(4) and (8) Rights Regarding Advance Directives, Treatment, and Experimental Research (F155) Surveyor Training of Trainers: Interpretive Guidance Investigative Protocol Federal Regulatory Language
More informationCarol Maher, RN-BC, RAC-CT. Long-Term Care MDS Coordinator s Field Guide
Carol Maher, RN-BC, RAC-CT Long-Term Care MDS Coordinator s Field Guide Long-Term Care MDS Coordinator s Field Guide Carol Maher, RN-BC, RAC-CT, RAC-MT, CPC Long-Term Care MDS Coordinator s Field Guide
More informationForm CMS (5/2017) Page 1
Use this pathway for a resident who has pain symptoms or can reasonably be expected to experience pain (i.e., during therapy) to determine whether the facility has provided and the resident has received
More informationSurvey Protocol for Long Term Care Facilities
Attachment B Survey Protocol for Long Term Care Facilities The provision of home dialysis treatments in a Long Term Care (LTC) facility place an increased burden on the LTC facility staff and may place
More information3/6/2017. CMS nursing home requirements have not been comprehensively updated since 1991 despite significant changes in the industry.
Debra Brown, PharmD Pharmaceutical Consultant II Specialist Licensing and Certification QCHF/CAHF Spring Legislative Conference March 2017 1 Describe impact of 2016 CMS Final Rule on SNF pharmacy services
More informationNew Strategies for Managing Medicare Risk
New Strategies for Managing Medicare Risk John Sheridan, MHSA, FACHE President, ehealth Data Solutions Keith Knapp, PhD, CFACHCA CEO, Christian Care Communities 1001. Survey and Certification Phase II
More informationPain: Facility Assessment Checklists
Pain: Facility Assessment Checklists A facility system assessment is a starting point for a quality improvement project. The checklists included in this booklet will be most useful if you take a critical
More informationPsychotropic Drug Use To Medicate or Not to Medicate?
Psychotropic Drug Use To Medicate or Not to Medicate? Presented by: Lydia Restivo, RN CDONA Regulatory Compliance Consultant West & Restivo Quality Consulting Cell: 516 318-9088 Email: lydrestivo@verizon.net
More informationSubject: Skilled Nursing Facilities (Page 1 of 6)
Subject: Skilled Nursing Facilities (Page 1 of 6) Objective: I. To ensure that Tuality Health Alliance (THA) and delegated Providence Health Plan Medicare members are appropriately placed in skilled nursing
More informationNursing Assistant
Western Technical College 30543300 Nursing Assistant Course Outcome Summary Course Information Description Career Cluster Instructional Level Total Credits 3.00 The course prepares individuals for employment
More informationOIG Risk Areas: Comprehensive Care Plans, Restorative/Personal Care Services & Medication Management
OIG Risk Areas: Comprehensive Care Plans, Restorative/Personal Care Services & Medication Management Presented by: Nan Impink, Esq. Kelly Priegnitz, Esq. Harvey Tettlebaum, Esq. Where We ve Been & Today
More informationc) Facilities substantially in compliance with the requirements of this Subpart will receive written recognition from the Department.
TITLE 77: PUBLIC HEALTH CHAPTER I: DEPARTMENT OF PUBLIC HEALTH SUBCHAPTER c: LONG-TERM CARE FACILITIES PART 300 SKILLED NURSING AND INTERMEDIATE CARE FACILITIES CODE SECTION 300.7000 APPLICABILITY Section
More informationChapter 01: Professional Nursing Practice Lewis: Medical-Surgical Nursing, 10th Edition
Chapter 01: Professional Nursing Practice Lewis: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. The nurse completes an admission database and explains that the plan of care and discharge goals
More informationActivities of Daily Living (ADL) Critical Element Pathway
Use this pathway for a resident who requires assistance with or is unable to perform ADLs (Hygiene bathing, dressing, grooming, and oral care; Elimination toileting; Dining eating, including meals and
More informationCOMMONWEALTH OF KENTUCKY OFFICE OF INSPECTOR GENERAL AND MYERS AND STAUFFER LC PRESENT MDS CODING AND INTERPRETATION ANSWER SLIDES
COMMONWEALTH OF KENTUCKY OFFICE OF INSPECTOR GENERAL AND MYERS AND STAUFFER LC PRESENT MDS CODING AND INTERPRETATION ANSWER SLIDES WOULD YOU COMPLETE A SIGNIFICANT CHANGE IN STATUS ASSESSMENT? Example
More informationA Nurse Leader s guide to a successful Restorative Nursing Program PRESENTER: AMY FRANKLIN RN, DNS MT, QCP MT, RAC MT
A Nurse Leader s guide to a successful Restorative Nursing Program PRESENTER: AMY FRANKLIN RN, DNS MT, QCP MT, RAC MT Requirements for Successful Completion 1. 2.0 contact hours will be awarded for this
More informationWhat do we promise people who are dying and those around them when we tell them about hospice care?
Care Planning The Road to Meeting Patients and Families Where They Are Charlene Ross, MBA, MSN, RN Consultant/Educator R&C Healthcare Solutions & Hospice Fundamentals 602-740-0783 charlene@rchealthcaresolutions.com
More informationWakeMed Rehab Hospital Stroke Rehabilitation Scope of Service
WakeMed Rehab Hospital Stroke Rehabilitation Scope of Service WakeMed Rehab Hospital provides an integrated, comprehensive delivery of rehabilitation services utilizing evidenced-based practice directed
More information9/17/2015. Bed Rail Safety A Clinical Process Guideline. Background. Federal Nursing Home Reform Act
Bed Rail Safety A Clinical Process Guideline Laura Funsch, RN, BSN, MS, Director of Regulatory Strategy Background Safety hazards related to bed rail use have been realized since 1990. Michigan s initial
More informationBed Rail Safety A Clinical Process Guideline. Laura Funsch, RN, BSN, MS, Director of Regulatory Strategy
Bed Rail Safety A Clinical Process Guideline Laura Funsch, RN, BSN, MS, Director of Regulatory Strategy Background Safety hazards related to bed rail use have been realized since 1990. Michigan s initial
More informationPharmacy Services. Division of Nursing Homes
Pharmacy Services Division of Nursing Homes 1 483.45 Pharmacy Services Overview The Pharmacy Services section of Appendix PP contains all Pharmacy Services requirements and interpretive guidelines (IG)
More informationWe use many of them. The devices are part of our restraint policy. See below
Do you utilize body pillow, beveled mattresses, moxi mattresses, rolled blankets, swim noodles for positioning or bed demarcation? Do you have a comprehensive device assessment? If so, would you please
More informationCMS Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents Phase 2--Payment Model
CMS Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents Phase 2--Payment Model The Revolving Door One fourth of all nursing home resident go the hospital each year - Some many
More informationTag Description Page. F607 Policies to Prohibit and Prevent Abuse, Neglect, Exploitation 125. F622 Transfer & Discharge 155
Tag Description Page F607 Policies to Prohibit and Prevent Abuse, Neglect, Exploitation 125 F622 Transfer & Discharge 155 F626 Permitting Residents to Return to Facility 170 F656 Comprehensive Care Plans
More informationHospice Education Network. PATIENT CARE CoPs: INTERDISCIPLINARY GROUP, CARE PLANNING, AND COORDINATION OF SERVICES - HOW TO PREPARE
PATIENT CARE CoPs: INTERDISCIPLINARY GROUP, CARE PLANNING, AND COORDINATION OF SERVICES HOW TO PREPARE HOSPICE REGULATORY BOOT CAMP Joy Barry, RN, MEd, CLNC Principal Weatherbee Resources, Inc Hospice
More informationBED RAIL SAFETY 9/15/2015. A Clinical Process Guideline. Background. Federal Nursing Home Reform Act
BED RAIL SAFETY A Clinical Process Guideline Laura Funsch, RN, BSN, MS Director of Regulatory Strategy, LeadingAge Michigan Background Safety hazards related to bed rail use have been realized since 1990.
More informationIndiana Association for Home & Hospice Care Shaping the Change May 6, Bonny Kohr, FR&R Healthcare Consulting, Inc.
Indiana Association for Home & Hospice Care Shaping the Change May 6, 2014 Bonny Kohr, FR&R Healthcare Consulting, Inc. Rebecca Zuber, Rebecca Friedman Zuber, Inc. Where you are going--destination Desired
More informationSuccessful Restorative Program When Therapy and Nursing Collaborate
Successful Restorative Program When Therapy and Nursing Collaborate AdvantageCare Rehabilitation / Advantage Home Health Services Kathy Kemmerer, NAC, RAC-CT 3.0, CPRA CMI Specialist & Medicare Reimbursement
More informationBased on the comprehensive assessment of a resident, the facility must ensure that:
13.A. Quality of Care Each resident must receive, and the facility must provide, the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being,
More informationMDS Training for Social Services Directors
MDS Training for Social Services Directors Kathy Sanders RN, RAC-CT, DNSCT Sanders Consulting 630 N. 3 rd St. Tecumseh, NE 68450 Hm: (402) 335-2736 Cell: (402) 921-0250 kathy@mdshelp.com Disclaimer The
More informationInitial Pool Process: Resident Interview
Initial Pool Process: Resident Interview Care Area Probes Response Options Choices Are you able to make choices about your daily life that are important to you? I d like to talk to you about your choices.
More informationThe Best In Restorative Nursing
The Best In Restorative Nursing Kathleen Mace, RN Director of Compliance and Clinical Cascadia Health Care Overview Outcome benefits of Restorative Nursing For the individual, for staff, and for the facility
More informationStage 2 General Critical Element Pathway Facility Name: Facility ID: Date: Surveyor Name:
Facility Name: Facility ID: Date: Surveyor Name: Resident Name: Resident ID: Initial Admission Date: Care Area(s): Interviewable: Yes No Resident Room: Use Use this General Investigative Protocol to investigate
More informationInterpretive Guidelines (b)(2) Interpretive Guidelines (b)(3)
F153 483.10(b)(2) Interpretive Guidelines 483.10(b)(2) The resident or his or her legal representative has the right (i) Upon an oral or written request, to access all records pertaining to himself or
More informationDetermining the Appropriate Inpatient Rehabilitation Candidate
Determining the Appropriate Inpatient Rehabilitation Candidate Brandi Damron, OTR/L, MBA Program Director Norton Community Hospital Inpatient Rehab Unit Objectives Discuss the preadmission process limitations
More informationCMS Updates RAI User s Manual
CMS Updates RAI User s Manual By Rena R. Shephard, MHA, RN, RAC MT, C NE AANAC Executive Editor The Centers for Medicare & Medicaid Services (CMS) June 2 posted revisions to the Long Term Care Facility
More informationInterim Final Interpretive Guidelines Version 1.1
Interim Final Interpretive Guidelines Version 1.1 Big Changes from November 2008 to January 2009 418.54 Condition of participation: Initial and Comprehensive assessment of the patient L522 418.54(a) Standard:
More informationRhode Island HEALTH. Continuity of Care Form. Referral to: Phone:
0 Specific Discharging Agency: Rhode Island HEALTH Continuity of Care Form Home Address: Referral to: Being Discharged to: Address: Contact Person @ Discharging Facility: Phone/Beeper #: The following
More informationService Plan for: Carine Schmitt Richmond - North 1. This Service has been reviewed by the following: Resident: Responsible Party: Administrator:
Service Plan for: Printed: 6/28/2010 Carine Schmitt This Service has been reviewed by the following: Resident: Responsible Party: Administrator: Health Services Director: Program Director: Other: Date:
More informationThe CMS State Operations Manual Overview and Changes
The CMS State Operations Manual Overview and Changes Omnicare, Inc. Page 1 Overview of the CMS State Operations Manual Executive Summary Historical Perspective The Requirements Pharmacy Services Labeling
More informationSite: Lovelace Health System Title: PATIENT CARE - Restraints Approved Date: 08/28/2015 Effective Date: TBD
Approved Date: 08/28/2015 Effective Date: TBD 08/01/2018 Document Number P-NS-1063.6 Document Type: Policy Page 1 of 11 1. Policy: All patients have the right to be free from physical or mental abuse,
More informationGet Ready for Phase 1 of the New Requirements of Participation
Pennsylvania Health Care Association November 7, 2016 Get Ready for Phase 1 of the New Requirements of Participation Paula G. Sanders, Esquire Post & Schell, P.C. Gail Weidman Dawn Murr-Davidson Pennsylvania
More informationConflict of Interest Statement
Conflict of Interest Statement RESTORATIVE NURSING: A WIN WIN for Everyone Involved! (Almost) Everything You Ever Wanted to Know About Restorative Nursing But Were Afraid to Ask! HealthCap s educational
More informationThanks to Anne C. Byrne, RN, Medical Monitor at Northwest Georgia Regional Hospital. This presentation was developed from one she designed for that
Thanks to Anne C. Byrne, RN, Medical Monitor at Northwest Georgia Regional Hospital. This presentation was developed from one she designed for that hospital. 1 2 3 Note that an actual variance occurs when
More informationImproving Quality Care
Improving Quality Care Making Restorative estoat enursing us Fun FADONA 25 TH Anniversary Convention Presented by: Harmony Healthcare International, Inc. PPS & Case Mix Onsite Chart Audits MMQ Audits Seminars
More informationChapter 2: Patient Care Settings
Chapter 2: Patient Care Settings MULTIPLE CHOICE 1. While the home health nurse is doing the entry to service assessment on a home-bound patient, the wife of the patient asks whether Medicare will cover
More informationON THE JOB LEARNING OUTLINE
ON THE JOB LEARNING OUTLINE 1. Occupational Title: Certified Nursing Assistant, Geriatric Specialty 2. DOT Code: 355.674-014 3. O*NET Code: 31-1012.00 4. RAIS Code: 0824-G 5. Occupational Description:
More informationMaggie Turner RN RAC-CT Kara Schilling RN RAC-CT Lisa Gourley RN RAC-CT
Maggie Turner RN RAC-CT Kara Schilling RN RAC-CT Lisa Gourley RN RAC-CT We do not have any financial relationships to disclose We do not have any conflicts of interest to disclose We will not promote any
More information3/12/2015. Session Objectives. RAI User s Manual. Polling Question
Session Objectives MDS 3.0 Coding Challenges: Questions, Answers, and Explanations Jen Pettis, BS, RN, WCC Associate March 19, 2015 Upon completion of the program, the participate will: Describe the four
More informationBehavioral Health Services. Division of Nursing Homes
Behavioral Health Services Division of Nursing Homes 483.40 Behavioral Health Services Overview F740 Introduction to Behavioral Health Services F741 Sufficient and Competent Staff F742 Treatment/Services
More informationAttachment A - Comparison of OASIS-C (Current Version) to OASIS-C1 (Proposed Data Collection)
Attachment A - Comparison of OASIS-C (Current Version) to (Proposed Data Collection) OASIS-C M0010 CMS Certification Number S M0010 CMS Certification Number M0014 Branch State S M0014 Branch State S M0016
More informationHospice Discharges. Legacy Hospice
Hospice Discharges Legacy Hospice Live Discharges Once a Medicare beneficiary elects the hospice benefit, hospice may not automatically or routinely d/c the beneficiary at it s discretion, even if the
More informationPERSON CENTERED CARE PLANNING HONORING CHOICE WHILE MITIGATING RISK
PERSON CENTERED CARE PLANNING HONORING CHOICE WHILE MITIGATING RISK The purpose of the Rothschild Person-Centered Care Planning process is to support long term care communities in their efforts to honor
More informationELIGIBILITY & CERTIFICATION THE CONTINUING SAGA
1 ELIGIBILITY & CERTIFICATION THE CONTINUING SAGA Hospice Fundamentals Charlene Ross, MSN, MBA, RN Consultant / Educator 2 What You Will Learn Today The regulatory requirements of certification, recertification
More informationTip Sheet Reducing Off Label Use of Antipsychotic Medications by Engaging Staff in Individualizing Care to Alleviate Resident Distress
Tip Sheet Reducing Off Label Use of Antipsychotic Medications by Engaging Staff in Individualizing Care to Alleviate Resident Distress WHAT IT IS Off label use of antipsychotic medications means uses the
More informationWhat s Happening in the Nursing Home? Cherry Meier, RN, MSN, NHA Vice President of Public Affairs
What s Happening in the Nursing Home? Cherry Meier, RN, MSN, NHA Vice President of Public Affairs Objectives Describe the benefits of partnering with hospice Explain the regulations for the interface between
More informationRESTORATIVE NURSING SERIES OVERVIEW 1st Session
RESTORATIVE NURSING SERIES OVERVIEW 1st Session Everything You Ever Wanted to Know But Were Afraid to Ask HealthCap RMS 1 Learner Objectives Evaluate the need for a restorative program Design a restorative
More information4/24/2012. Cake Walk for a Successful National Government Services Medical Review Process. Today s Presenter. Disclaimer. Sally Rosiello, BSN
Cake Walk for a Successful National Government Services Medical Review Process 2012 Today s Presenter Sally Rosiello, BSN 2 Disclaimer has produced this material as an informational reference for providers
More information2017 FOCUSED ON DOCUMENTATION NECESSITIES & PRE-CLAIM REVIEW
2017 FOCUSED ON DOCUMENTATION NECESSITIES & PRE-CLAIM REVIEW PRESENTED BY: MELINDA A. GABOURY, COS-C CHIEF EXECUTIVE OFFICER HEALTHCARE PROVIDER SOLUTIONS, INC. HEALTHCAREPROVIDERSOLUTIONS.COM ADDITIONAL
More informationDEMONSTRATED NEED FOR SKILLED CARE FOR MEDICARE PATIENTS: SKILLED NURSING SERVICES
DEMONSTRATED NEED FOR SKILLED CARE FOR MEDICARE PATIENTS: SCOPE: All Ascension At Home, LLC colleagues. For purposes of this policy, all references to colleague or colleagues include temporary, part-time
More informationThe RoPs are here! Do you know what s changing?
The RoPs are here! Do you know what s changing? Mary Madison, RN, RAC-CT, CDP Clinical Consultant, LTC/Senior Care Briggs Healthcare March 7, 2017 2 What we ll cover today CMS goals behind the updated
More informationPrepublication Requirements
Prepublication Requirements Standards Revisions for Swing Bed Final Rule in Critical Access Hospitals The Joint Commission has approved the following revisions for prepublication. While revised requirements
More informationSUNY DOWNSTATE MEDICAL CENTER UNIVERSITY HOSPITAL OF BROOKLYN POLICY AND PROCEDURE
SUNY DOWNSTATE MEDICAL CENTER UNIVERSITY HOSPITAL OF BROOKLYN POLICY AND PROCEDURE Subject: GUIDELINES FOR USE OF THE No. NURSE-17 INTERDISCIPLINARY PLAN OF CARE Page 1 of 5 Prepared by:dianne Woods, RN
More information8/22/2016. Chapter 5. Nursing Process and Critical Thinking. Introduction. Introduction (Cont.) Nursing defined Nursing process
Chapter 5 Nursing Process and Critical Thinking All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Introduction Nursing defined Nursing process
More informationTABLE OF CONTENTS. Medicare Charting Guidelines... Section 3 Documentation Guideline Procedures...1 Medicare Documentation Guidelines...
TABLE OF CONTENTS Medicare Skilled Nursing Training Handout...Section 1 Post Test...1 Training Content...3 Nursing Documentation Subjective/Objective Statements...22 Supportive Nursing Documentation...23
More informationCompetency Based Staffing. And the New RoPs
Competency Based Staffing And the New RoPs Objectives Discuss how the Facility Assessment correlates to qualified and competent staff expectations Explore the new requirements for staff competency Discuss
More informationHospice Care in the Nursing Home: The New Interpretive Guidelines for NF Surveyors
Hospice Care in the Nursing Home: The New Interpretive Guidelines for NF Surveyors Subscriber Webinar The Plan 1. Brief Look: The Hospice Nursing Home Partnership 2. Brief Look: The Nursing Home Survey
More information5. Personal Care Services
5. Personal Care Services Chapter IV - Services to Children A. Overview A child who requires personal care services is a child with a chronic medical condition or with medical needs requiring specialized
More informationOASIS ITEM ITEM INTENT
(M2400) Intervention Synopsis: (Check only one box in each row.) At the time of or at any time since the previous OASIS assessment, were the following interventions BOTH included in the physician-ordered
More informationExhibit A. Part 1 Statement of Work
Exhibit A Part 1 Statement of Work Contractor shall provide Basic Neurological services as described herein to Medicaid eligible Clients who are authorized to receive services at the Contractor s owned
More informationToday s educational presentation is provided by. The software that powers HOME HEALTH. THERAPY. PRIVATE DUTY. HOSPICE
Today s educational presentation is provided by The software that powers HOME HEALTH. THERAPY. PRIVATE DUTY. HOSPICE At Kinnser, we believe post-acute care businesses need the right software solution for
More informationGuidelines for Kuakini Medical Center General Surgery Rotation (Formulated by a previous Chief Surgical Resident)
Guidelines for Kuakini Medical Center General Surgery Rotation (Formulated by a previous Chief Surgical Resident) Welcome to Kuakini Medical Center! The typical patient is in the Geriatric age group. As
More informationCMS Proposed Rule. The IMPACT Act. 3 Overhaul Discharge Planning Processes to Comply With New CoPs. Arlene Maxim VP of Program Development, QIRT
Overhaul Discharge Planning Processes to Comply With New CoPs Arlene Maxim VP of Program Development, QIRT 1 CMS Proposed Rule Included discharge planning specifics However, when the CoPs were finalized,
More informationNurse Assistant (Certified) OUTLINE
Nurse Assistant (Certified) OUTLINE DESCRIPTION: Nurse Assistant - Certified is designed to prepare students for employment as a Nurse Assistant in a variety of settings. Students will learn patient care,
More informationThe policy applies to all SHS employees involved in direct patient care and medical staff.
Restraints Use of Violent - System Introduction Restraints, Use of Violent System Introduction SCOPE The policy applies to all SHS employees involved in direct patient care and medical staff. Implementation
More information