The Risk Monitor offers three views: FACILITY 1st column, total number year-to-date (calculated by the system, from January and including the current month); 2nd column, actual numbers submitted by your facility CURRENT MONTH 1st column, your peer group s rate/percent for the current month; 2nd column, your facility s rate/percent for the current month; 3rd column, your facility s score on a scale of 4 (worst) to +4 (best) YEAR-TO-DATE Rates/percentages displayed are year-to-date including the current month RESIDENT QUALITY OF CARE Falls A fall is a sudden, unintentional drop from a higher to lower position, most commonly to the floor. Total (Calculated by system) Total who fell Multiple falls Number of residents who fell more than once from the first day through the last Serious injury Number of falls resulting in a serious injury from the first day through the last Minor injury Number of falls resulting in a minor injury from the first day through the last Without injury Number of falls without injury from the first day through the last day of the month Total falls with serious injury, minor injury and without injury Number of residents who fell, not the number of falls. INCLUDES: An incident where the resident is found on the floor; a fall without injury. DOES NOT INCLUDE: The actual number of falls. Number of residents who fell more than once. INCLUDES: Residents reported as having at least one fall who fell again. Number of falls resulting in a serious injury For example, stitches, immobilization, emergency room (ER) treatment, surgery or hospitalization. Number of falls resulting in a minor injury Requiring on-site first aid treatment such as a dressing, ice pack or pain medication. Number of falls not resulting in injury 1/5/09, My InnerView Inc. Skilled Nursing Home Risk Monitor Metrics Page 1 of 12
Pressure ulcers A pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure or pressure in combination with shear and/or friction. Admitted Acquired On the last Fri Number of residents with suspected deep tissue injury, stage 2, 3, 4 or unstageable pressure ulcers ADMITTED with documented pressure ulcers Number of residents (not pressure ulcers) with suspected deep tissue injury, stage 2, 3, 4 or unstageable pressure ulcers acquired after admission Stage 2 Number of residents with acquired suspected deep tissue injury or stage 2 pressure ulcers on the last Fri Additional definition: A stage 2 pressure ulcer is a partial thickness skin loss involving epidermis, dermis or both. Superficial: Abrasion, blister or shallow crater. A suspected deep tissue injury is a purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. Number of residents with suspected deep tissue injury or stage 2 pressure ulcers acquired after admission Stage 3 Number of residents with acquired stage 3 pressure ulcers on the last Fri Additional definition: A stage 3 pressure ulcer is a full thickness skin loss. Deep crater with or without undermining of adjacent tissue. May extend down to, but not through, fascia. Number of residents with stage 3 pressure ulcers acquired after admission Stage 4 Number of residents with acquired stage 4 or unstageable pressure ulcers on the last Friday of the month Additional definition: A stage 4 pressure ulcer is full thickness tissue loss with exposed bone, tendon or muscle. An unstageable pressure ulcer is full thickness tissue loss in which the base of the ulcer is covered by slough and/or eschar. Number of residents with stage 4 or unstageable pressure ulcers acquired after admission 1/5/09, My InnerView Inc. Skilled Nursing Home Risk Monitor Metrics Page 2 of 12
Anti-psychotic medication use Acquired catheters Anti-psychotic medications are those listed in the general instructions for completing HCFA form 672. On the last Fri Number of residents receiving anti-psychotic medications. INCLUDES: All residents receiving anti-psychotic medications as described above. An indwelling or external catheter is any catheter which constantly drains the urinary bladder or is worn over the penis to collect urine in a drainage bag connected to the catheter. On the last Fri Number of residents with indwelling or external catheters MINUS the number of residents admitted with catheters Acquired physical restraints A physical restraint is any manual or physical restraint device that prevents freedom of movement and/or normal access to one s body. Includes material or equipment attached or adjacent to one s body not easily removed by a resident. Exceptions: Side rails when documented as assistive devices. On the last Fri Number of residents with physical restraints MINUS the number of residents admitted with an order for restraints Unplanned weight loss/gain Unplanned significant weight loss or gain is defined as a 5% loss/gain over a 30-day period, a 7.5% loss/gain over a 90-day period, or a 10% loss/gain over a six-month period. On the last Fri Number of residents with significant weight loss or gain not planned for in their plans of care 1/5/09, My InnerView Inc. Skilled Nursing Home Risk Monitor Metrics Page 3 of 12
Elopements An elopement is a resident's exit from the building that is (A) not documented as acceptable in the resident's care plan or (B) unauthorized and/or unsupervised. Total Total number of elopements from the first day through the last day of the month With external involvement Number of external elopements Number of ALL elopements. INCLUDES: Multiple elopements by the same resident. Number of elopements when a resident was returned with the involvement of someone other than facility staff Nosocomial infections Number of nosocomial infections Unplanned hospitalizations Number of unplanned hospitalizations from the first day through the last Unanticipated deaths Number of unanticipated deaths A nosocomial infection is an infection acquired in-house after admission. Number of nosocomial infections An unplanned hospitalization is a hospitalization that is not expected in the resident s plan of care. Number of unplanned hospitalizations An unanticipated death is one that was not anticipated as part of the current plan of care. Number of unanticipated deaths 1/5/09, My InnerView Inc. Skilled Nursing Home Risk Monitor Metrics Page 4 of 12
Medication errors Number of medication errors from the first day through the last day of the month Accidents Number of accidents from the first day through the last day of the month 911 (emergency) calls Number of (911) emergency calls A medication error results from NOT following protocols for 1. Right patient, 2. Right type, 3. Right dosage, 4. Right time or 5. Right route. Number of medication errors An accident is any incident or chain of events resulting in injury, harm or illness to a resident. Includes deaths, burns, cuts, bruises and other injuries. Number of accidents. DOES NOT INCLUDE: Falls of any type or elopements. A 911 (emergency) call is any call made to 911 or an emergency call center. Number of emergency calls made via the 911 or similar calling service, regardless of cause 1/5/09, My InnerView Inc. Skilled Nursing Home Risk Monitor Metrics Page 5 of 12
COMPLIANCE/COMPLAINTS Abuse allegations An allegation is where abuse is DOCUMENTED to have occurred. Includes resident-to-resident and staff-to-resident abuse. An allegation is substantiated (or found to have occurred) by an internal or external body. Physical Number of incidents of alleged or actual physical abuse from the first day through the last day of the month Physical substantiated Number of incidents of substantiated physical abuse Sexual Number of incidents of alleged or actual sexual abuse from the first day through the last day of the month Sexual substantiated Number of incidents of substantiated sexual abuse from the first day through the last day of the month Verbal/emotional Number of incidents of alleged or actual verbal/emotional abuse Verbal/emotional substantiated Number of incidents of substantiated verbal/emotional abuse from the first day through the last Number of incidents of alleged or actual physical abuse. INCLUDES: Both substantiated and unsubstantiated allegations. Number of incidents of substantiated physical abuse Number of incidents of alleged or actual sexual abuse. INCLUDES: Both substantiated and unsubstantiated allegations. Number of incidents of substantiated sexual abuse Number of incidents of alleged or actual verbal and/or emotional abuse. INCLUDES: Both substantiated and unsubstantiated allegations. Number of incidents of substantiated verbal/emotional abuse 1/5/09, My InnerView Inc. Skilled Nursing Home Risk Monitor Metrics Page 6 of 12
Total (Calculated by system) Total substantiated (Calculated by system) Number of incidents of alleged or actual physical, sexual and verbal and/or emotional abuse. INCLUDES: Both substantiated and unsubstantiated allegations. Number of incidents of substantiated alleged or actual physical, sexual and verbal and/or emotional abuse allegations. Complaints A complaint must be formally documented in writing (i.e., via letter, e-mail, suggestion box). Internal Number of complaints filed internally from the first day through the last Number of complaints filed internally. INCLUDES: Telephone calls only if documented by caller or person receiving call. DOES NOT INCLUDE: Informal verbal complaints (e.g., resident complains to staff that food menu or activities are boring) or staff grievances. External Number of external complaints filed from the first day through the last Additional definition: An external complaint is filed by a resident, family, employee or anonymous party with EXTERNAL agencies (e.g., state licensure, ombudsman, Better Business Bureau, adult protection or other outside entity). Number of external complaints filed Enforcement actions Number of enforcement (regulatory) actions given from the first day through the last day of the month An enforcement action is a regulatory action against the facility with penalties and/or punitive sanctions incurred as a result of the state survey. (Examples: Civil monetary penalties, denial of admissions, etc.) Number of enforcement (regulatory) actions given Actual number Average monthly number 1/5/09, My InnerView Inc. Skilled Nursing Home Risk Monitor Metrics Page 7 of 12
Local actions Number of local actions given from the first day through the last day of the month Compliance State survey Source: Month & A local action is a written notice due to failure to comply with regulatory or contractual obligations. (For example, a citation by the local fire department due to an inappropriately marked fire lane.) It requires action by the provider. Number of local actions given Actual number Average monthly number State surveys of every type, including standard, extended, complaint, abbreviated and look-behind. From most recent standard survey until next standard survey Automatically extracted from information submitted by the facility when survey activity occurs. INCLUDES: Deficiencies (citations) cited by tag number and scope/severity in each of the different types of surveys on Form 2567. Real-time score EMPLOYEE COMMITMENT RNs/LVNs/LPNs: Stability RNs/LVNs/LPNs: Turnover Stability is defined as having been employed at the facility for one year or more. On the last Fri Number of full- and part-time RNs/LVNs/LPNs (regardless of job duties) in the nursing department who have been in the facility s employment for one year or more Percent for the month Average monthly percent Turnover occurs when employment is terminated for any reason. Number of RNs/LVNs/LPNs (regardless of job duties) who left their employment in this facility s nursing department for any reason. DOES NOT INCLUDE: Agency staff. Percent for the month Average monthly percent 1/5/09, My InnerView Inc. Skilled Nursing Home Risk Monitor Metrics Page 8 of 12
RNs/LVNs/LPNs: Absenteeism CNAs/NAs: Stability CNAs/NAs: Turnover CNAs/NAs: Absenteeism Absenteeism occurs when an employee does not report for a scheduled shift. Also referred to as a call off or no show. Does not apply to shifts normally worked by a person currently on an authorized leave of absence. Number of shifts scheduled for RNs/LVNs/LPNs (regardless of job duties) who, for any reason, did not report for the scheduled shift. DOES NOT INCLUDE: Shifts scheduled for agency staff. Percent for the month Average monthly percent Stability is defined as having been employed at the facility for one year or more. On the last Fri Number of full- and part-time CNAs/NAs in the nursing department who have been in the facility s employment for one year or more Percent for the month Average monthly percent Turnover occurs when employment is terminated for any reason. Number of CNAs/NAs who terminated employment in this facility s nursing department for any reason. DOES NOT INCLUDE: Agency staff. Percent for the month Average monthly percent Absenteeism occurs when an employee does not report for a scheduled shift. Also referred to as a call off or no show. Does not apply to shifts normally worked by a person currently on an authorized leave of absence. Number of shifts in the nursing department scheduled for CNAs/NAs who, for any reason, did not report for the scheduled shift. DOES NOT INCLUDE: Shifts scheduled for agency staff. Percent for the month Average monthly percent 1/5/09, My InnerView Inc. Skilled Nursing Home Risk Monitor Metrics Page 9 of 12
Hours RNs/LVNs/LPNs: Overtime Number of overtime hours worked by hourly full- and part-time RNs/LVNs/LPNs from the first day through the last RNs/LVNs/LPNs: Agency Number of hours worked by agency-provided RNs/LVNs/LPNs from the first day through the last CNAs/NAs: Overtime Number of overtime hours worked by full- and part-time CNAs/NAs CNAs/NAs: Agency Number of hours worked by agency-provided CNAs/NAs from the first day through the last day of the month Grievances filed Number of workplace grievances filed from the first day through the last Number of overtime hours worked by hourly full- and part-time professional nursing employees (RNs/LVNs/LPNs) in the nursing department. DOES NOT INCLUDE: Salaried nurses or agency staff. Hours per resident day Average monthly hours per resident day Number of hours worked by agency-provided staff. DOES NOT INCLUDE: Full- and part-time professional nursing employees (RNs/LVNs/LPNs). Hours per resident day Average monthly hours per resident day Number of overtime hours worked in the nursing department by full- and part-time nursing employees (CNAs/NAs). DOES NOT INCLUDE: Agency staff. Hours per resident day Average monthly hours per resident day Number of hours worked by agency-provided CNAs/NAs. DOES NOT INCLUDE: Full- and part-time nursing employees (CNAs/NAs) employed by the facility. Hours per resident day Average monthly hours per resident day A workplace grievance must be filed in writing. Number of workplace grievances filed by full- and part-time employees Number per employee Average monthly number per employee 1/5/09, My InnerView Inc. Skilled Nursing Home Risk Monitor Metrics Page 10 of 12
FINANCIAL HEALTH Workers compensation Lost-time claims filed Number of lost-time claims filed Medical claims filed Number of medical claims filed Occupancy A lost-time claim is a workers' compensation claim that results in missed work related to the claim. Number of lost-time claims filed. DOES NOT INCLUDE: Claims that involve medical expenses without missed work. Number per 100 employees Average monthly number per 100 employees A medical claim is a workers' compensation claim that results in medical payment (e.g., medical-only claims). Number of medical claims filed. DOES NOT INCLUDE: Claims where an employee missed work. Number per 100 employees Average monthly number per 100 employees Occupancy is defined as a licensed bed occupied by a resident. On the last Fri Percent of occupancy averaged over the entire month Rate Average monthly rate 1/5/09, My InnerView Inc. Skilled Nursing Home Risk Monitor Metrics Page 11 of 12
CUSTOMER SATISFACTION Family Source: Most recent My InnerView satisfaction survey Overall satisfaction Quality of life Quality of care Quality of service Automatically extracted from ratings received on all Family Satisfaction Survey items relating to quality of life, quality of care and quality of service. An overall average for above-mentioned items on the survey Automatically extracted from ratings received on Family Satisfaction Survey items relating to quality of life An overall average for the quality of life items Automatically extracted from ratings received on Family Satisfaction Survey items relating to quality of care An overall average for the quality of care items Automatically extracted from ratings received on Family Satisfaction Survey items relating to quality of service An overall average for the quality of service items Employee Source: Most recent My InnerView satisfaction survey Overall satisfaction Work environment Training Supervision Automatically extracted from ratings received on all Employee Satisfaction Survey items relating to work environment, training, supervision and management An overall average for above-mentioned items on the survey Automatically extracted from ratings received on Employee Satisfaction Survey items relating to work environment An overall average for the work environment items Automatically extracted from ratings received on Employee Satisfaction Survey items relating to training An overall average for the training items Automatically extracted from ratings received on Employee Satisfaction Survey items relating to supervision An overall average for the supervision items Management Automatically extracted from ratings received on Employee Satisfaction Survey items relating to management An overall average for the management items Data collected on the last Fri are used to calculate a same-day snapshot of all facilities nationwide enrolled with My InnerView. The same-day snapshot approach is widely used in government-produced and other research statistics. Reports are confidential and prepared for internal quality assurance and improvement purposes only. They are entitled to protection of peer review privilege and similar privileges provided by law. Do not copy or distribute without written permission. 1/5/09, My InnerView Inc. Skilled Nursing Home Risk Monitor Metrics Page 12 of 12