Post on 25-Dec-2015
All in a Day’s Work
CV Quarterly MRD Workshop September 30, 2011
Presented by Lizeth Flores, RHIT, RAC-CT
Agenda
1. Alphabet Soup 1. Alphabet Soup
2. CQI / Analysis 2. CQI / Analysis
4. Vision Hints & Tips 4. Vision Hints & Tips
3. Critical Thinking Exercises 3. Critical Thinking Exercises
5. The Recipe for Quality of Care 5. The Recipe for Quality of Care
6. The News with Laurie 6. The News with Laurie
7. MDS 3.0 Update 7. MDS 3.0 Update
Alphabet Soup
HIM MDS RAI HIPAA OBRA CFR CMS CAAs RUG (as in MDS RUGs) PPS FI QIO
Alphabet Soup
HIM Health Information Management
RAI
Resident Assessment Instrument
OBRA
Omnibus Budget Reconciliation Act
CMS
Centers for Medicare & Medicaid Services
Alphabet Soup
RUG
Resource Utilization Group
FI
Fiscal Intermediary
MDS
Minimum Data Set
Alphabet Soup
HIPAA
Health Insurance Portability and Accountability Act
CFR
Code of Federal Regulations
CAA
Care Area Assessment
Alphabet Soup
PPS
Prospective Payment System
QIO
Quality Improvement Organization
CONTINUOUS QUALITY IMPROVEMENT EXERCISE
CQI Exercise – Behavior Drugs
You are the CQI team for Green Leaf Nursing Home, you have been presented with the following data regarding a recent behavior drug study conducted at your facility.
Review the information as a team and provide feedback as to root cause analysis, plans of action and follow up activities
Green Leaf Nursing Home Behavior Drug Study 2011
70%
70%
80%
75%
0%
100%26%
80%
60%
26%Physician's Order Specified Behavior
Physician's Order Specified Diagnosis
Informed Consent Verified
Monitor for each behavior
Monitor for Adverse Side Effects
Care Plan w ith non-drug interventions
CP Includes Measurable Goal
CP Includes Drug Type/Name
Monthly Psych Summary Behavior matches order
Monthly Psych Summary Behavior matches CP
Identify Weak Areas
Review the data Where are the lowest Percentages? What is the root cause? Plan of Action Specify Follow Up
Areas of Concern
Behavior not specified on all MD orders Diagnosis not specified on all orders Monitor for each behavior Care plan Interventions
Possible Root Causes?
New Nurses New MRD No daily review of orders
Task Segmentation & Timeframe
What will you do to correct the problem ? Staff Training
Who? What? When?
Follow Up Plan
How will you monitor progress?
Who? What? When?
What is the expected compliance and by when?
Critical Thinking Exercise
Case Study
Mr. Doe has resided at your facility since 2008. He is a stable resident with a diagnosis of Alzheimer’s Dementia, he is severely confused, he also has HTN, Diabetes and Osteoporosis.
Mr. Doe usually eats between 80-100% of his meals, he wears partial dentures and is assisted with set up only for meals
Decline
Mr. Doe has been refusing to eat almost at every meal this week. He has lost 5lbs since the last weigh-in 2 week ago. He seems unusually agitated.
The CNA reported today that Mr. Doe has been combative during care and has refused to get out of bed for a few days, he also has developed a reddened area on the coccyx.
What are the areas of concern?
Decreased intake Weight loss Increased confusion Skin breakdown
What would you look for?
Why is he refusing to eat?
Has there been a change in menu?
Has there been a change in his routine?
Is he wearing his dentures?
Could he be having pain?
CNA’s feedback & Nursing Assessment
The Findings
Answer: CNA reports that he is combative during oral care.
Nursing assessment reveals that Mr. Doe has 2 teeth that are severely decayed one of which is already infected.
What Should be documented
Change of condition assessment due to the weight loss and skin breakdown Hydration assessment Review of dietary needs due to his dentition problems Pain management review and adjustment as needed Care Plan Development / Update
What would you do?
Think About
Care Plan Interventions
and
Goals
Conclusion
Due to the pain caused by his decayed teeth and secondary infection; Mr. Doe had a change from his routine, he did not get out of bed as he usually does and had a decrease in dietary intake both of which contributed to his weight loss, skin breakdown and increased confusion.
MEDICAL RECORDS
HELPFUL HINTS
24/7 VISION SUPPORT
1-877-708-7444
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REMINDER
CensusAdmissions-
Demographic i.e. SS, education etcBed Assignments
LOA’s- Bed holds; private vs. medical DischargesRoom Transfers- residents out on medical bed
holdVerification
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REMINDER
Please DO NOT Remove diagnosis from the resident admission
All diagnosis must be INACTIVIATED if resident is gone >24hrs.
Never inactivate any diagnosis from another facility.
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REMINDER
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REMINDER
Before inactivating diagnosis you MUST changes the primary from YES to NO.
If this is a discharge please print the physician discharge summary before changing or inactivating.
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HEIGHT & WEIGHT
All residents height must be completed by November 1st ,2011 All weight must be entered by the 10th of every month. If there is a reweigh please only enter the reweigh
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PRINTING
Always print by station and never the entire facility.
If printing fail never process again, close browser , go to Home page –recent reports and process.
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REPORTS
FDB Medications-Diets, Psychotropic, Enteral, Pressure Ulcer, FSBS etc.
Diagnosis report Physician and resident list
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DOWN TIME
Announcement is found on your home page for all schedule down time i.e. maintenance and upgrade
Emergency package are prepared and available for all EMR facilities, which include all paper documentation.
What to do when down time is over.
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Quality of Care
Resident Name
Physician Name
Date
Time
Name of Medication
Dosage
Route
Frequency
Diagnosis
Nurse’s signature
Physician Signature
What do you get ?
A complete telephone Order
Common Issues
Incomplete Orders Illegible Content No Diagnosis No signature MD must sign within 5 days
Plan of Action
What will you do when you return to your facility to ensure complete and accurate orders?
New Policies
Q&A
MDS 3.0 Update