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Director of Nursing Training Manual

September 2014

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PAE – PRE-ADMISSION EVALUATION REVISED 9/2014 ........................................................... 1

THE FINANCIAL APPLICATION ............................................................................................................. 2 THE MEDICAL APPLICATION ................................................................................................................ 2 THE TENNCARE PRE-ADMISSION EVALUATION SUBMISSION SYSTEM (TPAES) ................................. 2

Access into the System .................................................................................................................... 2 Setting “My Projects” .................................................................................................................... 3 Home Page View ............................................................................................................................ 4 Submit a New Pre-Admission Evaluation ....................................................................................... 5 Completing the Pre-Admission Evaluation Form ........................................................................... 5 Submit to Long Term Care ........................................................................................................... 16

REASONS FOR PAE DENIALS ............................................................................................................. 23 PAE GUIDELINES ............................................................................................................................... 24

A PAE is required in the following circumstances: ...................................................................... 24 A PAE is not required in the following circumstances: ................................................................ 24

PRE-ADMISSION EVALUATION CHECKLIST ........................................................................................ 24 GENERAL RULES (TENNESSEE DEPARTMENT OF HEALTH) SEC. 1200-13-1-.10

WWW.STATE.TN./SOS/RULES/1200/1200-13/1200-13-01.PDF ............................................................. 25 PAE LOG 9/2014 ............................................................................................................................... 26 NURSING FACILITY DISCHARGE/TRANSFER/HOSPICE ........................................................................ 27 TENNCARE CHOICES ENROLLMENT FORM ......................................................................................... 27

PAGING/INTERCOM SYSTEM ....................................................................................................... 28

PAIN MANAGEMENT ....................................................................................................................... 29

GENERAL INFORMATION 9/2014 ........................................................................................................ 29 PATIENT CONTROLLED ANALGESIC (PCA) PUMP 3/24/14 .................................................................. 29 PAIN ASSESSMENT 9/2014 ............................................................................................................... 31 PAIN MANAGEMENT REVIEW 9/2014 ................................................................................................. 31 PAIN MANAGEMENT ROSTER (FORM 4211) REVISED 7/27/04 ............................................................ 32

PARKING ............................................................................................................................................. 33

OVERVIEW ......................................................................................................................................... 33 PARKING AVAILABILITY/RESTRICTIONS ............................................................................................ 33 SAFETY/NOISE LEVELS ...................................................................................................................... 33

PASRR .................................................................................................................................................. 34

GENERAL INFORMATION .................................................................................................................... 34 PASRR LEVEL 1 ASSESSMENT .......................................................................................................... 35

Patient/Provider Information ....................................................................................................... 35 Assessment Screen ........................................................................................................................ 37

ADDITIONAL PASRR EVALUATIONS ................................................................................................. 39


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September 2014

DMRS REPORT FORM FOR CHANGE IN MENTAL/HEALTH STATUS .................................................... 40 REPORT FORM FOR CHANGE IN MENTAL STATUS .............................................................................. 41

PATIENT TRUST FUND.................................................................................................................... 42

PAYROLL ............................................................................................................................................ 43

PAYCHECKS ....................................................................................................................................... 43 PAY PERIODS ..................................................................................................................................... 43

PERIPHERAL NERVE CATHETER/PUMP ................................................................................... 44

PURPOSE ....................................................................................................................................... 44 GUIDELINES ....................................................................................................................................... 44

PHARMACY (AMPHARM)............................................................................................................... 46

GENERAL INFORMATION .................................................................................................................... 46 CONSULTANT PHARMACIST ............................................................................................................... 46 FORMS AND SUPPLIES ........................................................................................................................ 47 BACK-UP PHARMACY ........................................................................................................................ 47 BACK-UP PHARMACY LOG (FORM 4223) REVISED 7/27/07 ............................................................... 48

PHYSICIAN’S PROGRESS NOTES ................................................................................................. 49

PHYSICIAN PROGRESS NOTES (FORM 4148) REVISED 12/02/04 ......................................................... 49 General Information ..................................................................................................................... 49 Requirements ................................................................................................................................ 49

PNEUMONIA GUIDELINES ............................................................................................................. 50

PURPOSE ......................................................................................................................................... 50 To improve patient clinical outcomes by reducing avoidable hospital readmission within 30 days

of admission to the skilled facility. ............................................................................................... 50 GUIDELINES ................................................................................................................................... 50

DECREASE THE RISK OF PNEUMONIA ........................................................................... 50

PNEUMOCOCCAL VACCINE ......................................................................................................... 54

GENERAL INFORMATION 9/2014 ....................................................................................................... 54 POLICY & PROCEDURES ..................................................................................................................... 55 DEVELOPMENT ................................................................................................................................... 55 REVIEW AND/OR REVISION ................................................................................................................ 55

POOL TIME RECORD ...................................................................................................................... 56

INTER-COMPANY POOL TIME RECORD (FORM 4216) REVISED 8/05/04 ............................................. 56

POST – PHYSICIAN ORDERS FOR SCOPE OF TREATMENT ................................................. 57

PURPOSE (1/28/14) .................................................................................................................... 57

POSTINGS, REQUIRED EMPLOYEE ............................................................................................ 58

PREGNANCY/MATERNITY LEAVE .............................................................................................. 59

PROBATIONARY PERIOD .............................................................................................................. 60

PROFIT SHARING PLAN (401)(K) .................................................................................................. 61

PROMOTIONS & TRANSFERS ....................................................................................................... 62

PPS – PROSPECTIVE PAYMENT SYSTEM .................................................................................. 63

PURCHASE REQUEST ...................................................................................................................... 64

OVERVIEW ......................................................................................................................................... 64 PURCHASE REQUEST (FORM 2011C) REVISED 10/5/04 ....................................................................... 65


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September 2014


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February 2012 Page 1

PAE – Pre-Admission Evaluation Revised 9/2014

Medicaid pays for nursing home care only for patients who meet both medical and

financial guidelines. The approval process/time period for the electronic PAE

usually takes 1-2 days; the Department of Human Services (DHS) financial

application approval process varies county to county.

The family representative will be notified by mail of the decisions. The facility will

receive a fax of the decisions. The decisions are sent separately for each part of the

application. If DHS has denied the financial application, appeals must be submitted

within 30 days. Denials from the State PAE office can occur for a variety of different

reasons. Refer to page 23 for Reasons for Denials.

If an approved PAE is not used (not billed on) within ninety (90) calendar days

beginning with the PAE Approval Date it can be updated within 365 calendar days of

the PAE Approval Date if the physician certifies that the patient’s current medical

condition is consistent with that described in the approved PAE.

A PAE may be “open ended” with no end date listed or may be approved for a fixed

period of time with an end date based on a determination of the patient’s medical

condition and anticipated continuing need for inpatient nursing care by the State.

PAEs should be kept in the patient’s electronic chart. An additional copy should be

maintained in the patient’s business folder.

The earliest date of Medicaid reimbursement for NF services is the date that ALL of

the following criteria are met:

Effective date of level of care eligibility by TennCare (i.e., effective date of

the PAE), which cannot be more than 10 days prior to date of submission of

the approvable PAE;

Effective date of Medicaid eligibility (in most cases, the date of DHS

application; and

Date of NF admission.

Questions regarding PAE submissions should be referred to the PAE Unit at 615-507-

6964 or 1-877-224-0219 or 1-877-224-3170. Online support is also available from

the TPAES site.


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September 2014 Page 2

THE FINANCIAL APPLICATION

The financial application begins during the Admission process. The financial form is

included in the Admission Packet and is completed by the Admission Coordinator.

This form must be faxed or delivered to the DHS on the day of admission. The

Admission coordinator or other facility personnel will estimate the personal liability

portion that is owed the facility on move-in.

The family representative will then receive notification of an appointment time with

the county Department of Human Services (DHS) for a review of the patient’s assets

and income and final determination of the patient’s liability. A nursing home patient

on Medicaid gets to keep a personal needs allowance each month.

THE MEDICAL APPLICATION

A Pre-Admission Evaluation, most commonly referred to as a PAE, is a process that

the nursing home completes on a patient and submits to the Tennessee Department of

Health long term care division in Nashville. The PAE must be completed by Day 2

of the patient’s stay regardless of payor source with only one (1) exception. If a

patient is admitted to the facility for HOSPICE SERVICES ONLY, a PAE must

NOT be submitted. This process explains that the person is in need of daily nursing

services that can only be given in a nursing home. The nurses in the long term care

office review the application and decide whether the patient’s medical condition

meets Medicaid’s guidelines.

THE TENNCARE PRE-ADMISSION EVALUATION

SUBMISSION SYSTEM (TPAES)

The TennCare Pre-Admission Evaluation Submission System (TPAES) is accessed

from a Web browser. The Web interface reflects the Division of Long Term Care’s

tracking processes through the life-cycle of the Pre-Admission Evaluation (PAE) and

Pre-Admission Screening and Resident Review (PASRR) processes for Long Term

Care (LTC).

Access into the System

Begin by logging into the TennCare Pre-Admission Evaluation System (TPAES).

Enter the website https://tcreq.tn.gov. The user will be prompted to enter a unique

User Name and Password. The User Name will be a unique identifier that is issued

by the State of Tennessee. The password will be created by TennCare and relayed to

the user. For help with accessing the system, changing the user or password reset,

please contact TennCare’s Serena Customer Service Coordinator at 1-877-224-3170.

https://tcreq.tn.gov/


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Setting “My Projects”

Users can set the types of PAEs they normally summit to TennCare by clicking on the

“Submit” pane and under “Advanced Tasks:” select “Manage My Projects” on the left

side of the screen. The user will then be able to select what PAE or Transfer types

are most often submitted to TennCare. To do this, highlight the PAE type (Level I,

Level II, Transfer-Level I to Level I, etc….) and click the right arrow. Once all types

are listed in “My Projects,” the user may select “Save” for future submissions. The

system will generate a message to inform the user that “the changes were saved

successfully.” Now these PAE types will be the only ones that are displayed for

selection.


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Home Page View

All submissions can be viewed by the last five (5) digits of the Control Number (Item

ID) by clicking “Home.” Submissions are grouped by submission type (i.e. NF Level

I, Transfer from Level I to Level I, etc….).


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Submit a New Pre-Admission Evaluation

Click on “Submit to my Preferred Projects.” Select the type of PAE you are

submitting for review.

Completing the Pre-Admission Evaluation Form

The electronic version of the PAE is similar in flow to the paper version. TennCare

will continue to require certain elements to be completed and correct before a

decision is rendered to approve or deny the PAE.

To see a larger version of the forms, the user should move to the left side of the page

and click on the double left arrow in the “Submit” section of the menu.


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Applicant Information

The first step is to begin with the applicant information by filling in all information

indicated on the form. The initial entry will be the Provider’s drafting state. All

required fields are indicted with red text. To move from the top of the form to the

bottom to ensure all fields are entered, use the scroll bar on the right side of the

window.

The next step is to fill in all of the information about the patient. If the Medicaid

Identification Number has been issued, enter it AND the patient’s Social Security

Number. If there is no Medicaid Identification Number, enter the patient’s Social

Security Number. Entering a Social Security Number other than the patient’s will

result in the PAE being returned for technical requirements not being met. The

Medicaid Identification Number is a numeric field. The provider will not be allowed

to enter “pending.”

Service/Reimbursement Requested

Under “Service/Reimbursement Requested”, click on “Nursing Facility”. All fields

that need to be completed will then appear. The Reimbursement Level, the

Admission Date, and the Discharge Expectation must be completed. You must

answer the question on whether the patient is currently residing in the nursing facility.

Search for and ensure that the nursing facility name is showing in the selection box

and enter the fax number where they would like the system generated faxes sent.


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Request Info

Included in this section is the PAE Request Date which must be completed. Also

included in this tab is the designee information. If the patient has a designee,

complete the information. If the patient DOES NOT have a designee, indicate that by

checking the box “Designee Not Provided.”

Functional Assessment/Assessment of Capabilities and Needs

After all demographic information is complete, move to the Functional Assessment or

Assessment of Capabilities and Needs tab to fill in all questions regarding the

patient’s activities of daily living (ADLs).

For each question that requires an answer will have drop down lists with answers in

alphabetical order as “Always, Never, Usually or Usually Not”. Be careful to select

the correct response. Each functional area listed includes clarification regarding the

meaning of each of the available responses. Questions that are not applicable for the

patient (e.g. catheter, wheelchair or insulin), may be left as “(None)” for the response.

There is an additional comment field at the bottom of this tab where further

clarification can be included if needed.


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Nursing & Rehabilitative Services (NF Level 2 PAEs)

The next tab is Nursing and Rehabilitative Services and must be completed when

completing a PAE for Level 2 reimbursement. Please refer to the physician’s orders

when indicating the services that are being provided to the patient. Also found under

each skilling service is the specific documentation required in italics to be submitted

with the PAE. The nurse reviewers at TennCare request that nursing facilities select

the skilling service that will allow the most time to receive Level 2 payment. The

documentation (physician’s orders, progress notes) that supports that particular

service needed should be attached to the PAE upon submission. This will help

minimize the documentation for review.


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There are comment areas at the bottom of the page that can be used for additional

information if needed for the TennCare nurses to make a determination.

Certification

When all information for the PAE is completed, the submission must then be certified

by the person who has completed the PAE information as well as by the prescribing

physician. The certification information will be captured on the Certification tab.

Also on this tab are the fields to be completed for the Diagnosis, Physician or Level

of Care assessor’s name and date of certification.


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TennCare requires that the certification page from the PAE be printed from this

system, physically signed by the physician, scanned, and attached as part of the PAE

submission.

Admit Screen

The final tab to be completed is the Admit Screen Tab. The information on this tab

will need to be completed before the applicant is to be enrolled in the CHOICES

program. The submitter can complete this information on initial submission or they

will be able to compete it after submission by utilizing the Edit Admission Info button

on approved PAEs.

The Medicaid Only Payer Date (MOPD) should be left blank if not known on

admission and inserted only when it is known for certain. The MOPD is the date

the facility certifies that Medicaid reimbursement for nursing facility services will

begin because the person has been admitted to the facility and all other sources of

reimbursement (including Medicare and private pay) have been exhausted. This date

must be known and not estimated. Including an inaccurate MOPD could result in an

unintended overpayment to the managed care organization (MCO).


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Once all tabs within the PAE have been filled in, the facility is able to save that

submission in a “draft” status prior to submitting to TennCare. This will allow any

changes that might need to be made or outside reviews that need to occur before

submitting. Click the “OK” button at the top of the page.

Finalize PAE

When the PAE is ready to by finalized and submitted to TennCare, search for the

PAE in the “Awaiting Submission” report and click once on the blue item ID to open

the PAE. When the PAE is open, click the “Finalize PAE” button at the top of the

form. At this point, you will be able to make any changes necessary prior to printing

a copy for your records. Once all changes are made, click “OK” at the top of the

form.


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Attachments

Any attachments that are required are listed on the Certification tab. Please read

through the requirements necessary to submit a PAE for consideration. A PAE must

include a recent history & physical including a review of systems. A history and

physical performed within 365 calendar days of the PAE request date may be used if

the patient’s condition has not significantly changed. The H&P may be obtained

from a recent hospitalization or a physician visit. A discharge summary or admission

assessment by the physician at the hospital may be used if it includes a review of

systems.

The next step will be to attach electronic copies of documentation. To attach

electronic documentation, move to the top of the application and go to “Actions:”

Select “Add File” and a dialog box will pop up to allow you to add attachments from

the computer. Select the “Browse…” button to search the computer’s files for the

correct documents to attach.


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Select the Medical Records, Physician’s Order, etc. . . . and upload those into the

submission.


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TennCare asks facilities to name the document with the patient last name, first name,

and the type of document that is being attached. Click “Upload & Attach File.”

Make sure the box is checked to automatically close the window when complete.


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After the file is attached, it will be displayed on a tab labeled Attachments at the

bottom of the screen. Ensure you are looking at the Patient/Provider Information tab

to see the Attachments tab when adding documents. These steps may be repeated as

often as needed to include all documentation needed to support the PAE. After all

attachments are made, click “OK” at the top of the screen.

Produce Printable Copy of the PAE

Now the ability to print a PAE is available for the facility. Click on “Produce

Printable Copy” at the top of the form. The PAE will be located on the Related Items

tab at the far right side of the submission.


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Find the “Generated Attachments” section on this tab and single-click on the icon

next to the PAE to open the attachment.

The PAE will open in a new window. Scroll all the way to the bottom of the new

window to the section called “Attachments.” Single click on the blue text of the

document name. Again, this will pull up another window with a printable copy of the

PAE. Right click on the mouse to open a print option. Once the PAE is printed,

please obtain a physical signature from the physician on the certification page beside

their type-written name. Additionally, the person certifying the accuracy of the PAE

contents should sign beside their type-written name as well.

Submit to Long Term Care

When the form is complete and all required attachments are included, the PAE is

ready for submission. It is imperative that PAEs be double-checked and that all

information is completed to minimize the chances of denial. A single error, no matter

how small or insignificant, can be the reason for a denial and there would be no

retroactive payment. The effective date would be the date the PAE was submitted

with all information complete. When admitting a patient to the facility as an ICF

patient with Medicaid as their only payer source, the preferred method would be to

obtain an approved PAE prior to admission.

Once the physical signatures are obtained on the PAE, click the “Submit PAE” button

at the top of the form.


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Notice the word “File” on the next form next to “Actions:” at the top.

The signed certification page must now be attached to the PAE. Follow the steps

outlined under Attachments section on how to attach a file. When the attachment has

been loaded into the submission, click “OK” to submit the PAE.

If there are any errors throughout the form, the user will be prompted at the top of the

page with an error message in red text. The field where the error exists will be

indicated. The submission will not be allowed until all errors have been resolved.

Once the items have been submitted to LTC, the application will give the submitter a

tracking number for that PAE with a message that the item was successfully

transitioned.


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The user will receive notification via email that the PAE has been submitted. You

will not be able to make corrections until the PAE is reviewed and a decision by LTC

has been rendered.

Control Number

Each PAE that comes into the Division of Long Term Care receives a “Control

Number”. This number is located at the top of the “Patient/Provider Info” tab.

This is how LTC will identify the individual PAEs submitted for an applicant. It will

be very important to refer to this control number for any correspondence regarding

this PAE. If you must update any information on the PAE such as a certification

update, you will access the existing PAE by the control number. The control number

is assigned to the PAE once it has been transitioned to LTC for review.

Home Page Report

There are two (2) reports available from the Home Page: 1) Items that have not been

submitted (pending in a draft state) and; 2) Items where a disposition has been made

by the Division of Long Term Care including the Submit Date and the date the

Division of Long Term Care made a determination. Only submissions that have an

approved or denied status will appear on this view. Once a PAE has been submitted


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to LTC, it will not be visible until there is a determination. The status of the PAE will

also be located on the top section in the Patient/Provider Info tab.

Obtaining the PAE Status

Once a PAE has been submitted to TennCare, you can log back into TPAES to check

the status of their submission. The Home Page report will show the status of

submission where the Division of LTC has made a determination. The last five (5)

digits of the assigned control number must be used to locate the item in question.

This is also known as the “Item ID”. Click once on number of the “Item ID” to open

the PAE. To see the expanded view of the PAE, click on the “Expand this Report

View” icon at the top right corner.

Viewing Notification Documents

Once LTC has made a determination on the PAE, the notification can be found within

the individual submission. Select the item by clicking once on the Item ID. The

notification will be located on the Related Items tab. Move to the Generate Items

section on the Related Items tab to view the notifications that have been generated.

Click once on the icon beside the notification. This will open a new window where

the document can be viewed. When a document is open, the letter is displayed and

additional information is at the bottom of the screen. There will be a section called


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Attachments at the bottom of the letter. If the letter needs to be printed for a hard

copy file, press the “Shift” button and single click on the mouse at the same time.

This will open the letter into another window where you have the option to print.

You can now “File:Print”. Note: When opening attachments, you may encounter a

“Pop-Up Blocker error.” Always allow pop-ups from the Serena website.

Revise a PAE

When a PAE has been denied, you may have to update information such as correcting

a Social Security Number, updating information in the Functional Assessment tab or

other such edits. To perform this function, start at your home page and choose the

PAE for revision from the list of existing PAEs. To search by control number, you

must type the last 5 digits into the search field. When the PAE is found, open up the

case by clicking once on the control number or item ID. When the form is opened

you may click on the “Revise” button at the top of the form. This function creates a

copy of the original submission; therefore the control number will be followed by .1

or .2 depending on the revision number. Each subsequent revision will follow in

numerical order.

You must now click the “Edit” button. All fields are now available for editing. Once

all revisions have been made to the form, the PAE can be re-submitted by selecting

the “Re-Submit PAE” button. If there is additional documentation to attach, follow


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the steps outlined in “Attachments” described earlier in this chapter. Please take time

to ensure all information is correct as once the submission button is pushed, it will

transmit to LTC and you will not have access to make corrections until determination

is made by LTC. A confirmation message with a new control number will appear on

the screen. Always search by the new control number to get a status of the request.

Recertify an Approved PAE

When a PAE has been approved, you may have the option to recertify the PAE. This

requires updated information on the Certification of Care tab, in the following fields:

“Revised PAE Request Date”, “Revised Certifying Physician” and “Revised

Physician Certification Date”. To perform this function, start at the home page and

choose the PAE for recertification from the list of existing PAEs. To search by

control number, you must type the last five (5) digits into the search field and click

“Go”. When the PAE is identified open up the case by clicking once on the control

number or Item ID. When the form is opened, you may click on the “Recertify”

button at the op of the form. This function creates a copy of the original submission;

therefore, the control number is followed by .1. Each subsequent recertification will

follow in numerical order. Always search by the new control number to get a status

of the PAE.

Next, click the “Start Recertification” button at the top of the form.


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Upon clicking the “Start Recertification” button, you will now be able to update the

Certification for the approved PAE. Click on “Recertify PAE” button. Review the

information provided and update the information on the Certification of Care tab, in

the following fields: “Revised PAE Request Date,” “Revised Certifying Physician,”

and “Revised Physician Certification Date”.

Click “OK” accept the changes and a confirmation message and a new Item ID

number will appear on the screen.


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REASONS FOR PAE DENIALS

Any deficiency in a PAE must be corrected prior to submission of the PAE to

preserve the PAE request date for payment purposes. THM requires that two (2)

people check the PAE before submission to the state to minimize the chances of

denial.

A denied PAE when resubmitted will be processed as a new application and if

approved, the effective date can be no earlier than the date of receipt of the

information that cured the denied PAE.

EX: A PAE was submitted on Day 2 of a patient’s stay. The error is

corrected and the PAE is resubmitted on Day 5. Payment will NOT BE

retroactive to the original date requested. The effective date in this case will

be Day 5 and 4 days of reimbursement will be lost.

Other reasons for a denied PAE:

There is no explanation why “Transfer” and “Toileting” and “Medications and

Eating” do not match.

There are no diagnoses listed to support the patient limitations.

The PAE must be approved on either physical or mental disabilities or both.

Functional Assessment must be marked with “Usually Not” or “Never” to

determine the need for inpatient nursing facility care.

The PAE is inconsistent with the MDS, H & P, therapy notes or diagnosis.

The PAE, H & P or physician orders are not signed and dated.

The H & P is not current (within the past year).

The PAE was submitted incomplete.

Patient teaching is not included to show why a patient cannot administer their

own fixed dose of insulin or place eye drops in their eyes, etc. For limitations

such as these, you should document teaching provided to patient and patient

response.


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PAE GUIDELINES

A PAE is required in the following circumstances:

When a Medicaid eligible patient is admitted to the facility

When a private pay patient attains Medicaid eligibility

When a patient changes from Medicaid Level 1 to Medicaid Level 2

When a patient changes from Medicaid Level 2 to Medicaid Level 1 with no

previously approved Level 1 PAE

When a patient requires continuation of the same level of care beyond the end

date assigned by the State

When a change in the skilled service for a Level 2 patient occurs

When a patient changes from Medicaid to private pay and then back to

Medicaid after a 90 day time frame

A PAE is not required in the following circumstances:

When a patient with an approved unexpired Level 1 PAE returns to the

facility after being hospitalized

When a patient with an approved unexpired Level 2 PAE returns to the

facility after being hospitalized unless the skilling services changes

When a patient changes from Level 2 to Level 1 if that patient was previously

receiving Level 1 care and still has an approved unexpired Level 1 PAE

When a patient changes from Medicaid to private pay and then back to

Medicaid within a 90 day time frame

To receive Medicaid co-payment when Medicare is the primary payor of

Level 2 care.

When a patient is admitted to the nursing home for hospice services only

PRE-ADMISSION EVALUATION CHECKLIST

Facilities should use this checklist to review the application prior to submission to

ensure that all elements have been completed and that all required documentation is

attached before or on date of admission.


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GENERAL RULES (TENNESSEE DEPARTMENT OF

HEALTH) SEC. 1200-13-1-.10

WWW.STATE.TN./SOS/RULES/1200/1200-13/1200-13-01.PDF

http://www.state.tn./sos/rules/1200/1200-13/1200-13-01.pdf

http://www.state.tn./sos/rules/1200/1200-13/1200-13-01.pdf


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PAE LOG 9/2014

Nurse management must complete and maintain the electronic PAE Log. End dates

must be tracked so that a new PAE can be completed prior to the PAE end date.

This log must be updated and end dates and certification updates completed

appropriately so that no revenue is lost due to untimely submissions.


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NURSING FACILITY DISCHARGE/TRANSFER/HOSPICE

The discharging/transferring/hospice facility must complete this form if the patient is:

1. Transferred to another facility

2. Transferred to the hospital

3. Discharged home with Home and Community Based Services (HCBS)

4. Discharged home without HCBS

5. Expired

6. For patients receiving nursing facility services and who elect hospice

The completed form must be submitted to the patient’s MCO via fax.

TENNCARE CHOICES ENROLLMENT FORM

This form must be completed for patients with a PAE completed prior to August 1,

2010 and are now converting to Medicaid as their payor. The facility should

complete the top part of the form and enter the date the patient’s payor source will be

changed to Medicaid. The form must be submitted to TennCare BEFORE the patient

will be enrolled in Choices. The form must be faxed to the Bureau of TennCare,

Choices Enrollment Unit at 615-253-3179.


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Paging/Intercom System

Paging systems are installed to communicate pertinent information throughout the

facility. Information of interest to all occupants may be broadcast over the overhead

system. Examples are emergency codes, safety matters, patient activity events, tray

cart readiness etc. Locating individuals for an urgent phone call or to respond to a

patient call may be reasons for overhead paging due to its relative timeliness. When

nurses are out on the floor managing patients, they may be paged to answer a

hospital, pharmacy, family and physician calls as well.

Employees may not use paging to locate each other for non-urgent matters such as

taking a break together. When one employee needs to speak to another, they should

use direct dial intercom numbers instead of overhead paging. If paging is necessary,

the extension to be called should be announced rather than paging, for example,

"DON to the Administrator's Office".

Private incoming telephone calls should not be announced overhead; rather, a

message is taken and given to the employee to handle at an appropriate time. Some

exceptions are allowed: an example might be a school calling for a parent when a

child is sick. When THM staff calls, they should be asked if the employee should be

paged or if a message is acceptable. The name of the person calling should not be

announced over the paging system.

Paging must be audible throughout the facility. Conversely, the volume should not be

so loud that it annoys people living in the facility. Everyone needs to be able to hear

emergency announcement, but patients trying to sleep should not be disrupted by

improperly adjusted PA speakers. When routine fire drills are held, all employees

should be able to confirm hearing the announcement regardless of their location.

The main concern is to ensure that overhead paging is minimal, effective, and

appropriate for those who live in the facility. The Director of Nursing should listen to

the paging and correct employees when necessary. Visitors hear everything paged

and develop their own impressions about the facility's operation based upon what

they hear, as well as what they see or smell.


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Pain Management

GENERAL INFORMATION 9/2014

A definition for pain widely used in nursing is “Pain is whatever the experiencing

person says it is, existing whenever he says it does.” It is a major symptom in many

medical conditions significantly interfering with a person’s quality of life and general

functioning.

The phrase “Pain as the 5th

Vital Sign” was initially promoted by the American Pain

Society to elevate awareness of pain treatment. Vital signs are assessed and taken

seriously by healthcare professionals. We should also assess and treat pain with the

same zeal.

PATIENT CONTROLLED ANALGESIC (PCA) PUMP

3/24/14

The utilization of a Patient Controlled Analgesic (PCA) Pump is an excellent pain

relief system for patients that experience severe pain that can interfere with their daily

activities.

A prescribing physician will order a PCA pump with a determined flow rate with or

without bolus of medication to be used for controlling pain. When using the bolus

button, an extra dose of medication is delivered to the body. This option allows for

the management of breakthrough pain on an individual level.

Patient education – review the purpose for using the pump, how to

administer bolus dose for pain control, and potential side effects. Remind the

patient to use assistive devices (i.e. walker, crutches, wheel chair, etc.) or staff

assistance due to the risk of falling associated with extremity

numbness/tingling sensation.

Infusion Device – inspect the infusion device, pumping chamber, and

administration set before use. Do not use any pump or administration set that

appears to be damaged or tampered with or if there is any indication of

improper function.

In order to prevent infection, clean the pump and bolus cord with a Super-sani

wipe, or per manufactures guidelines, before and after use.


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Follow the manufactures directions on how to use the pump and/or priming of

the tubing.

The physician should complete the PCA order set in Vision.


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PAIN ASSESSMENT 9/2014

The patient is observed for signs of pain or verbalization of pain from the patient.

The method to relieve pain must be documented in the patient’s electronic medical

record. Effectiveness should be measured in one hour and documented in the

electronic medical record.

PAIN MANAGEMENT REVIEW 9/2014

The 24° report and new physician orders will be discussed in the morning QA

meeting. Nurse management should review the Patient Vital Sign Report for pain

levels each day. Contact the physician for unresolved pain issues, as needed.


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PAIN MANAGEMENT ROSTER (FORM 4211) REVISED

7/27/04


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Parking

OVERVIEW

Our facility attempts to provide adequate parking spaces for our employees and

visitors.

PARKING AVAILABILITY/RESTRICTIONS

Parking availability is made on a "first-come" basis. Neither the Administrator nor

other supervisors have designated parking spaces. The spaces designated for

handicapped and emergency vehicle parking must be left available for those

appropriately-marked vehicles. Parking at entrances, and blocking of exits or fire

hydrants is prohibited. Employees should always utilize the parking areas to the rear

or sides of the facility, as well as those spaces farthest from entrances, so as to allow

closer access to our facility for family members and other visitors.

The parking areas are a part of the facility's premises, and therefore all facility rules

and regulations apply therein. The facility has the right, in accordance with all

applicable laws, to search any vehicle on the facility premises. The facility assumes

no responsibility for any damage to, or the theft of, any non-company vehicles or

personal property in vehicles while on facility premises.

SAFETY/NOISE LEVELS

Drivers on our parking areas must use caution, and not exceed ten (10) miles per

hour. The unsafe operation of vehicles by employees can result in disciplinary action;

other violators may be reported to local law enforcement officials.

Noises within and outside our facility should be kept at minimum levels, for the

comfort and well-being of patients, employees and visitors. Employees should

refrain from operating vehicles on the premises with loud exhaust pipes, or while

playing music that can be heard within the facility.


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PASRR

GENERAL INFORMATION

The Federal Nursing Home Reform Law of 1987 requires that a PASRR, which

stands for Pre-Admission Screening and Annual Resident Review be completed on all

individuals prior to admission to a nursing facility, regardless of payor source, and

regardless of the level of reimbursement for nursing facility services – Level I

(Intermediate) or Level II (Skilled). The PASRR process must be completed for

transfers from Level I to Level I and transfers to a nursing facility from an HCBS

program. The PASRR “screen”, intended to identify persons known or suspected to

have mental illness and/or mental retardation, is sometimes referred to as a “level 1”

PASRR, which refers to the level of PASRR review and not to the level of

reimbursement for nursing facility services. The PASRR is used to ascertain if a

patient needs mental health treatment.

The PASRR screen or Level I PASRR must be completed and submitted via the

PAESS system prior to admission to the facility for ALL individuals seeking

admission to a certified nursing facility. The PASRR Level I screens must be

completed prior to after hours, weekend or holiday admissions.

While PASRR screens may be performed by hospital discharge planners and others,

THM requires the facility (not the hospital) to complete and fax the PASRR before

admission. (Only in instances when the referral is received the same day of

admission to the facility should the Level I PASRR be completed and submitted on

the day of admission). Nursing facilities who do not comply with federal PASRR

requirements face risk of cited deficiencies in the survey process, as well as non-

payment and/or recoupment of Medicaid payments for dates of service that required

documentation is not in order.

The PASRR screen form must be completed and submitted to TennCare prior to

admission for ALL individuals seeking admission to a certified nursing facility: (1)

regardless of payor source; (2) regardless of whether the PASRR screen is “positive”

(the person is known or suspected to have mental illness and/or mental retardation

such that a PASRR evaluation must be performed) or “negative” (the person meets

specified exemptions); and (3) regardless of the level of nursing facility

reimbursement requested. This requirement is applicable to all Medicaid and

private pay individuals, as well as all Medicare patients seeking admission to dually

certified facilities. (Medicare patients seeking admission to a SNF-only certified

facility are exempt until/unless subsequently transitioned to a dually certified or

Medicaid-only facility).

All Level II PASRR evaluations should be filed on the patient’s medical record with

other mental health evaluations.


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PASRR LEVEL 1 ASSESSMENT

The PASRR process for submission is found on the same website as the PAE process

with the same login and password. Refer to “PAE” in this manual for information on

accessing this website.

From the My Projects screen on the TPAES website, select Level 1 PASRR.

Patient/Provider Information

The first step is to begin with the Patient/Provider Information tab by filling in all

information indicated on the form. All required fields are indicated with red text.

Scroll to the bottom of the page to ensure all fields are entered.

Based upon the log-on identification, the “Submitting Agency” fields will be

automatically populated. Check the box that states “Check here if the service

provider is the same as the submitting agency.” The information will not

automatically populate upon checking this box; however, it will be populated when

submitted to TennCare.


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The next step is to fill in all of the information about the applicant (patient). If the

Medicaid Identification (MID) has been issued, please enter it AND the applicant’s

Social Security Number. If there is no MID, please enter the patient’s valid Social

Security Number. Entering a Social Security Number other than the applicant’s will

result in the PAE being returned for technical requirements not being met. The

Medicare Identification Number is a numeric field. The provider will not be allowed

to enter “pending”.

If the applicant has a designee, please fill out all information. If the applicant DOES

NOT have a designee, please indicate that by checking the box “Designee Not

Provided.”


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Assessment Screen

All of the fields under “Mental Illness” and “Mental Retardation” are required and

must be answered with either a “no” or “yes”. The person’s name and credentials

certifying the PASRR questions will need to be typed into the “PASRR Certifier” and

“PASRR Certifier Credentials” fields and indicate the date completed in the “PASRR

Certification Date” field.

Once all questions are answered, if applicable, users must indicate if there are any

PASRR exemptions by checking the appropriate box(es). If there are any exemptions

checked, the physician’s name that is certifying this should be typed into the “PASRR

Physician” field and the date indicated in the “PASRR Physician Signature Date”

field. If there are any exemptions, the paper PASRR page 2 should be signed by the

physician, scanned, and attached with the submission.

The facility should examine the H&P and other medical records for any information

that could trigger a Level II PASRR evaluation. A few examples of major mental

illnesses that would trigger a Level II evaluation are paranoia, major depression,

bipolar or schizophrenia. Be sure to review medications such as antipsychotic meds

as they are indicative of major mental illness.

The facility may submit the Level I PASRR for the patient that flags for MR or MI

but cannot accept them until they have an approved Level II PASRR. The facility

will need this Level II PASRR and the approved PAE before the admission.


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If the PASRR screen indicates mental illness or mental retardation or the H&P

contains information that may trigger a Level II PASRR evaluation, the patient may

not be admitted to the facility until the Level II is completed and approved. All Level

II PASRR evaluations should be filed on the patient’s medical record with other

mental health evaluations.

If the PASRR is not submitted prior to admission, payment will be denied.

If the evaluation indicates a need for special services, the patient and family will be

assisted by the State in finding an alternative setting for the required care.

If the PASRR Level I screen indicates an exemption for a Level II PASRR, the

facility may admit the patient. If an individual enters the nursing facility with an

exemption of “120-day short term stay” or “hospital exemption criteria” on the

PASRR screen form, and it is determined that the individual will need to extend the

stay beyond that point, it is the responsibility of the nursing facility to notify

TennCare timely to ensure that a PASRR evaluation is completed before the

exemption expires.


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ADDITIONAL PASRR EVALUATIONS

Additional PASRR Level II evaluations may be required if significant changes occur

in a resident’s mental or medical health status. Nursing facilities must report changes

promptly to the DMH (Department of Mental Health) or Department of Mental

Retardation Services (DMRS), whichever is appropriate for the patient, whenever any

of the following circumstances are noted:

A patient is admitted to a mental health facility. A Level II evaluation must

be obtained prior to re-admission to the nursing facility.

A patient with an approved Level I screen but later receives a diagnosis of

major mental illness or antipsychotic medication.

A patient with a previously approved Level II evaluation that experiences a

significant increase in their symptoms and/or behavior.

A patient with a previously approved Level II evaluation that experiences a

significant improvement in their medical health status.

Nurse management and the MDS Coordinator should agree within 14 days of the

change in condition that a significant change has occurred. This change would

indicate the need to complete a MDS Significant Change Assessment form as well as

a notification to the appropriate state agency. Facilities should report to DMH or

DMRS using the appropriate report form. For patients with mental retardation, use

the DMRS Report Form for Change in Mental/Health Status. For patients with

mental illness, use the Report Form for Change in Mental Status.


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DMRS REPORT FORM FOR CHANGE IN

MENTAL/HEALTH STATUS


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REPORT FORM FOR CHANGE IN MENTAL STATUS


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Patient Trust Fund

Patients have the right to access their personal funds and the facility is required to

manage their funds when requested by a patient. A form is reviewed and signed by

the patient or responsible party at the time of admission to have their personal funds

managed by the facility. Should a patient want cash to purchase something from the

vending machine or need money for an outing with the family they can obtain funds

from their trust fund from the facility office.


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Payroll

PAYCHECKS

Any error, caused by an employee's failure to provide an accurate and legible time

record, will be corrected on the next available payroll. Employees should carefully

examine each check and request explanation if their understanding is not clear.

Only the employee may pick up their paycheck unless the employee requests mailing

of the paycheck and provides a self-addressed stamped envelope.

PAY PERIODS

Hours worked from the 1st through the 15

th will be paid on the last day of the month;

hours worked from the 16th

through the last day of the month will be paid on the 15th

of the following month. Should a scheduled payday fall on a Sunday, pay checks

may be distributed on the preceding Saturday. IN THE EVENT OF RESIGNATION

OR TERMINATION, checks will be distributed on the regular pay schedule. Pay

checks WILL NOT be distributed prior to established pay days.

Example:

Any hours worked February 1st thru February 15

th will be paid to you on

February 28th

(the last day of the month), and any hours worked February 16th

thru

February 28th

will be paid to you on March 15th

.


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PERIPHERAL NERVE CATHETER/PUMP

PURPOSE

The utilization of the Peripheral Nerve Catheter is an excellent postoperative pain

relief system for patients that have recently had shoulder, knee, ankle, leg, or arm

surgery. The continuous peripheral nerve infusion through a catheter provides a

continuous infusion of local anesthesia for pain control.

GUIDELINES

A prescribing physician will order a peripheral nerve catheter/pump with a

determined flow rate of medication to be used for controlling postoperative pain.

When using the bolus button, an extra dose of medication is delivered to the body.

This option allows for the management of breakthrough pain on an individual level.

Side effects – Ringing in ears, blurred vision, confusion, skin rash/hives,

bleeding, mouth or tongue numbness or tingling, dizziness or lightheadedness,

drowsiness, heart arrhythmias, risk of injury d/t weakness/numbness. Stop the

infusion system by clamping the system and notify the physician of

temperature greater than 101 degrees, excessive pain at nerve catheter

insertion site, increased numbness or weakness in extremity after flow rate has

been decreased or after pump has been stopped/removed or if any of the above

side effects are noted.

Patient education – review the purpose for using the pump, how to

administer bolus dose for pain control, and potential side effects. Remind the

patient to use assistive devices (i.e. walker, crutches, wheel chair, etc.) or staff

assistance due to the risk of falling associated with extremity

numbness/tingling sensation.

Infusion Device – protect the medication reservoir from sunlight and heat.

Do not immerse the infusion device in water. Do not shower or take a bath

while the device is in use; a sponge bath is permissible.

In order to prevent infection, do not remove the clear dressing that is covering

the catheter site until you are ready to remove the catheter. If the dressing


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should become lose or come off, reinforce the current covering or place a new

dressing over the catheter insertion site.

End of Infusion – the infusion is complete when the pump is no longer

inflated and a hard tube is noted in the middle of the pump. The pump is

disposable and cannot be refilled.

Removal of catheter –

o Wash hands

o Turn infusion off by clamping the tubing

o Remove the dressing and Steri-strips

o Slowly remove catheter (it should come out easily with a gentle tug), if

you meet resistance, stop and contact the physician

o Examine the catheter to be sure that the catheter is intact, if not,

contact the physician

o You may apply adhesive band aid or leave uncovered in no drainage is

noted after catheter is removed

o Call the physician if bleeding or swelling occurs

o Place infusion device, catheter and dressing in a plastic bag and place

in trash container


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Pharmacy (AmPharm)

GENERAL INFORMATION

AmPharm, Inc. is the pharmacy provider for THM managed facilities. Services

provided by Ampharm include:

o Pharmaceutical Services

- Medication Dispensing

- Order Processing

- Prospective Drug Utilization Review

- Formulary Compliance

- Medical Records and other computer services

o Billing Services

- Medicare Billing for appropriate services

- Private Insurance Billing

o Consulting Services

- Drug Regimen Review

- Nursing In-services

- Medication Destruction

o Other Services that are provided/assisted with:

- Enteral Feedings and Supplements

- House Stock Supplies

- Catheter and Colostomy Products

- Influenza and other vaccinations

(Note: This list is not all inclusive, but just examples of services that are provided)

CONSULTANT PHARMACIST

Your facility’s consultant pharmacist will conduct a drug regimen review monthly

and perform drug destruction with the DON or designee as needed. Nurse

management must call to schedule a visit for drug destruction.

As a part of the drug regimen review the consultant may review diagnosis, formulary

issues, drug interactions and other irregularities. Other focuses that will be performed

on a rotating basis include:

Weight Loss PRN Medications

Multiple Medications Necessary Lab Monitoring

Psychoactive Therapies Coumadin Monitoring


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Insulin Monitoring

The consultant pharmacist is also available to assist with in-services as needed.

Physician recommendations/suggestions must be communicated to the physician.

Any changes must be entered as orders into Vision. This process must be completed

within ten (10) business days to remain in compliance. The DON must maintain the

drug regimen review list in a date sequence file. They must be readily available as

the survey team will review with their annual visit.

Other functions that may be performed monthly by a pharmacy representative

include:

- Nursing Station Review

- Medication Prep Room Inspection

- Inspection of Emergency and Night Box

FORMS AND SUPPLIES

Some Tennessee Health Management forms are to be ordered from AmPharm. The

library website lists all forms either as “Facility Printable” forms or “AmPharm

Forms”. Forms that are supplied by AmPharm should not be photocopied.

BACK-UP PHARMACY

AmPharm contracts with a local pharmacy in the community where each facility is

located to provide medications in an emergency situation. If applicable, AmPharm

will bill patient’s insurance for any back-up pharmacy charge. The facility will be

billed by AmPharm for any back-up pharmacy charges not covered by insurance.

The charge nurse should check the facility’s night box for starter dose. If medication

is not available in the night box, the medication should be ordered from the back-up

pharmacy quantity sufficient until the next scheduled AmPharm delivery. The Back-

Up Pharmacy Log (Form 4223) must be completed to record the med order and the

reason.


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BACK-UP PHARMACY LOG (FORM 4223) REVISED

7/27/07


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Physician’s Progress Notes

PHYSICIAN PROGRESS NOTES (FORM 4148) REVISED

12/02/04

General Information

The physician must take an active role in supervising the care of his/her patients.

Their physician visit should not be a superficial visit. The progress note should

include an evaluation of the patient’s condition and a review of and decision about the

continued appropriates of the patient’s current medical regimen.

Requirements

1. The physician must review the patient’s total medical regimen, including

medications, treatments, and plan of care.

2. The nurse making rounds with the physician should have available

Physician’s Progress Notes (Form 4148) for the physician and request and

encourage the physician to address newly identified physical, mental,

emotional and nutritional problems of the patient or the progress of previously

identified problems. (Please include accidents, weight loss/gain, pressure

ulcers, and/or any skin problems.)

3. “Condition same” or “No change” is not acceptable. Note should be pertinent

to patients actual condition. This documentation helps to paint a clearer

picture of the patient.

4. Progress notes must be written every 30 days x 120 days and then every 60

days thereafter, preferably on day of re-certification.

5. Whenever the physician’s visit is due during a period when the patient is

absent from a nursing facility, i.e., in the hospital or on therapeutic leave, the

physician must visit the patient within 3 days of his/her return to the nursing

facility.

6. The physician should write all dates on any of the above areas. Dates must

NEVER be typed.


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Pneumonia guidelines

PURPOSE

To improve patient clinical outcomes by reducing avoidable hospital readmission

within 30 days of admission to the skilled facility.

GUIDELINES

The Pneumonia (PNE) INTERACT Care Path Version 3.0 Tool

(http://interact2.net/docs/INTERACT%20Version%203.0%20Tools/Decision%20Sup

port%20Tools/Care%20Paths/Care_Path_LOWER_RESPIRATORY_INFECTION%

20Dec%2029%202012%20revised.pdf) is an evidence-based interdisciplinary quality

improvement program. It is designed to assist the facility with “early identification,

evaluation, management, documentation, and communication about acute changes in

condition” in long term care patients (INTERACT Implementation Guide, 2011).

The Care Path is also intended to aid in the prevention of re-hospitalization for

patients admitted to the facility with a hospital discharge diagnosis of Pneumonia.

DECREASE THE RISK OF PNEUMONIA

The physician will provide a treatment regimen specific to the patient’s needs, based

on assessment findings. The Influenza (offered during the specified flu season, as

recommended by CDC) and the Pneumococcal vaccinations are important prevention

measures in reducing the development of Pneumonia. A second dose of the

Pneumococcal vaccination is recommended for people of 65 years and older who get

their first dose when they were younger than 65 and it have been 5 or more years

since the first dose.

“See Tab I of the DON Manual for instructions related to vaccination administration

and documentation.” Complete the AmPharm Vaccine Form and submit to

AmPharm as vaccinations are completed (this form is provided by AmPharm). In

completing the scheduled MDS assessment, the MDS Coordinator can identify

outlying patients that have not received/ been offered the Influenza and

Pneumococcal vaccinations.

Other factors to consider (list not all inclusive):

http://interact2.net/docs/INTERACT%20Version%203.0%20Tools/Decision%20Support%20Tools/Care%20Paths/Care_Path_LOWER_RESPIRATORY_INFECTION%20Dec%2029%202012%20revised.pdf




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Good oral hygiene

Proper nutrition

Avoid or lower doses of drugs that will decrease alertness

Treatment of underlying illnesses

Smoking cessation

Change in Patient Condition/Plan of Care

Detecting and reporting a change in patient condition is essential to assure quality

patient centered care outcomes. The Interdisciplinary Team will provide education to

the patient/responsible party regarding the patient’s current health status to assist in

developing/modifying a plan of care that will achieve the patient’s desired goal(s).

CNAs/caregivers will notify the charge nurse of any change in the patient

condition.

The nurse will assess the patient and implement appropriate nursing

interventions; following the INTERACT Care Path for Lower Respiratory

Infection (vital signs will be monitored as ordered) or as specified by the

practitioner.

Symptoms or Signs for Pneumonia:

o New or worsened cough

o New or increased sputum production

o New or worsening shortness of breath (Refer to INTERACT

Shortness of Breath Care Path)

o Chest pain with inspiration or coughing

o New or increased findings on lung exam (rales, wheezes, etc.)

o Fever

o Change in physical, cognitive, or functional status

Complete the SBAR tool to improve communication with the practitioner.

Notify the practitioner according to the INTERACT Care Path for Lower

Respiratory Infection or as needed.

Document assessment findings and implementation of treatment regimen in

the patient’s medical record (consider requesting a substitution when the

ordered medication(s) is not readily available for administration).

Discharge Planning: Discharge planning should begin on the day of admission. The process must be an

interdisciplinary approach to coordinate and ensure continuity of care and to ensure

that a safe and healthy environment is arranged for the patient. The key to a

successful discharge is to remain flexible. Discharge planning is a process and is ever

changing, as are the needs of the patient.


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Special equipment needs of the patient must be considered prior to discharge and

plans for home health or other follow-up care arranged.


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References:

American Lung Association. Prevent Pneumonia. Retrieved March 5, 2013 from:

http://www.caring-for-aging-parents.com/pneumonia-elderly.html

Centers for Disease Control and Prevention. Pneumococcal Polysaccharide Vaccine.

Retrieved March 5, 2013 from: http://www.cdc.gov/vaccines

Interventions to Reduce Acute Care Transfers. Retrieved February 27, 2013 from:

http://www.interact2.net/[email protected]&_hsmi=BE573758&_hs

h=af3a3bb24d083db779b32687029037c5&utm_campaign=EmailMarketing_

Email+Interact+II+Announcement_20121004

Kilgore, C. (2007). Address Nursing Home Pneumonia on Site if Possible. AMDA:

Caring for the Ages. Retrieved from:

http://www.caringfortheages.com/news/geriatric-medicine/single-

article/address-nh-pneumonia-on-site-if-

possible/e45607213d846015885efcb27690fc90.html

Oklahoma Foundation for Medical Quality, Inc. National Pneumonia Medicare

Quality Improvement Project Literature Review July 2010 Update.

http://www.caring-for-aging-parents.com/pneumonia-elderly.html

http://www.cdc.gov/vaccines

http://www.interact2.net/[email protected]&_hsmi=BE573758&_hsh=af3a3bb24d083db779b32687029037c5&utm_campaign=EmailMarketing_Email+Interact+II+Announcement_20121004



http://www.caringfortheages.com/news/geriatric-medicine/single-article/address-nh-pneumonia-on-site-if-possible/e45607213d846015885efcb27690fc90.html




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Pneumococcal Vaccine

GENERAL INFORMATION 9/2014

The pneumococcal vaccine is offered to all patients who are 65 years of age

and older.

During the admission process, information is obtained as to the status of

immunization against the pneumococcal disease. If the pneumococcal vaccine

has not been administered, or there is no record of administration, consent is

obtained, if not medically contraindicated, for the pneumococcal vaccine to be

administered. Patients have the right to refuse the vaccine and it must be

documented.

Follow the Flu/Pneumonia Vaccine process in Vision, documenting as

applicable. . Refusals of the vaccine must be documented.


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POLICY & PROCEDURES

DEVELOPMENT

Policies and procedures are developed by the management office.

REVIEW AND/OR REVISION

Review and/or revision of policies and procedures are necessary to stay

current with changes in the healthcare industry, management philosophy,

governing regulations or laws, and evidence based best practices.

Policies and procedures are reviewed and/or revised as needed and annually at

a minimum. The Chief Operating Officer designates the persons to serve on

the review/revision committee. All policy and procedure revisions are

reviewed for approval by the Director of Clinical Services and the Chief

Operating Officer. The Medical Director of the facility is to review the

policies and procedures of the facility at least annually. Any revision of

policy is completed at the management office level and distributed to the

individual facilities.

Staff affected by revisions of policies and procedures receive education to the

change by in service training and/or external educational seminars.

We welcome suggestions or recommendations that would be beneficial to our

facilities in meeting compliance as well as assist us in delivering quality care and

services to our patient and the community. The suggestions and/or recommendations

should be in written form, signed and dated, and submitted to the Director of Clinical

Services of the Management Company. On review, a decision will be made and

notification will take place.

We ask that you not alter, revise or in any way change the facility's policies and

procedures without the appropriate authorization. Always communicate with your

regional team if any clarification is required regarding the adopted policies and

procedures.


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Pool Time Record

INTER-COMPANY POOL TIME RECORD (FORM 4216) REVISED 8/05/04

Should you find your facility in the unfortunate position of having to use inter-

company pool help, the Inter-Company Pool Time Record Form must be completed

to effect proper payment.


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POST – Physician Orders for Scope of Treatment

PURPOSE (1/28/14)

The POST form is a standardized form containing orders by a physician who has

examined a patient regarding that patient’s preferences for end of life care.

Admission Coordinators and/or Social Service Directors can complete the POST form

with the patient and/or responsible party during the admission process. Upon

completion of the form, the POST form must be signed by a physician to be valid (a

verbal order can be obtained until the physician can sign the POST form).

The form provides a clear path of the patient’s or responsible parties wishes, to the

clinical staff when a patient demonstrates a change in condition. Section A includes

Cardiopulmonary Resuscitation (CPR) orders. Should the patient show signs of

cardiopulmonary arrest, the clinician will follow the CPR order. If a patient has

chosen CPR to be implemented, the clinician should begin CPR upon finding the

patient in a cardiopulmonary crisis. The form also addresses Medical Interventions;

Antibiotics; Medically Administered Fluids and Nutrition; allowing the patient and/or

responsible an opportunity to be involved in creating their advanced care plan. If a

section of the POST form is left incomplete or has not been signed by the physician,

full treatment for the section(s) should be implemented. For more information, visits

the following website: http://health.state.tn.us/AdvanceDirectives/PDFs/PH-4193.pdf

http://health.state.tn.us/AdvanceDirectives/PDFs/PH-4193.pdf


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Postings, Required Employee

The following required postings are to be located in an area visible to all employees.

Normally these are posted in the area where time clock is located. The Administrator

is responsible to ensure that these are posted as required.

1. The complete Compliance Poster to include the following:

a. EEOC

b. Fair Labor Standards Act

c. Employee Polygraph Protection Act

d. FMLA

e. Your Rights Under USERRA (uniform services employment and

reemployment act)

f. OSHA (It’s the Law)

2. Reporting Fraud and Abuse (Compliance Line Phone Number)

3. Harassment Policy

4. Worker's Compensation (Name of Insurance Company, Who is in charge

at the facility level) (LB-0922)

5. Unemployment Insurance for Employees

6. Rule Out Workers' Compensation Fraud

7. Child Labor Law

8. Employee Choice of Physician (Employee Injury)

9. Statement to notify employee the date payroll checks will be available;

this notice is also posted in another area visible to employees.

10. OSHA form 300A (summary of work-related injuries and illnesses must

be posted from February 1 through April 30 in the year following the year

the log covers)

11. TOSHA (It's the Law)


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Pregnancy/Maternity Leave

(See “Leave of Absence” under “Employee” Section E of this Manual).


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Probationary Period

(See “Employee” in Section E of this Manual).


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Profit Sharing Plan (401)(k)



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Promotions & Transfers



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PPS – Prospective Payment System

(See “Skilled” in Section S of this Manual).


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Purchase Request

OVERVIEW

Purchase Requests are to be submitted by the Administrator and approved by the

Management Office prior to the purchase of items that will cause you to be over

budget. In an emergency, a verbal approval from the Regional Administrator,

Director of Clinical Services, or Chief Operating Officer, followed by a formal

purchase request is permissible.

It is of utmost importance that you communicate with your Administrator on a

weekly basis the needs of your nursing department in relation to supplies. Submit

invoices to the Administrator timely of all nursing supply orders. More information

regarding nursing supply budgets can be found in Section S of this Manual.


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PURCHASE REQUEST (FORM 2011C) REVISED 10/5/04

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