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