Transcript Slide 1

1
Addressing Outcomes– Results & OASIS training
CMS - Therapy Documentation Changes
MedX - Procedures & Policy
Anticoagulation Safety in Homecare
UPDATES & REMINDERS
Face To Face Encounters
Discharge Planning
Case Conference
Equipment Cleaning
CPR
2

SEE ATTACHMENT
3



(M1730) Depression Screening: Has the
patient been screened for depression, using a
standardized depression screening tool?
⃞ 0 - No
⃞ 1 - Yes, patient was screened using the
PHQ-2©* scale. (Instructions for this twoquestion tool: Ask patient: “Over the last two
weeks, how often have you been bothered by
any of the following problems”)
4


(M2250) Plan of Care Synopsis: (Check only one box in each row.) Does the physician-ordered plan of care
include the following:
a. Patient-specific parameters for notifying physician of changes in vital signs or other clinical findings
◦
◦
◦
◦


⃞0
⃞
1
⃞na
Physician has chosen not to establish patient-specific parameters for this patient. Agency will use
standardized clinical guidelines accessible for all care providers to reference
b. Diabetic foot care including monitoring for the presence of skin lesions on the lower extremities and
patient/caregiver education on proper foot care
◦ ⃞0
◦ ⃞1
◦ ⃞na
◦ Patient is not diabetic or is bilateral amputee
c. Falls prevention interventions
◦
◦
◦
⃞0
⃞
1
⃞na
Patient is not assessed to be at risk for falls
5


(M2250) Plan of Care Synopsis: (Check only one box in each row.) Does the physician-ordered plan of care
include the following:
d. Depression intervention(s) such as medication, referral for other treatment, or a monitoring plan for current
treatment
◦
◦
◦
◦

e. Intervention(s) to monitor and mitigate pain
◦
◦
◦
◦


⃞0
⃞
1
⃞na
Patient has no diagnosis or symptoms of depression
⃞0
⃞
1
⃞na
No pain identified
f. Intervention(s) to prevent pressure ulcers
◦ ⃞0
◦ ⃞1
◦ ⃞na
◦ Patient is not assessed to be at risk for pressure ulcers
g. Pressure ulcer treatment based on principles of moist wound healing OR order for treatment based on moist
wound healing has been requested from physician
◦
◦
◦
◦
⃞0
⃞
1
⃞na
Patient has no pressure ulcers with need for moist wound healing
6


(M2400) Intervention Synopsis: (Check only one box in each row.) Since the previous OASIS assessment, were
the following interventions BOTH included in the physician-ordered plan of care AND implemented?
a. Diabetic foot care including monitoring for the presence of skin lesions on the lower extremities and
patient/caregiver education on proper foot care

⃞0

⃞1

⃞na

Patient is not diabetic or is bilateral amputee

b. Falls prevention interventions

⃞0

⃞1

⃞na


Formal multi-factor Fall Risk Assessment indicates the patient was not at risk for falls since the last OASIS
assessment
c. Depression intervention(s) such as medication, referral for other treatment, or a monitoring plan for current
treatment

⃞0

⃞1

⃞na

Formal assessment indicates patient did not meet criteria for depression AND patient did not have diagnosis of
depression since the last OASIS assessment
7

(M2400) Intervention Synopsis: (Check only one box in each row.) Since the previous OASIS assessment, were
the following interventions BOTH included in the physician-ordered plan of care AND implemented?

d. Intervention(s) to monitor and mitigate pain

⃞0

⃞1

⃞na

Formal assessment did not indicate pain since the last OASIS assessment

e. Intervention(s) to prevent pressure ulcers

⃞0

⃞1

⃞na

Formal assessment indicates the patient was not at risk of pressure ulcers since the last OASIS assessment

f. Pressure ulcer treatment based on principles of moist wound healing

⃞0

⃞1

⃞na

Dressings that support the principles of moist wound healing not indicated for this patient’s pressure ulcers OR
patient has no pressure ulcers with need for moist wound healing
8
9
10



Release is April 1, 2011
Per Healthwyse, updates to
documentation will be
available at this time
A qualified therapist
(PT/OT/ST) must perform at
30 day service or the 13th visit,
again at the 19th visit to write
up a functional reassessment


PTA and COTA cannot make
functional assessment visits at
30 day, 13th visit or 19th visit.
Reassessment must include
summary of care, functional
reassessment, and progress
patient has made toward 60day Medicare episode.
11




Assessment is clinical
judgment that examines
objective data
1. Gait: Must describe qualitywhat deficits you are seeing
and why you are indispensible
for that gait analysis
2. Tasks: Tasks should be
individualized: Do not put
IADLS and ADLs; what are each
of them specifically?
3. Oral Motor: What does 6580% improved mean to the
patient’s function?


Movement away from quantity
and move toward quality of
functional tasks that are
meaningful to patient in their
home. (more free text)
Overall: In every visit, from
first one to last, determine
each time “why” the patient is
being seen. If that question
does not have a clear answer,
the plan of care needs to be
reassessed.
12



Policy is in review and will be available online
soon. You will be notified when available.
MEDX manual available today for all
therapists.
Key components of policy:
◦ Therapist must complete competency on this
modality prior to using.
◦ Order must include settings for duration, Joules,
pulsing, and console setting.
◦ Cleaning log is required each Monday. MEDX
cleaning log available online –See Intranet.
13




MUST put into 485 careplan.
Example:
Intervention: PT to assess patient’s
pain and use MedEx to decrease
patient’s pain while improving
household mobility.
Goal: LTG: Patient to ambulate
modified independently 150’ out to
car using walker and pain <3/10 in R
knee.




The Cleaning Logs:
MedX cleaning logs must be cleaned
after each patient use.
MedX cleaning logs must be emailed
of faxed to Mike Kerry every Monday
and even if you DID NOT use, must
write “not used for week of ‘x’” and
turn that sheet in every Monday.
[email protected]
Mike Kerry has Operating Guide and
Treatment Manual in his office in
Supplies.
Must put protocol that is in the 485
under the “exercise” tab.
14


An Estimated 3Million People in the US oral
anticoagulant therapy annually.
Anticoagulation Therapy is delivered as Short
Term (6 weeks or less) or Long Term
( frequently an indefinite timeline.)
15

Adverse Events Related to inadequate or
excessive coagulation include:
◦
◦
◦
◦
◦
◦
CVA
PE
DVT
VTE
Hemorrhage
GI Bleed
16

The following Risk Factors may pre-dispose a
patient for bleeding and should necessitate
additional monitoring while on OAT.
◦
◦
◦
◦
◦
◦
◦
Age 65 or older
History of CVA
History of GI Bleed
Recent MI
HCT <30%
Creatinine over 1.5mg/dL
Diabetes Mellitus
17

Other Factors that may influence the
therapeutic window include:
◦
◦
◦
◦
◦
◦
◦
◦
◦
Other medications
Concurrent medication changes
Renal function
Body Weight
Age
Dietary Habits
Alcohol Consumption
Smoking Habits
Temperature Changes
18

Generally Accepted TARGET INR based on DX.
Indication
INR Range
Target INR
Prophylaxis of Venous Thrombosis, Tx of Thrombosis,
TX embolism, Prevention of Embolism, AMI to prevent
systemic embolism, Non mechanical Heart Valves,
Afib,
2.0-3.0
2.5
Mechanical Valves, AMI to prevent recurrence, Certain
thrombosis and antiphospholipid syndrome
2.5 -3.5
3.0
Bi-leaflet Mechanical Valve in Aortic Position
2.0 -3.0
2.5
Orthopedic (THR,TKR,)
1.5 – 2.5
1.9
19

Vegetables

Meats
◦
◦
◦
◦
◦
•
•
•
•
•
Broccoli
Cabbage
Brussel sprouts
Green onions
Avocado

Leafy Greens

Other
◦ • Beef liver
◦ • Pork liver
◦
◦
◦
◦
◦
◦
◦
◦
•
•
•
•
•
•
•
•
Iceberg lettuce
Green leaf lettuces
Spinach
Turnip greens
Parsley
Endive
Kale
Collard greens
◦
◦
◦
◦
•
•
•
•
Mayonnaise
Margarine
Canola Oil
Soybean Oil
20


Ibuprofen
◦
◦
◦
◦
◦
◦
◦
◦
• Advil®
• Midol®
• Excedrin IB®
• Motrin®
• Haltran®
• Nuprin®
• Mediprin®
• Pamprin HB
naproxen
◦ • Aleve
◦ • Anaprox
◦ • Naprosyn
®
®
®




ANY PRODUCT THAT
CONTAINS ASPIRIN.
cimetidine
◦ • Tagamet HB®
famotidine
◦ • Pepcid AC®
Herbal Products
◦
◦
◦
◦
◦
danshen
ginseng
garlic
green tea
ginkgo
kava kava
21



The Safety and Effectiveness of OAT depends
critically on maintaining the INR within a narrow
therapeutic window.
Due to the importance of this therapeutic
window, NGHHC requires strict adherence to this
policy surrounding use of the INRatio devise.
NGHHC requires that PT/INR that are completed
with the INRatio machine have laboratory
validation if:
 The results are greater than 4.5
 The results are less than 1.5
22

The Role of the Clinician…
◦ Review SOC Call log from Intake. F2F information
will be found in this call log.
◦ If a F2F appointment is needed – work with your
patient to schedule.
◦ Communicate to your CC when the appointment is
scheduled.
◦ Patient’s must understand without this appointment
and documentation of the appointment ~ Medicare
services will end.
23




CPR that is approved by the American Heart
Association/ American Red Cross is required
by 3/31/2011. See Melinda Jewell if you want
to sign up for a session at NGHHC.
Case Conferences Due every 30 days.
Discharge Planning should be in every SOC
narrative and at least weekly in your note.
Equipment Cleaning Logs ( MEDX. PT/INR)
due every Monday.
24




All Skilled Staff
Thursday, May 19th
Pre-work on Nightingale University will be required
prior to attending.
Skills “check off” will be scheduled individually
Beginning May 02nd.

25