Archive for 'MDS Minute'

Prepare Yourself & Your SNF Staff for MDS 3.0 Change Management

Posted on 29. Nov, 2009 by .

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Juggling too much at once? Master these 2 inside secrets to saying ‘No’ in an affirmative way.

Most nursing homes are tackling a growing mound of new initiatives, which means you may be routinely getting requests to go above and beyond the usual call of duty. And that can eventually lead to overload, if you aren’t careful.

The answer: Learn to say No in a way that allows you to maintain optimal performance and also puts you in a positive light.

The big pitfall: “People who don’t have boundaries about what they are willing to do and always say Yes are the ones who end up taking on more and more,” cautions Sara Joffe, national director of training and organizational development for PHI in Bronx, N.Y., an advocacy organization for nursing home direct-care staff. (more…)

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MDS 3.0 Quick Start Tip

Posted on 29. Nov, 2009 by .

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Here’s what your facility can do now without having to backtrack later.

Talk about frustrating: The final MDS 3.0 is out, but CMS strongly advises facilities to hold off on MDS 3.0 training until after the agency conducts its train-the-trainer sessions next spring.

So how can you comply without falling behind in preparing for the new assessment instrument?

Focus on the big picture, advise MDS experts. People can begin to get familiar with the MDS 3.0 without get into the “final detailed training,” says Rena Shephard, MHA, RN, RAC-MT, C-NE,founding board chair and executive editor for the American Association of Nurse Assessment Coordinators. For example, take a look at the changes in assessments themselves and when they have to be done, she suggests.

For more detailed tips on how to prepare now, see MDS Alert, Vol. 7, No. 13, available online immediately when you subscribe— AND check out this exciting MDS 3.0 audio conference!

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MDS F Tag Alert: Compare Sections F & E To Spot Trouble

Posted on 23. Nov, 2009 by .

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Follow this simple protocol to spot trouble brewing for a resident.

The MDS should paint a consistent picture of the resident. So if you see a resident coded in Section F as having recently lost a close family member or friend, take a look at Section E to see if the staff captured any mood or anxiety indicators in E1, or behavioral symptoms in E4. If not, take a closer look.

“You wouldn’t expect someone to have a significant loss without some manifestations of anxiety or sadness,” observes Sue LaBelle, RN, MSN, a senior healthcare specialist with PointRight Inc. in Lexington, Mass. Thus, PointRight includes in its MDS integrity audit a flag that detects a discrepancy between Section F and E.

“The staff may have missed certain behavioral changes or they may have seen them but didn’t document them,” says LaBelle.

When the resident has experienced a significant loss, the team should be on the lookout for how that’s affecting the resident in terms of mood and sleep patterns, as examples, says LaBelle. Next: Survey heads up … (more…)

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Birth Announcement: Final MDS 3.0

Posted on 15. Nov, 2009 by .

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The final MDS 3.0 debuted on Oct. 29, although sans the RAI User’s Manual. But don’t worry — the Centers for Medicare & Medicaid Services says the instruction manual is coming soon.

“CMS was committed to publishing the MDS 3.0 item set, the data specs and the RAI User’s Manual by the end of October — they succeeded with two out of three,” says Rena Shephard, MHA, RN, RAC-MT, C-NE, founding chair and executive editor for the American Association of Nurse Assessment Coordinators, and president, RRS Healthcare Consulting Services in San Diego. “It was critical for the software vendors to get the data specs,” which they did, adds Shephard.

The MDS 3.0 is scheduled to go into effect on Oct. 1, 2010. Next: When will we see the RAI Manual? (more…)

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Prevent Burnout as MDS 3.0, RUG-IV, RAC Readiness & More Heat Up

Posted on 02. Nov, 2009 by .

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Juggling Too Much at Once? Try These 5 Savvy Job-Enhancing Strategies

The saying about having so much to do and so little time to do it has never held more true. That’s why ramping up your time management techniques at work may be one of the smartest career moves you can make these days.

The bottom line: “If you don’t take control of your job, it takes control of you and you will become ineffective,” cautions Marilyn Mines, RN, RAC-CT, BC, manager of clinical services for FR&R Healthcare Consulting in Deerfield, Ill. These strategies can help you make the most of your efforts:

Strategy No. 1. Do an inventory. Step back and look at where you’re spending your time and energy at work, suggests Francis Battisti, a social worker and nursing home consultant in Binghamton, N.Y. “Ask if it’s worthwhile or are you spinning your wheels? For example, if you’re trying to change someone’s behavior, step back and ask if they did something their way, would that be OK?” If so, put your energy into something where the outcome makes a difference.

Also take a look at whether you’re hitting your key deadlines, such as getting the MDSs completed on time or documenting care with enough detail to pass muster with auditors. If you’re not keeping up, take a look at whether you need to work smarter — and/or need better systems or resources to keep everything running smoothly. For example, if you have an “outlier” on the MDS team who always turns in her sections late, there should be a process for dealing with that behavior, Battisti says.

Beware this trap … (more…)

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SNF Medication Review QI: Residents Taking 9 or More Meds

Posted on 26. Oct, 2009 by .

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4 ways to keep adverse drug reactions at bay.

Ensuring medications help rather than cause harm can be tricky when caring for nursing home residents with multiple co-morbidities. That’s why a resident triggering on the QI for use of nine or more different medications definitely needs review.

Run the numbers: “If a person takes nine or more meds, he’s statistically 100 percent certain to have an adverse drug reaction,” cautions Russell Jenkins, MD, an internist and a board member of the Institute for Safe Medication Practices.

Thus, the QI provides a safety net or threshold for detecting residents in potential jeopardy; however, facilities should monitor residents’ meds and related outcomes in real time. Experts suggest these key strategies.

1. Review medications at admission and periodically. The clinician should ask if there’s a good reason for not stopping each medication, advised Matthew Wayne, MD, CMD, in a presentation at the March 2009 American Medical Directors Association meeting. And even if the drugs all have appropriate indications, look to see “whether the aggregate of the medications is causing nausea or drug-drug interactions,” advises Harold Bob, MD, CMD, a nursing home and hospice administrator in Baltimore. Medication-related nausea or gastrointestinal distress can lead to appetite loss — a key factor in triggering a downward spiral, Bob cautions. That’s especially true for people with dementia, he adds. (more…)

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3 Ways SNFs Can Head Off Hospital-Acquired Pressure Ulcers

Posted on 19. Oct, 2009 by .

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Synching wound care efforts with the hospital helps keep residents’ skin in the clear.

Cooperation is the name of the game for nursing homes and hospitals that want to make sure that elderly patients don’t develop pressure ulcers in either setting. These key strategies can do the trick.

1. Coordinate wound assessment and documentation with the hospital. A physician or nurse manager in the hospital needs to certify the status of the patient’s wound when he goes to the nursing home, says Marty Pachciarz, RN, RACCT, a consultant with The Polaris Group in Tampa, Fla. And the nursing home needs to do the same when the patient is admitted from the hospital. Both care settings should use the same wound terminology and staging parameters.

That way, if the nursing home identifies suspected deep tissue injury (DTI) at admission — or the resident’s skin breaks down within a few days to a stage 3 or 4 pressure ulcer — the hospital can use that information for QA purposes, says Pachciarz. Perhaps the hospital can trace the problem back to a particular unit or to a specific type of surgery where the OR needs to be more proactive to prevent skin breakdown. (more…)

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Survey Risk Management: Hospice Patient With Skin Breakdown

Posted on 12. Oct, 2009 by .

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Use these parts of the MDS form to communicate clearly with surveyors, auditors.

Providing good skin and wound care for a resident on hospice is one thing, but you have to be able to show surveyors and other auditors that you did.

Start by keeping the nursing home and hospice plans of care in lockstep. A mismatch between the plans could get the F tags flying (or the L tags for hospice).

Must do: “The Conditions of Participation for both SNFs and hospices require that the care plans for both providers “correspond to each other,” says Harold Bob, MD, CMD, a medical director for nursing homes and hospices in Baltimore, Md.

The care plan should reflect the patient’s and family’s input and goals. And the record should show evidence that the nursing facility and hospice providers discussed the plan with the patient’s routine healthcare providers, adds Bob.

Ask Physicians to Document Proactively

Spotty physician documentation can leave the facility in the lurch come survey time. For example, the physician notes should spell out the rationale for the care plan and expected outcomes. (more…)

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Boost Immunization Rates and Capture Them in Section W

Posted on 05. Oct, 2009 by .

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Protect residents against flu and pneumococcal infection, and get credit for it.

Are your long-term care patients up to date with their pneumococcal vaccinations? The answer has become more important than ever now that the Centers for Disease Control & Prevention has confirmed that bacterial lung infections and H1N1 flu make for a dangerous combination.

To examine what role bacterial co-infection may be playing in the current H1N1 flu pandemic, CDC researchers looked at 77 postmortem lung specimens from patients who died this year from H1N1. “Evidence of concurrent bacterial infection was found in specimens from 22 (29 percent of the 77 patients, including 10 caused by Streptococcus pneumoniae (pneumococcus),” states the September 29 MMWR. (more…)

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Tackle 2 Tasks When Reviewing Clinical Records for MDS Assessments

Posted on 27. Aug, 2009 by .

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We show play-by-play how to use MDS for QA — & catch cracks in the system before it’s too late.

Doing the MDS provides an ideal time to perform QA checks that can help prevent resident harm, not to mention staff and facility liability.

A real-life example: Attorney Jennifer Gimler Brady knows of a situation in which an LPN failed to notify the physician about a diabetic patient’s elevated blood glucose readings. The LPN obtained and recorded the intermittently high blood glucose readings over a number of weeks, giving the oral diabetic medication as ordered. The facility discovered the omission and treated it as a disciplinary and counseling matter. Once notified, the physician tweaked the resident’s medication, which alleviated the high blood sugars, says Brady, with Potter Anderson & Corroon LLP in Wilmington, Del.

AUDIO: Documentation essentials for short-stay LTC residents.

Some time later, regulators discovered the error during an audit and referred the matter to the Medicaid fraud control unit. And when the investigators talked to the director of nursing, their focus began to shift to — ”Why didn’t you pick up on this?” Brady says. (more…)

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