PIN CAH CMS Standards Review
Corrected Conference Call Notes
Call: May 25, 2011
Tag C 395, Comprehensive Care Plan for Each Resident (swing beds)
Big Sandy: Holds a regular care planning meeting for each resident; invitations sent out 1 week in advance of the meeting (their ALOS for swing is ~ 1 week)
· Have a roster that all attendees sign in on, including the provider
· Rosters kept in each resident’s chart
· If an out-of-state family member wants to participate, they set up a conference call for them
· If unable to attend, receive a summary of what happened
NVH Nurse meets with the resident and family, preferably same day as admission (ALOS: 6 d)
MDMH: Most of their residents stay in swing less than 1 week
· The discharge plan includes functional goals, like a care plan
· White board in each resident’s room lists members of the IDT and the resident’s discharge/functional goals
Tag C 396, Plan Completed by IDT within 7 Days of the Comprehensive Assessment
Barrett: If resident has a longer stay:
· Care plan meeting is held every 2 weeks; the provider is expected to attend
· Evaluate resident’s progress
· Evaluate if additional/other services needed
· Manage family’s expectations for the resident
· Discharge planner schedules the meetings and time out of office for doc to attend
· Have difficulty with physician’s saying they ‘don’t have time to attend’
Big Sandy: Doesn’t ask provider to attend each care plan meeting; only when really need them there
· Most of their swing bed residents are skilled patients, therefore, per their policy, are seen once a week by the provider; can be seen daily if needed
· Medicare requires the residents to be seen at least once a month, but they have found resident issues tend to fall through the cracks if not seen more frequently
MDMH: Most of their residents stay in swing less than 1 week
· Social services and rehab staff round with the provider; are the primary communicators between the resident, provider and family about care plan and discharge issues
NVH: Has a hospitalist; under contract, he/she must be available and attend these meetings
Tag C 398, Services Are Provided or Arranged by Qualified Personnel, According to Care Plan
NVH: If the resident is receiving skilled care: the IDT rounds every morning
· Care plan goals are written on the MAR and nurse initials as they are completed
· Head nurse’s job is to ensure the care plan is implemented
· Rehab staff check off functional goals as they are achieved
Errors in medication administration?
Barrett: Does conduct random observations of med pass to see if nurse uses 2 identifiers
NVH: Use a Pyxis; it monitors all dispensing
· Pharmacy reviews all dispensed drugs
· Nursing conducts a 24 hr chart review for transcription errors
MDMH: Went live May 1st with a new eMR (Cerner, ‘RxStation’) which has enabled:
· Barcoding patient identification bands and medications when received in pharmacy
· Patient ID is scanned at bedside at time of administration
· Medication to be administered is scanned at bedside at time of administration
· Results of both scans stored in the patient’s eMR-MAR
· If there is a discrepancy between the patient and med to be administered, error warning appears on computer monitor screen
· Person preparing to administer the med is told by the program what the error is
Can staff describe the care, services and expected outcome of the care they provide?
NVH: On their last state certification survey, a staff member was asked what their restraints policy was
· Staff person was not able to tell the surveyor about that policy
· NVH was cited for ‘not implementing the policy’
Tag C 399, Discharge Summary
CMMC: were having a problem with the resident being ready for discharge, but the needed DME or HH weren’t ready
· Changed to a daily-in-the-morning IDT meeting; discharges much smoother
Tags C 400-401, Nutrition
Body Weight
MDMH: Residents are weighed twice a week; this is on each care plan
· always use the same scale for the resident
· always weigh on the same days of the week
CMMC: weigh skilled residents every day; primarily checking for weight gain, CHF
NVH: weigh after the 5th day of admission; from that, determine the frequency of weight monitoring
Protein
NVH: the dietician monitors this value
Barrett: A low nutrition score on the Braden scale for PU prevention is referred to RD
(they also do a skin assessment daily as part of their PU prevention protocol)
Risk Factors for Malnutrition
All Facilities The head cook rounds with at-risk residents daily
On the Call
· works with residents to identify food likes/dislikes
· works with residents to select meals for the day
· residents really appreciate the extra effort
Tags C 402-403, Specialized Rehabilitation Services
Big Sandy Rehab services are contracted; contracts reviewed annually (see tag C 285)
· Evaluating the quality of care provided under the contract activities include:
- valid order for service
- functional goals stated for resident
- documentation of all visit progress notes
- when goals are achieved
- discharge from service summary
- any other related documentation is on the chart
Mental Health Services no one on the call has residents in need of these services at this time
Tag C 404, Dental Services
MDMH: broken dentures are their primary issue
CMMC: has a contract with a dentist to provide emergency, on-call services as needed
Big Sandy: in an emergency, the physician on call provides emergency dental services on weekends, holidays
· Most often, these needs are related to pain and/or abscess issues
· The regular dentist has hours Mon – Fri, so would see patient as soon as possible after the weekend/holiday
Tags C 405 - 408, Skilled Nursing Facilities: no additional issues
Next Call: Wed, June 22, 2:00 pm beginning with tag C 330: Periodic Evaluation
Continuing through C 343, documentation of the outcome of remedial action
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