MIDWEST MULTISTATE DIVISION

EDUCATIONAL PLANNING FORM

V1.2016

Instructions:For educational activities with multiple sessions, please complete a planning form for each individualsession for which contact hours will be awarded. Type directly into blank cells of the tables. Save the completed form to your computer.

Educational Activity Title: / Midwest Regional Conference on Palliative & End-of-Life Care
Individual Session Title: (if different than activity title) / Bureau of Home Care Update
Learning outcome(s)
List learning outcome(s) in behavioral terms using a single measurable verb for each. Outcomes are evaluated to determine the impact of educational activities on patient care and professional development of the learner. Learning outcomes should fit into one of Miller’s zones1:
List the top 5 Conditions of Participation cited in Missouri over the past year and describe several examples from case scenarios of standard deficient practices leading to noncompliance with these conditions.
Describe several practices that hospices are inquiring about as to whether they would be in compliance with the regulations if they were to change these practices.
Identify 3 trends noted from the hospice annual statistical report for 2015.
Explain several items that need to be included on a plan of correction in order for it to be acceptable.
Content / Time Frame / PRESENTER/Faculty/
AUTHOR / LEARNER ENGAGEMENT
STRATEGIES
Provide an outline of the content to be presented, related to each learning outcome, in sufficient detail to determine consistency with learning outcomes and appropriate time allotted.
(Restatement of learning outcomes does not meet the criteria) / List the number of minutes2for each topic/ content area3. / List the presenter, faculty person or author for each content area. / List the engagement strategies used by each presenter for each content area.
  1. 418.54 Condition of Participation: Initial & Comprehensive Assessment of the Patient
  2. 418.56 Condition of Participation: Interdisciplinary Group, Care Planning, and Coordination of Services
  3. 418. Condition of Participation: Core Services
  4. 418.76 Condition of Participation: Hospice Aide and Homemaker Services
  5. 418.112 Condition of Participation: Hospices that Provide Hospice Care to Residents of a SNF/NF or ICF/MR
/ 20 minutes for each of CoP= 100 minutes / Judy Morris, Assistant Bureau Administrator
Kelly Colwell, HFNC
Vickie Heuett, HFNC
Deanna McCarter, HFNC / ☒Question/Answer
☐Self-check or self-assessment
☒Audience response system
☐Return skill demonstration
☒Role play
☒Small group discussion
☐Assignments/testing/practice
☐Engaging learners in dialogue
☒ Analyzing case studies
The following practices will be discussed and to determine if they would be in compliance with the hospice regulations:
1.IDG via conference call or teleconference via internet
2. Discharge for cause
3. Offering continuous care or respite care
4. Issues with agencies not involving the core services in plan of care and decisions, but rather having the nurses make decisions without team input
The trends found from the 2015 Missouri Hospice Statistical Report will be reported to the audience, not compiled yet.
The components needed for an acceptable plan of correction will be provided. / 80 minutes / Judy Morris,
Kelly Colwell
Vickie Heuett
Deanna McCarter / ☒ Question/Answer
☐Self-check or self-assessment
☒ Audience response system
☐Return skill demonstration
☒ Role play
☒ Small group discussion
☐Assignments/testing/practice
☒ Engaging learners in dialogue
☐Analyzing case studies

1Examples of learning outcomes for each zone: Knows (knowledge gained) – Learners will self-report an increase in knowledge about XYZ Knows how (knows how to apply the knowledge)– Learners will describe how they will integrate XYZ into their practice Shows (demonstrates how to apply knowledge) – Learners will demonstrate the correct procedure for XYZ during the learning activity Does (applies knowledge in practice) – Learners will integrate knowledge into practice as validated by an decrease in the incidence of XYZ measure. NOTE that evaluation questions should reflect the learning outcomes.

2Total number of minutes should match the total number of hours used to calculate the contact hours awarded.

3Time spent on learner feedback and/or evaluation is acceptable to include in calculation of contact hours.

Total minutes for this activity/session (including time spent on evaluation) = 180

List the evidence-based reference(s) used for developing the content of this educational activity/session next to the appropriate category:

Information from organization/website:
(current available evidence within past 5-7 years; may be published or unpublished content. Examples – Agency for Healthcare Research and Quality, Centers for Disease Control, National Institutes of Health) / The 2015 Missouri Hospice Annual Statistical Report
Peer –reviewed journal/resource:
(reference should be within past 5-7 years) / The CMS citation frequency reports from CASPER 6/13/16
Clinical guidelines:
(published or online. Example - / The federal and state hospice regulations.
Expert resource:
(individual, organization, or educational institution - book, article, website) / The Bureau of Home Care and Rehabilitative Standards seasoned management and survey staff
Textbook reference:
Other: