1. All in a Day’s Work CV Quarterly MRD Workshop September 30, 2011 Presented by Lizeth Flores, RHIT, RAC-CT

2. Agenda 1. Alphabet Soup 2. CQI / Analysis 4. Vision Hints & Tips 3. Critical Thinking Exercises 5. The Recipe for Quality of Care 6. The News with Laurie 7. MDS 3.0 Update

3. Alphabet Soup HIM MDS RAIHIPAA OBRA CFR CMS CAAs RUG (as in MDS RUGs) PPS FIQIO

4. Alphabet Soup HIM Health Information Management RAI Resident Assessment Instrument OBRA Omnibus Budget Reconciliation Act CMS Centers for Medicare & Medicaid Services

5. Alphabet Soup RUG Resource Utilization Group FI Fiscal Intermediary MDS Minimum Data Set

6. Alphabet Soup HIPAA Health Insurance Portability and Accountability Act CFR Code of Federal Regulations CAA Care Area Assessment

7. Alphabet Soup PPS Prospective Payment System QIO Quality Improvement Organization

8. CONTINUOUS QUALITY IMPROVEMENT EXERCISE

9. 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

10. Green Leaf Nursing Home Behavior Drug Study 2011

11. Identify Weak Areas Review the data Where are the lowest Percentages? What is the root cause? Plan of Action Specify Follow Up

12. Areas of Concern Behavior not specified on all MD orders Diagnosis not specified on all orders Monitor for each behavior Care plan Interventions

13. Possible Root Causes? New Nurses New MRD No daily review of orders

14. Task Segmentation & Timeframe What will you do to correct the problem ? Staff Training Who? What? When?

15. Follow Up Plan How will you monitor progress? Who? What? When? What is the expected compliance and by when?

16. Critical Thinking Exercise

17. 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

18. 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.

19. What are the areas of concern? Decreased intake Weight loss Increased confusion Skin breakdown

20. 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?

21. CNA’s feedback & Nursing Assessment

22. 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.

23. 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

24. What would you do? Think About Care Plan Interventions and Goals

25. 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.

26. MEDICAL RECORDS HELPFUL HINTS

27. 24/7 VISION SUPPORT 1-877-708-7444 cDmz.8.12.11

28. REMINDER Census Admissions- Demographic i.e. SS, education etc Bed Assignments LOA’s- Bed holds; private vs. medical Discharges Room Transfers- residents out on medical bed hold Verification cDmz.8.12.11

29. 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. cDmz.8.12.11

30. REMINDER cDmz.8.12.11

31. 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. cDmz.8.12.11

32. HEIGHT & WEIGHT All residents height must be completed by November 1 st,2011 All weight must be entered by the 10 th of every month. If there is a reweigh please only enter the reweigh cDmz.8.12.11

33. 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. cDmz.8.12.11

34. REPORTS FDB Medications-Diets, Psychotropic, Enteral, Pressure Ulcer, FSBS etc. Diagnosis report Physician and resident list cDmz.8.12.11

35. 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. cDmz.8.12.11

37. Quality of Care

38. Resident Name Physician Name Date Time Name of Medication Dosage Route Frequency Diagnosis Nurse’s signature Physician Signature

39. What do you get ? A complete telephone Order

40. Common Issues Incomplete Orders Illegible Content No Diagnosis No signature MD must sign within 5 days

41. Plan of Action What will you do when you return to your facility to ensure complete and accurate orders?

42. New Policies

43. Q&A

44. MDS 3.0 Update