Advancing Excellence in America’s Nursing Homes A Review of 2 Clinical Tools: Pressure Ulcer and Restraints

Pressure Ulcer Tool Clinical tools are for internal performance improvement work only There is no website data entry required with the clinical goals Use this to track these clinical goals in the absence of the Quality Measures

Pressure Ulcer Campaign Resources Implementation Guide Pressure Ulcer Fact Sheets – 1 for consumers – 1 for nursing home staff Tracking Tool & Instructional Webex Video’s, Guidance and much more

4 Resources

Website: Pressure Ulcer Resources

Pressure Ulcers– Goal Definition Goal 4 Pressure Ulcers: Nursing home residents receive appropriate care to prevent and appropriately treat pressure ulcers when they develop.

National Pressure Ulcer Data Some Key Campaign Objectives: By December 31, 2011 The national average for high risk pressure ulcers will be below 9% 30% of nursing homes will report rates of high risk pressure ulcers at or below 6% 22,500 fewer residents will have pressure ulcers compared to 6/06

Using The Pressure Ulcer Tool Go to the Goal and download the tool into your computer. You will need Excel. Size the tool to fit your computer. The data is entered just one time per month – pick a date and stay with it consistently. Gathered information before filling out the tool. Information can be found through several sources in your nursing home including MDS 3.0 submissions and reports, Pressure Ulcer reduction committee notes, individual resident medical records and charting, and from admission information - to name a few sources. Data is entered in the blue columns.

Special Tool Features Allows nursing home to monitor in-house acquired and admission acquired by source and stage Identifies settings where pressure ulcers come from Provides multiple graphs for ongoing monitoring There are currently no questions and answers tied to this tool The tool has been revised and updated for July 2011

Pressure Ulcer Tool Demonstration/ Screen Shots

Pressure Ulcer Welcome Page

Pressure Ulcer Instruction Page

Pressure Ulcer Data Entry Page

Pressure Ulcer Tool - Graphs and Trends

Monthly Notes

Physical Restraint Goal Goal 3 – Physical Restraints: Nursing home residents are independent to the best of their ability and rarely experience daily physical restraints.

Restraint Campaign Resources Implementation Guide Restraint Fact Sheets – 1 for consumers – 1 for nursing home staff Tracking Tool Video’s, Guidance and much more

Website: Restraint Goal Resources

Use the Restraint Tracking Tool Go to the Goal and download the Excel based tool Compile data monthly and update the tool (from MDS 3.0 and records) Enter data weekly – tool uses 12 weeks of data then start over Print off graphs for trending

Use the Restraint Tracking Tool Clinical tools are for internal quality improvement work only There is no website data entry required with the clinical goals Use this to track your restraints in the absence of the Quality Measures

Restraint Tool Welcome Page

Restraint Instruction Page Restraint Tool Instruction Page

Restraint Instruction Page Restraint Tool Q & A Page

Restraint Instruction Page Restraint Data Entry Page Week 1

Restraint Instruction Page Restraint Data Entry Page Week 2

Restraint Instruction Page Restraint Graph / Trends Page

Goal 6: Advance Care Planning Restraint Goal Data Input Portal

Restraint Tracking Tool Questions Q: What is a restraint? A: CMS defines “physical restraints” in the State Operations Manual (SOM), Appendix PP as, “any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident’s body that the individual cannot remove easily which restricts freedom of movement or normal access to one’s body.

Restraint Tracking Tool Questions Q. Can restraints be used for the purpose of "safety" to reduce the potential for falls? A: Although the requirements describe the narrow instances when physical restraints may be used, growing evidence supports that physical restraints have a limited role in medical care. Restraints limit mobility and increase the risk for a number of adverse outcomes. Physical restraints certainly do not eliminate falls. In fact in some instances reducing the use of physical restraints may actually decrease the risk of falling.

Restraint Tracking Tool Questions Q: How is the Physical Restraint rate calculated on the publicly reported long stay quality measure? A: MDS 3.0 codes three categories for restraint use; "0" for no restraint, "1" for used less than daily, and "2" for daily use. Nurse must determine restraints used when resident is in bed separately from restraints used in chair or out of bed. Bed rails or chair preventing resident from rising, trunk restraints, and limb restraints are counted separately in each category. This is different than MDS 2.0. For the purposes of this tool, restraint use, following the guidelines of MDS 3.0, will be totaled for all residents who have a restraint while in bed and separately totaled for all residents who have a restraint while in chair or out of bed.

Restraint Tracking Tool Questions Q. May I go back and change incorrect information? A: Yes. Simply highlight the information to change, right click, select "Clear Contents," and then enter the corrected data. Q. Where do I find the data that I will enter on this internal tracking tool? A: This data can be found in the most recent MDS Section P0100 of each resident MDS 3.0 and should be entered when coded as a 1 or 2 in section P. Your software provider may offer a submission summary form that will enable you to easily locate and tally this information. This tool is designed to assist NHs to collect their own internal data and to monitor their improvement.

No Campaign Data Entry There is no Campaign Website Data entry required for any of the clinical goals. This tools is provided for your internal tracking, monitoring and Performance Improvement purposes Website data entry is only required for the “organizational” goals (goal #’s1,2,6,7 & 8)

Thank You! Tammy Rolfe (207)