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INSIDE THIS ISSUE Medicare Coverage for Skilled Wound Care To Weigh or Not to Weigh That is the Question Hospice Public Recording Coming This Year Blood Transfer Devices Why How and Where How Can a Therapist Minimize Re Hospitalization Rates And More March 2017 COMPLAINTS CAN BE OPPORTUNITIES Melanie Purvis RN Director of Operational Compliance Complaints are not a negative reflection on you your position or your branch You WILL NOT be in trouble for reporting a complaint Complaints present an opportunity for ALACARE to improve our care responses and or processes What is a complaint It is a statement that a situation is unsatisfactory or unacceptable A complaint is not always a BIG issue like I am calling my lawyer or You don t know how to do your job A complaint can be expressed as You don t come at the time I asked This Includes the people we see all the time Those who we say They are always unhappy or They complain about everything or He she is just grumpy THESE ARE COMPLAINTS and they need to be addressed so that they don t become BIG issues How to enter or report a complaint Tell your supervisor Enter the complaint into the QI Event area of HCHB Your manager will enter the complaint into the Compliance Response Center CRC either after you tell them or enter the complaint in HCHB We would rather know about a complaint and have a chance to make things better BEFORE or INSTEAD of someone else taking care of the complaint for us
INSIDE THIS ISSUE Medicare Coverage for Skilled Wound Care To Weigh or Not to Weigh  That is the Question. Hospice Public ...
Medicare Coverage for Skilled Wound Care To Weigh or Not to Weigh That is the Question Angela Graham BSN RN CWOCN Manager of Education Support Services Jana Tuck RN VP Business Clinical Intelligence M edicare pays for home care agencies to provide skilled reasonable and necessary wound care to patients on an intermittent basis We often see chronic non healing wounds which require ongoing assessment and Plan of Care changes in order to show we are making progress and setting realistic goals We do not get reimbursed for preventing wounds or protecting healed wound sites by the application of wound products These activities can be provided by a non skilled person and do not require the skills of a licensed nurse Once a wound we have been treating heals we must notify the MD write a verbal order and end our skilled care of that site For ICC purposes these are the steps to heal a wound 1 Notify the MD upon discovery of a healed wound site 2 Write a VO stating wound is healed and d c wound care 3 Complete ICC by a Associating the new healed VO to the wound in ICC b Making a new template based on that order which would be HEALED which would be printed under Wound Care Provided c Stating Not assessed due to being healed no further orders or completing questions answering all to state intact skin and or 100 epithelialized N EW OASIS Item M1060 Height and Weight While measuring if the numbers x 1 round down x 5 or greater round up a Height in inches Record most recent height measures since the most recent SOC ROC b Weight in pounds Base weight on most recent measure in last 30 days measure weight consistently according to standard agency practice for example in a m after voiding before meal with shoes off etc Item Intent These items support calculation of the patient s body mass index BMI using the patient s height and weight Item Rationale Diminished nutritional and hydration status can lead to debility that can adversely affect wound healing and increase risk for the development of pressure ulcers Height and Weight measurements and BMI calculation assist staff in assessing the patient s nutritional and hydration status by providing a mechanism for monitoring stability of weight and BMI over a period of time The measurement of height and weight for the calculation of BMI is one guide for determining nutritional status Weight measurement is also used in assessment of heart failure n WE OFTEN SEE CHRONIC NON HEALING WOUNDS WHICH REQUIRE ONGOING ASSESSMENT d Once all 3 boxes in ICC are checked Orders Assessment and Wound Care Provided then INACTIVATE the wound location Again we cannot provide wound care products barrier creams etc in homecare for intact healed skin If any questions please feel free to contact me Angela Graham alacare com n WE CANNOT PROVIDE WOUND CARE PRODUCTS BARRIER CREAMS ETC IN HOMECARE FOR INTACT HEALED SKIN Steps for Assessment for M1060a Height 1 Measure height in accordance with the agency s policy and procedures which should reflect current standards of practice shoes off etc 2 Measure and record height in inches 3 When reporting height for a patient with bilateral lower extremity amputation measure and record the patient s current height i e height after bilateral amputation Instructions for N1060 a Height 1 Complete only if M0100 1 Start of Care or Resumption of Care 2 Record the patient s height to the nearest whole inch 3 Use mathematical rounding i e if height measurement is X 5 inches or greater round height upward to the nearest whole inch If height measurement number is X 1 to X 4 inches round down to the nearest whole inch For example a height of 62 5 inches would be rounded to 62 inches A dash value is a valid response for this item A dash value indicates that no information is available and or an item could not be assessed This most often occurs when the patient is unexpectedly transferred discharged or dies before the assessment of the item could be completed CMS expects dash use to be a rare occurrence Steps for Assessment for M1060 b Weight 1 Weight should be measured in accordance with the agency s policies and procedures which should reflect current standards of practice shoes off etc 2 Measure and record the patient s weight in pounds 3 If a patient cannot be weighed for example because of extreme pain immobility or risk of pathological fractures enter the dash value and document the rational on the patient s medical record Instructions for M1060 b Weight Complete only if M0100 1 Start of Care or 3 Resumption of Care 1 Use mathematical rounding e g if weight is X 5 pounds lbs or more round weight upward to the nearest whole pound If weight is X 1 to X 4 lbs round down to the nearest whole pound For example a weight of 152 5 lbs would be rounded to 153 lbs and a weight of 152 4 lbs would be rounded to 152 2 A dash value is a valid response for this item A dash value indicates that no information is available and or an item could not be assessed This most often occurs when the patient is unexpectedly transferred discharged or dies before the assessment of the item could be completed CMS expects dash use to be a rare occurrence 3 Reminder You cannot use the patient s stated weight or height or a height and weight obtained by another provider It is expected that you perform this as part of your assessment This is in addition to documenting height and weight in the vital sign section of the record 4 This question is used to risk adjust other items and patients overall potential for improvement 5 Even if you cannot weigh the patient you can measure patient s height You should remember to document the reason you were unable to perform the height or weight It is not appropriate that it is due to a lack of equipment so please make sure you have the supplies to perform all aspects of the physical assessment
Medicare Coverage for Skilled Wound Care  To Weigh or Not to Weigh  That is the Question.  Angela Graham, BSN RN CWOCN, Ma...
Medicare Coverage for Skilled Wound Care To Weigh or Not to Weigh That is the Question Angela Graham BSN RN CWOCN Manager of Education Support Services Jana Tuck RN VP Business Clinical Intelligence M edicare pays for home care agencies to provide skilled reasonable and necessary wound care to patients on an intermittent basis We often see chronic non healing wounds which require ongoing assessment and Plan of Care changes in order to show we are making progress and setting realistic goals We do not get reimbursed for preventing wounds or protecting healed wound sites by the application of wound products These activities can be provided by a non skilled person and do not require the skills of a licensed nurse Once a wound we have been treating heals we must notify the MD write a verbal order and end our skilled care of that site For ICC purposes these are the steps to heal a wound 1 Notify the MD upon discovery of a healed wound site 2 Write a VO stating wound is healed and d c wound care 3 Complete ICC by a Associating the new healed VO to the wound in ICC b Making a new template based on that order which would be HEALED which would be printed under Wound Care Provided c Stating Not assessed due to being healed no further orders or completing questions answering all to state intact skin and or 100 epithelialized N EW OASIS Item M1060 Height and Weight While measuring if the numbers x 1 round down x 5 or greater round up a Height in inches Record most recent height measures since the most recent SOC ROC b Weight in pounds Base weight on most recent measure in last 30 days measure weight consistently according to standard agency practice for example in a m after voiding before meal with shoes off etc Item Intent These items support calculation of the patient s body mass index BMI using the patient s height and weight Item Rationale Diminished nutritional and hydration status can lead to debility that can adversely affect wound healing and increase risk for the development of pressure ulcers Height and Weight measurements and BMI calculation assist staff in assessing the patient s nutritional and hydration status by providing a mechanism for monitoring stability of weight and BMI over a period of time The measurement of height and weight for the calculation of BMI is one guide for determining nutritional status Weight measurement is also used in assessment of heart failure n WE OFTEN SEE CHRONIC NON HEALING WOUNDS WHICH REQUIRE ONGOING ASSESSMENT d Once all 3 boxes in ICC are checked Orders Assessment and Wound Care Provided then INACTIVATE the wound location Again we cannot provide wound care products barrier creams etc in homecare for intact healed skin If any questions please feel free to contact me Angela Graham alacare com n WE CANNOT PROVIDE WOUND CARE PRODUCTS BARRIER CREAMS ETC IN HOMECARE FOR INTACT HEALED SKIN Steps for Assessment for M1060a Height 1 Measure height in accordance with the agency s policy and procedures which should reflect current standards of practice shoes off etc 2 Measure and record height in inches 3 When reporting height for a patient with bilateral lower extremity amputation measure and record the patient s current height i e height after bilateral amputation Instructions for N1060 a Height 1 Complete only if M0100 1 Start of Care or Resumption of Care 2 Record the patient s height to the nearest whole inch 3 Use mathematical rounding i e if height measurement is X 5 inches or greater round height upward to the nearest whole inch If height measurement number is X 1 to X 4 inches round down to the nearest whole inch For example a height of 62 5 inches would be rounded to 62 inches A dash value is a valid response for this item A dash value indicates that no information is available and or an item could not be assessed This most often occurs when the patient is unexpectedly transferred discharged or dies before the assessment of the item could be completed CMS expects dash use to be a rare occurrence Steps for Assessment for M1060 b Weight 1 Weight should be measured in accordance with the agency s policies and procedures which should reflect current standards of practice shoes off etc 2 Measure and record the patient s weight in pounds 3 If a patient cannot be weighed for example because of extreme pain immobility or risk of pathological fractures enter the dash value and document the rational on the patient s medical record Instructions for M1060 b Weight Complete only if M0100 1 Start of Care or 3 Resumption of Care 1 Use mathematical rounding e g if weight is X 5 pounds lbs or more round weight upward to the nearest whole pound If weight is X 1 to X 4 lbs round down to the nearest whole pound For example a weight of 152 5 lbs would be rounded to 153 lbs and a weight of 152 4 lbs would be rounded to 152 2 A dash value is a valid response for this item A dash value indicates that no information is available and or an item could not be assessed This most often occurs when the patient is unexpectedly transferred discharged or dies before the assessment of the item could be completed CMS expects dash use to be a rare occurrence 3 Reminder You cannot use the patient s stated weight or height or a height and weight obtained by another provider It is expected that you perform this as part of your assessment This is in addition to documenting height and weight in the vital sign section of the record 4 This question is used to risk adjust other items and patients overall potential for improvement 5 Even if you cannot weigh the patient you can measure patient s height You should remember to document the reason you were unable to perform the height or weight It is not appropriate that it is due to a lack of equipment so please make sure you have the supplies to perform all aspects of the physical assessment
Medicare Coverage for Skilled Wound Care  To Weigh or Not to Weigh  That is the Question.  Angela Graham, BSN RN CWOCN, Ma...
Hospice Public Reporting Coming This Summer Blood Transfer Devices Why How and Where Selena Matthews RN Director of Hospice Compliance Kathy Kirkpatrick RN Infection Control Coordinator A CMS s Hospice Compare website should be up and running by spring summer 2017 The Compare database displays quality of care and patient satisfaction measures for all certified agencies The data is publically accessible The initial data will reflect our performance from October 2014 through September 2015 The following quality measures will be publically displayed Pain Screening Pain Assessment Dyspnea Screening Dyspnea Treatment Treatment Preferences Beliefs Values Patients Treated with Opioid who are Given a Bowel Regimen In addition Hospice Experience of Care satisfaction survey results Hospice CAHPS will be part of public reporting The survey focuses on customer satisfaction in the following areas Starting hospice care Help for patients symptoms Communication with hospice team Caregivers own experience with hospice Overall rating of hospice care Willingness to recommend hospice Remember The best preparation for tomorrow is doing your best today CTCs to Educate Referral Sources Richard Nieves VP Marketing I n April Alacare Care Transition Coordinators CTCs will be educating referral sources on Alacare s HOME HEALTHcare program When faced with illness it s not surprising that a majority of patients would much rather receive care at home After all there is no place like home The Alacare HOME HEALTHcare program can provide care for a recent diagnosis ongoing therapy physical rehabilitation or a declining medical condition all in the home surrounded by family in a familiar setting blood transfer device is a sterile single use device It is designed for use for the safe transfer of blood specimens from a syringe to a evacuated blood tube or blood culture bottles These transfer devices are available in both a male and female design The use of these devices helps to minimize the opportunity for needle sticks during the transfer of blood specimens to collection tubes Per OSHA guidelines whenever a safety designed device is available it should be used If you are unfamiliar with the use of these devices Alacare University has a training program available that demonstrates a step by step use of this product The name of the program is Blood Transfer Devices The process of acquiring these devices is as follows The Clinical Managers Branch Directors or Office Managers should notify Kathy Kirkpatrick RN ICC per email of the number of devices that need to be shipped to your branch Please include the number of each device male and female that you need You may place your branch on a standing monthly order and these will be shipped to you from Lab Corp during the first or second weeks of each month The standing order is sent to Lab Corp on the 1st day of each month and Lab Corp will only ship one time each month If you find your usage of these devices changes you can notify me and I can adjust your amounts shipped Remember submit your changes prior to the 1st in order for it to be effective for the upcoming month Branches cannot order these devices directly from Lab Corp If you are not using these devices for all your blood specimen transfers please begin to do so immediately Don t risk an exposure to blood borne pathogens The HEART of ALACARE n IF YOU ARE UNFAMILIAR WITH THE USE OF THESE DEVICES ALACARE UNIVERSITY HAS A TRAINING PROGRAM AVAILABLE
Hospice Public Reporting Coming This Summer  Blood Transfer Devices  Why, How and Where  Selena Matthews, RN, Director of ...
Hospice Public Reporting Coming This Summer Blood Transfer Devices Why How and Where Selena Matthews RN Director of Hospice Compliance Kathy Kirkpatrick RN Infection Control Coordinator A CMS s Hospice Compare website should be up and running by spring summer 2017 The Compare database displays quality of care and patient satisfaction measures for all certified agencies The data is publically accessible The initial data will reflect our performance from October 2014 through September 2015 The following quality measures will be publically displayed Pain Screening Pain Assessment Dyspnea Screening Dyspnea Treatment Treatment Preferences Beliefs Values Patients Treated with Opioid who are Given a Bowel Regimen In addition Hospice Experience of Care satisfaction survey results Hospice CAHPS will be part of public reporting The survey focuses on customer satisfaction in the following areas Starting hospice care Help for patients symptoms Communication with hospice team Caregivers own experience with hospice Overall rating of hospice care Willingness to recommend hospice Remember The best preparation for tomorrow is doing your best today CTCs to Educate Referral Sources Richard Nieves VP Marketing I n April Alacare Care Transition Coordinators CTCs will be educating referral sources on Alacare s HOME HEALTHcare program When faced with illness it s not surprising that a majority of patients would much rather receive care at home After all there is no place like home The Alacare HOME HEALTHcare program can provide care for a recent diagnosis ongoing therapy physical rehabilitation or a declining medical condition all in the home surrounded by family in a familiar setting blood transfer device is a sterile single use device It is designed for use for the safe transfer of blood specimens from a syringe to a evacuated blood tube or blood culture bottles These transfer devices are available in both a male and female design The use of these devices helps to minimize the opportunity for needle sticks during the transfer of blood specimens to collection tubes Per OSHA guidelines whenever a safety designed device is available it should be used If you are unfamiliar with the use of these devices Alacare University has a training program available that demonstrates a step by step use of this product The name of the program is Blood Transfer Devices The process of acquiring these devices is as follows The Clinical Managers Branch Directors or Office Managers should notify Kathy Kirkpatrick RN ICC per email of the number of devices that need to be shipped to your branch Please include the number of each device male and female that you need You may place your branch on a standing monthly order and these will be shipped to you from Lab Corp during the first or second weeks of each month The standing order is sent to Lab Corp on the 1st day of each month and Lab Corp will only ship one time each month If you find your usage of these devices changes you can notify me and I can adjust your amounts shipped Remember submit your changes prior to the 1st in order for it to be effective for the upcoming month Branches cannot order these devices directly from Lab Corp If you are not using these devices for all your blood specimen transfers please begin to do so immediately Don t risk an exposure to blood borne pathogens The HEART of ALACARE n IF YOU ARE UNFAMILIAR WITH THE USE OF THESE DEVICES ALACARE UNIVERSITY HAS A TRAINING PROGRAM AVAILABLE
Hospice Public Reporting Coming This Summer  Blood Transfer Devices  Why, How and Where  Selena Matthews, RN, Director of ...
How Can a Therapist Minimize Re Hospitalization Rates Noelle Ward OTR Director of Rehabilitation W atch for signs and symptoms of dehydration UTI and infection Increased confusion is often the first indicator of these issues If you notice or if the caregiver reports increased confusion CALL THE CLINICAL MANAGER IMMEDIATELY Explain your concern of risk for rehospitalization and ask for a nursing visit ASAP Prevent risk for dehydration Many patients won t drink much liquid due to fear of incontinence or lack of thirst Make toilet transfers a therapy priority Place a bedside commode nearby if needed Recommend a toileting schedule of every 2 hours while awake Work on ambulation specifically to the bathroom Does patient need a timer to remind them to drink frequently Can the patient get water on their own Patients with walkers often can t safely get water without a cup holder or walker basket Can the caregiver leave water bottles nearby Therapists can make a positive impact by focusing on these 2 actions I Listen Kaye Keel VP Clinical Compliance S chool Bus Story Here is a riddle for you You re the bus driver You re going on your route and on the first stop you pick up one child At the second stop 3 children get on and one child gets off On the fourth stop 4 children get on and 2 children get off Are you ready for your question What color are the bus driver s eyes How would I know right Remember what I said when I first started the story I said you re the bus driver When we listen we don t always hear We don t process what s going on we think There are many barriers to effective listening yet effective listening is one of the most important things we can do to ensure customer satisfaction Some of those barriers include Multitasking doing too many things at once Listening to other conversations while someone is talking to you Thinking that we know what someone is going to say so we stop listening and begin formulating a response Not hearing what the other person is saying because we are anxious to make our point or eager to know all the answers Overcome those barriers by Engaging with the speaker don t multitask Make eye contact put down other things or look away from your computer Listen not only to what is being said but how it s being said Pay attention to the speaker s tone of voice and inflection often the non verbal signals tell you what they are really trying to say Be careful to make sure you understand what is being said not what you think someone is saying We have 2 ears and one mouth We should use them in that proportion
How Can a Therapist Minimize Re-Hospitalization Rates  Noelle Ward, OTR, Director of Rehabilitation  W  atch for signs and...