January 2011 Skilled In-service Agenda

1. January 2011Skilled In-service Agenda ACHC Overview Discharge Planning Aide Care Plans Writing Clear and Complete Orders Equipment Cleaning G Codes NGHHC NOTTINGHAM 1/10/2011

2. ACHC Overview • December 13,14,15,16, 2010 • 4 Days of Survey • 50 Clinical Records Reviewed • 11 Home Visits Completed NGHHC NOTTINGHAM 1/10/2011

3. ACHC OverviewDeficiencies • Reporting Patient Incidents – Form and format inconsistent. *New Online Reporting Now Available. • Mandatory In-services not completed by all staff. * Mandatory In-services must be completed each year by 12/31. Several will be available on line. Enhancements have been made to Nightingale University. • CPR – the only acceptable CPR is from the American Heart Association. * Nightingale is trying to have a CPR instructor available one Saturday per month at the Carmel office. However this is not finalized. • AIDE Care Plans – aide documentation does not meet the aide care plans. Personal Care is too vague. • Orders/Interventions/ Safety Measures not complete. Glucometer readings without freqencies, no diabetic interventions for diabetics, no bleeding precautions for patients on coumadin, no seizure precautions for patients with seizure activity. • PT/OT/Nursing – All cited for lack of discharge planning documentation. • PT cited for cleaning logs MEDX. * MedX cleaning logs have been developed. • MSW and Speech Therapy Services were deficiency free. NGHHC NOTTINGHAM 1/10/2011

4. Incident Reporting NGHHC NOTTINGHAM 1/10/2011

5. In-services • Monthly In-services Will Continue in 2011 • In addition to the routine in-services held here in Carmel, some monthly in-services will be available on line, some by GO TO MEETING. • It is important that everyone completes the monthly inservices. NGHHC NOTTINGHAM 1/10/2011

6. In-services NGHHC NOTTINGHAM 1/10/2011

7. CPR • Only AMERICAN HEART ASSOCIATION certifications will be accepted on a go forward basis. • Nightingale Home Healthcare is looking into having a class, once a month, in the Carmel office. More information will be coming on this soon. NGHHC NOTTINGHAM 1/10/2011

8. Aide Care Plans • Aide Care Plans MUST be completed at time of the SOC. Orders/Visits for the aide MUST be completed at the SOC. The care plan MUST be specific. What type of bath? Choice Bath? Assist with dressing/undressing? • Precautions MUST be specified for each patients as needed (Diabetic, Oxygen, Seizure, Bleeding) • LIMIT/ELIMINATE the use of “personal care”. Care plans need to be more specific. • Aides need to chart to the care plan specifics. NGHHC NOTTINGHAM 1/10/2011

9. Complete Orders • An order is complete when it says WHO will do it, WHAT is to be done and WHEN it is to be done. • Supplies must be added to the supply box to complete the order. NGHHC NOTTINGHAM 1/10/2011

10. Discharge Planning • Discharge Planning begins on the admission visit. • Discharge planning should be part of every visit. *Documentation is expected at least weekly. • Documentation of discharge planning includes documentation of patient/family/ caregiver involvement. NGHHC NOTTINGHAM 1/10/2011

11. MedX Cleaning Log • MEDX must be cleaned after each patient use. • The cleaning log must be faxed or scanned to Mike Kerry every *Monday. NGHHC NOTTINGHAM 1/10/2011

12. MedX Cleaning Log NGHHC NOTTINGHAM 1/10/2011

13. G Codes • On December 28th,  Healthwyse  released an update for PALMWYSE. • One of the key items that  changed in the release is the update and expansion of “G-CODES.” • Simply put, “G-Codes” are  codes that Medicare is requiring that further clarify both the actual provider of services and the actual focus of the care provided during the visit. • As a clinician, you will be selecting the code that identifies your discipline and the code that most appropriately identifies the focus of the care provided during the visit – i.e. what you spent the most time on during your visit. We recognize that you may provide a variety of services of services at the same visit ( patient teaching, assessment and skilled care). However only one code can be used. Our direction from Medicare is to code what the clinician spent the majority of their time on for that particular visit. NGHHC NOTTINGHAM 1/10/2011

14. G Codes • REVISIONS FOR CURRENT DESCRIPTIONS FOR THERAPIST • G0151 • Services provided by PT • In home health or hospice setting • G0152 • Services provided by OT • In home health or hospice setting • G0153 • Services provided by SLP • In home health or hospice setting • G0157 • Services provided by PTA • In home health or hospice setting • G0158 • Services provided by COTA (OTA) • In home health or hospice setting NGHHC NOTTINGHAM 1/10/2011

15. G Codes • ADDITIONS FOR REPORTING ESTABLISHMENT OR DELIVERY OF THERAPY MAINTENANCE PROGRAMS. (Nightingale does not provide therapy maintenance services.) • G0159 • Services provided by PT • In the home health setting for establishment or delivery of  a safe and effective therapy maintenance programs, each 15 minutes • G0160 • Services provided by OT • In the home health setting for establishment or delivery of a safe and effective therapy maintenance programs, each 15 minutes • G0161 • Services provided by ST • In the home health setting for establishment or delivery of a safe and effective therapy maintenance programs, each 15 minutes NGHHC NOTTINGHAM 1/10/2011

16. G Codes • REVISIONS/ADDITIONS FOR REPORTING CARE PROVIDED FOR SKILLED NURSING • G0154 • Services provided by RN or LPN/LVN • In the home health setting, for direct skilled care, each 15 minutes • G0162 • Services provided by RN ( RN ONLY) • For management and evaluation of the plan of care, each 15 minutes, to ensure that the essential non-skilled care achieves it purpose in the home health or hospice setting. • G0163 • Services provided by RN or LPN/LVN • In the home health setting, each 15 minutes, for the observation and assessment of the patient’s condition. ( The patient’s condition requires skilled nursing personnel to identify and evaluate the patient’s need for possible modification of treatment.) • G0164 • Services provided by RN or LPN/LVN • In the home health setting, each 15 minutes, for the training and/or education of a patient or family member. NGHHC NOTTINGHAM 1/10/2011