Identify 3 to 5 terms used in conjunction with the MDS 3.0 and how they can be used in care planning.
Define the expectations of person centered care planning.
Identify the seven components of the care plan and at least one key factor of each as it relates to RAI expectations.
Determine the three primary content areas to be considered in care planning
NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com
A brief update on the National Chlamydia Coalition by Ashley Coffield, MPA, Senior Fellow, Partnership for Prevention. Presented at the 2012 National Chlamydia Coalition meeting.
NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com
A brief update on the National Chlamydia Coalition by Ashley Coffield, MPA, Senior Fellow, Partnership for Prevention. Presented at the 2012 National Chlamydia Coalition meeting.
An interdisciplinary process is required to have success with MDS 3.0. Because of the recent RAI manual changes for MDS 3.0, many of the tool’s definition and instruction have changed.
Individuals often do not know their own mind. Most thinking is automatic and frequently unchecked. During waking hours, the separation between mind and consciousness is not often discernible. The character of consciousness makes the mind both simple and complex at the same time. Simple in that if a person has awareness, they are in charge of what they are thinking, feeling, and doing. Complex in that seeming awareness is often compromised, clouded by an unconscious (subconscious) mind.
Ethical and Legal Foundations of PMHNP Care Across the LifespanIBetseyCalderon89
Ethical and Legal Foundations of PMHNP Care Across the Lifespan
In your role as a PMHNP, you will regularly encounter situations that require your ability to make sound judgments and practice decisions for the safety and well-being of individuals, families, and communities. There may not be a clear-cut answer of how to address the issue, but your ethical decision making must be based on evidence-based practice and what is good, right, and beneficial for patients. You will encounter patients who do not hold your values, but you must remain professional and unbiased in the care you provide to all patients regardless of their background or worldview. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action.
· Analyze salient ethical and legal issues in psychiatric-mental health practice
· Analyze the impact of cultural considerations on ethical/legal decision making in advanced practice nursing
· Evaluate mastery of nurse practitioner knowledge in preparation for the nurse practitioner national certification examination*Discussion: Ethical and Legal Foundations of PMHNP Care
Advanced practice nursing in all specialties is guided by codes of ethics that put the care, rights, duty, health, and safety of the patient first and foremost. PMHNP practice is also guided by ethical codes specifically for psychiatry. These ethical codes are
frameworks to guide clinical decision making; they are generally not prescriptive. They also represent the aspirational ideals for the profession. Laws, on the other hand, dictate the requirements that must be followed. In this way, legal codes may be thought to represent the minimum standards of care, and ethics represent the highest goals for care.
Photo Credit: [Hero Images]/[Hero Images]/Getty Images
For this Discussion, you select a topic that has both legal and ethical implications for PMHNP practice and then perform a literature review on the topic. Your goal will be to identify the most salient legal and ethical facets of the issue for PMHNP practice, and also how these facets differ in the care of adult patients versus children.
Keep in mind as you research your issue, that laws differ by state and your clinical practice will be dictated by the laws that govern your state.To Prepare
·
Select one of the following ethical/legal topics:
· Autonomy
· Beneficence
· Justice
· Fidelity
· Veracity
· Involuntary hospitalization and due process of civil commitment
· Informed assent/consent and capacity
· Duty to warn
· Restraints
· HIPPA
· Child and elder abuse reporting
· Tort law
· Negligence/malpractice
·
locate a total of four scholarly, professional, or legal resources related to this topic. One should address ethical considerations related to this topic for adults, one should be on ethical considerations related to this topic for children/adolescents, one should be on legal considerations related to this ...
Presentation by Mel Pickup, Partnership Lead and Kieran Murphy, Partnership Clinical Lead, Cheshire & Merseyside Health & Care Partnership at the Clinical Academy Design Event on Tuesday 10 July , LACE Centre, Liverpool.
Article by Dr Mary Haynes about her agency's journey to a recovery orientation via CDOI and PCOMS published in the SAMHSA Recovery to Practice Newsletter.
An interdisciplinary process is required to have success with MDS 3.0. Because of the recent RAI manual changes for MDS 3.0, many of the tool’s definition and instruction have changed.
Individuals often do not know their own mind. Most thinking is automatic and frequently unchecked. During waking hours, the separation between mind and consciousness is not often discernible. The character of consciousness makes the mind both simple and complex at the same time. Simple in that if a person has awareness, they are in charge of what they are thinking, feeling, and doing. Complex in that seeming awareness is often compromised, clouded by an unconscious (subconscious) mind.
Ethical and Legal Foundations of PMHNP Care Across the LifespanIBetseyCalderon89
Ethical and Legal Foundations of PMHNP Care Across the Lifespan
In your role as a PMHNP, you will regularly encounter situations that require your ability to make sound judgments and practice decisions for the safety and well-being of individuals, families, and communities. There may not be a clear-cut answer of how to address the issue, but your ethical decision making must be based on evidence-based practice and what is good, right, and beneficial for patients. You will encounter patients who do not hold your values, but you must remain professional and unbiased in the care you provide to all patients regardless of their background or worldview. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action.
· Analyze salient ethical and legal issues in psychiatric-mental health practice
· Analyze the impact of cultural considerations on ethical/legal decision making in advanced practice nursing
· Evaluate mastery of nurse practitioner knowledge in preparation for the nurse practitioner national certification examination*Discussion: Ethical and Legal Foundations of PMHNP Care
Advanced practice nursing in all specialties is guided by codes of ethics that put the care, rights, duty, health, and safety of the patient first and foremost. PMHNP practice is also guided by ethical codes specifically for psychiatry. These ethical codes are
frameworks to guide clinical decision making; they are generally not prescriptive. They also represent the aspirational ideals for the profession. Laws, on the other hand, dictate the requirements that must be followed. In this way, legal codes may be thought to represent the minimum standards of care, and ethics represent the highest goals for care.
Photo Credit: [Hero Images]/[Hero Images]/Getty Images
For this Discussion, you select a topic that has both legal and ethical implications for PMHNP practice and then perform a literature review on the topic. Your goal will be to identify the most salient legal and ethical facets of the issue for PMHNP practice, and also how these facets differ in the care of adult patients versus children.
Keep in mind as you research your issue, that laws differ by state and your clinical practice will be dictated by the laws that govern your state.To Prepare
·
Select one of the following ethical/legal topics:
· Autonomy
· Beneficence
· Justice
· Fidelity
· Veracity
· Involuntary hospitalization and due process of civil commitment
· Informed assent/consent and capacity
· Duty to warn
· Restraints
· HIPPA
· Child and elder abuse reporting
· Tort law
· Negligence/malpractice
·
locate a total of four scholarly, professional, or legal resources related to this topic. One should address ethical considerations related to this topic for adults, one should be on ethical considerations related to this topic for children/adolescents, one should be on legal considerations related to this ...
Presentation by Mel Pickup, Partnership Lead and Kieran Murphy, Partnership Clinical Lead, Cheshire & Merseyside Health & Care Partnership at the Clinical Academy Design Event on Tuesday 10 July , LACE Centre, Liverpool.
Article by Dr Mary Haynes about her agency's journey to a recovery orientation via CDOI and PCOMS published in the SAMHSA Recovery to Practice Newsletter.
School of Nursing FNP
MSN5400 Health Care Policy
and Delivery System
MSN5400-week #6. Dr. Dionne, Dr. Perez, Dr. Gonzalez, Dr. Crespo, Dr. Trabanco, Dr.
Sanchez, Dr. Anderson. 06/22
1
PURPOSE
The purpose of this assignment is to write a literature review on a healthcare legislature of interest
COURSE STUDENT LEARNING OUTCOMES
Relate the role of the nurse leader as a driver of policy reform
Interpret research, bringing the nursing perspective, for policy makers and stakeholders
Promote policies that incorporate ethical principles and standards for the use of health and
information technologies.
Advocate for patients, families, caregivers, communities, and members of the healthcare team.
End of Program Student Learning Outcomes
I-Integrate nursing and related sciences into the delivery of care to clients in diverse healthcare
settings.
III-Analyze quality initiatives to improve health outcomes across the continuous of care.
IV-Apply practice guidelines to improve practice and health outcomes.
VII-Employ collaborative interprofessional strategies for improving client and population health
outcomes.
VIII-Evaluate the effectiveness of clinical prevention interventions that affect individual and
population based-health outcomes, perform risk assessments, add design plans or programs of care.
IX-Relate knowledge of illness and disease management to providing evidence-based care to clients,
communities, and vulnerable populations in an evolving healthcare delivery system.
DUE DATE: Submit to the Moodle by Saturday of the end Week 6 at 11:59 p.m. ET.
POINTS: This assignment is worth a total of 100 points.
School of Nursing FNP
MSN5400 Health Care Policy
and Delivery System
MSN5400-week #6. Dr. Dionne, Dr. Perez, Dr. Gonzalez, Dr. Crespo, Dr. Trabanco, Dr.
Sanchez, Dr. Anderson. 06/22
2
REQUIREMENTS
à To complete this application, you will need to access the Miami Regional University virtual library
database: CINAHL Complete Database, MEDLINE Complete Database, LIRN, and so forth. Our Librarian is
available to help on campus from Monday to Friday 7:30 am to 9:00 pm & Saturday 8:00 am to 3:00 pm.
Remember we now also have a Ask a Librarian option 7 days a week available in Moodle. Should you
have any questions, feel free to reach out to your professor or post your question in the Q/A forum on
Moodle. We are here to help. J
à This assignment is worth 100 points and will be graded on the required components as summarized
in the directions and grading criteria/rubric. This assignment will be graded on quality of information,
use of citations, use of Standard English grammar, sentence structure, and overall organization based
on the required components as summarized in the directions and grading criteria and rubric.
à APA format and effective writing is required for the paper. Use your APA manual or Purdue Owl t.
Webinar on Quality Improvement Strategies in a Team-Based Care Environment CHC Connecticut
Building a quality improvement (QI) infrastructure within team-based care is an organizational strategy that will establish a culture of continuous improvement across departments and improve quality in all domains of performance. Many positions in primary care now require QI training as part of employees' professional development.
Our expert faculty discuss tools you can use to build and implement a QI infrastructure within your team-based setting to improve patient care.
Panelists:
• Deb Ward, RN, Senior Quality Improvement Manager, Community Health Center, Inc.
• Kathleen Thies, PhD, RN, Consultant, Researcher, Weitzman Institute
Implement Behavioral Health Training Programs to Address a Crucial National S...CHC Connecticut
Health centers are uniquely positioned to address the unprecedented need for behavioral health services but are challenged by the workforce shortage. Participants will gain the knowledge needed to begin conceptualization of a training pathway.
Join us to discuss the considerations of sponsoring an in-house training program across all educational levels, including the benefits, program structure, design, curriculum, supervisors' role, and required resources.
Experts will provide participants with examples from practicum and postdoctoral level training programs to help them gain confidence in developing a behavioral health training pathway.
Parity and Healthcare Reform: Community Behavioral Health at a CrossroadsNational Council
The parity law and national healthcare reform are opportunities for community behavioral healthcare organizations to provide services to a broader spectrum of residents in their respective catchment areas. Additionally, accountable care organizations are now a part of the national healthcare delivery landscape, which will require CBHOs to assess their ability to provide additional service capacity so they can participate as valuable partners in new integrated healthcare service delivery systems.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
From Paper to Person
1. From Paper to Person MDS 3.0 Care Planning Presented by Debbie Ohl RN, M.Msc., PhD. Ohl and Associates Committed to Quality Care & Professional Excellence 613 Compton Road Cincinnati, Ohio 45231 MDSCarePlanBuilder.com
2. Debbie Ohl RN, M.Msc., PhDOhl and AssociatesLong Term Care ConsultantsDebbie@MDSCarePlanBuilder.com Debbie’s 30 year consulting practice is an outcome of learning lessons the hard way as a nursing director, sometime nurse’s aide and behind the scenes administrator. She is a regulatory compliance and interdisciplinary care planning specialist, authoring more than a dozen manuals including HcPro’s, Big Book of Care Plans. As a nationally recognized expert, Debbie has presented for many prestigious organizations including the National Institute for Health , the American College of Nursing Home Administrators, the National Health Care Lawyer’s Association, and numerous Health Care Organizations, and Nursing Facilities throughout the country. Recently completing her Ph.D in Holistic Life Coaching, Debbie brings a unique perspective on the impact that thoughts, feelings, and actions have on ourselves and those we serve. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
3. Tennessee’s Top Deficiencies Not in handouts Given care & services to get or keep the highest quality of life possible. Develop a complete care plan within 7 days. Prepare care plan with the care team. Check and update the care plan. Develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured. Give professional services that follow each resident's written care plan.
4. Quality … Degree of excellence or worth Life… A manner or way of existing Autonomy… Self-governance, self-sufficiency Quality of Life RAI… The path to improvement.
5. Getting to the Care Plan Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
6. Program Objectives Identify and discuss 3 to 5 new terms used in conjunction with the MDS 3.0 and how they can be used in care planning. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
7. Program Objectives Discuss the expectations of person centered care planning. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
8. Not on handout Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com "Person-centered planning begins when people decide to listen carefully and in ways that can strengthen the voice of people who have been or are at risk of being silenced.” John O'Brien A Little Book about Person Centered Planning
9. Program Objectives Identify the seven components of the care plan and at least one key factor of each as it relates to RAI expectations. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
10. Program Objectives Discuss the three primary content areas to be considered in care planning. P C P Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
11. Evolution of Care Planning Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
15. SSA does not specify enforcement standards1956 Feds find NH substandard 1965 Medicare/Medicaid programs funded by Feds Standards put in place 1970 NH atrocities hit front page of news papers 1972 Comprehensive Welfare Reform Act funds state survey and certification to establish uniform standards and conditions. Emphasis is on institutional framework: CAPACITY to deliver care.
16. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com Mid 70’s-early 80’s Patient Care & Services Survey born to correct emphasis on capacity to deliver to ACTUAL delivery of care. Controversy over legitimacy. Paper compliance in the form of policies was nearing its end. 1975-76 Use of paper in the form of care plan takes center stage to insure care delivery.... or at least begins the process.
20. 2010Quality of Care Actualized Quality of Life Comes to Forefront Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
21. Terms for Care Planning RAI MDS CATs CAAs CPGs EBPs SOP Decision Trees PCP Critical thinking Multidisciplinary Interdisciplinary Transdisciplinary Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
24. CATs Clinical Assessment TriggersCAAs Clinical Assessment Areas EBPs Evidenced Based Practices CPGs Clinical Practice Guidelines SOP Standards of Practice PCP Person Centered Planning Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
25. Clinical Assessment Areas CAA’s Identify and clarify areas of concern from CATs. Promote identification of underlying cause(s), risks, complications. Consider fixability factors. Establish correlations among multiple triggered CATs. Demands critical thinking skills. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
26. RAP CAA Possible problems in 18care areas. Triggers alert to possible issues in care needs. Triggered care area must be thoroughly assessed. Documentation must meet criteria. RAPS must be the tool used for conducting the assessment. Possible problems in 20 care areas. Triggers alert to possible issues in the care needs. Triggered care area must be thoroughly assessed. Documentation must meet criteria. There is no mandated specific tool for assessment. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
28. CAA Completion Psychosocial Well Being Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
29. CAA Demands Coming off of auto pilot. Problem solving in addition to problem management. Assessment and Care Planning Policies and Procedures. Staying up to date on changing practices. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
30. CPGs Clinical Practice Guidelines Guidelines developed to help health care professionals and patients make decisions about screening, prevention, or treatment of a specific health condition. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
31. EBPs Evidence Based Practices Conscientious decision-making based not only on the available evidence but also on patient characteristics, situations, and preferences. Recognizes that care is individualized and ever changing and involves uncertainties and probabilities. A philosophical approach that is in opposition to rules of thumb, folklore, and tradition. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
32. SOP Standard of Practice A diagnostic and treatment process that a clinician should follow for a certain type of patient, illness, or clinical circumstance. That standard will follow guidelines and protocols that experts would agree with as most appropriate, also called "best practice." Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
33. Decision Tree Used in determining the optimum course of action, in situations having several possible alternatives with uncertain outcomes Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
34. Don’t get bogged down! EBP, CPG, Care paths, etc. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
43. Person Centered Care How does person centered care differ from resident centered care? Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
44. Not in handouts Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com Person-centered planning was “invented” in an effort to offer people who request and receive human services the opportunity to describe and define the characteristics and conditions of life that represent for them a desirable present and future. It was “invented” in an effort to offer people who deliver those services an opportunity to learn and to grow alongside the person who is at the core of the planning process. “When People Matter More Than Systems” Keynote Presentation for the Conference “The Promise of Opportunity”, Albany, NY, March 2000, Michael Kendrick PhD Person-centered care is an idealistic approach to resident care thatbecame common around 1985. It was designed to allow people with developmental disabilities to have a voice in their lives and to facilitate self determination. By the late 1990’s the concept had filtered into other areas of health care.
45. Not in handouts Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com Person-centeredness is about intentionally being with people. It demands a personal commitment to engaging conscious awareness and self-reflection about the relationship between what we are thinking, feeling and actually doing …… Not everyone needs or benefits from a person-centered planning process… Essential lifestyles plans are developed through a process of asking and listening. The best essential lifestyle plans reflect the balance between competing desires, needs, choice and safety ……… It is critically important to remember that a plan is not an outcome. Introduction to Person-Centered Planning, Cornell University. http://www.ilr.cornell.edu/edi/pcp/course01.html
46. Critical Thinking Underpins the CAA Process The identification and evaluation of evidence to guide decision making. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
49. Comes to well-reasoned conclusions and solutions testing them against relevant criteria and standards; Thinks open-mindedly within alternative systems of thought, recognizing and assessing: if, then Communicates effectively with others in figuring out solutions to complex problems without being unduly influenced by others' thinking on the topic. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
50. Summarize your learning. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com Slide moved forward
51. Your Job To interpret and address the Care Areas identified by the CATs and develop an individualized care plan that keeps the person at the center of all activities. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
56. Transdisciplinary Strategy that crosses many disciplinary boundaries to create a holistic approachDebbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
57. Care Area Assessments Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
58. CAA Review Identify relevant triggers. Identify type of trigger. Identify the possible causes, contributing factors, and risk factors . Analyzing and draw conclusions. Develop a personalized, resident-specific care plan based directly on conclusions including insight of IDT members, resident, significant others. 42
59. Tools, Tips & Clarifications for Care Planning BIMS CPS MMSE PHQ-9 Issue Problem Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
62. RecallResidents must be capable of responding. If resident rarely/never understands staff assesses resident based on their observations. CPS Cognitive Performance Scale used in RUGs III to evaluate the level of cognitive impairment MMSE Mini Mental Status Exam questionnaire used to screen for cognitive impairment. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
63. PHQ9 Resident Mood Interview Patient Health Questionnaire with 9 questions Looking for signs of depression Residents must be capable of responding. Staff PHQ if 3 or more items not completed by resident. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
64. ISSUE About yesterday and tomorrow. Grey area, intangible. Typically not solvable. PROBLEM About here and now. Black and white, tangible. Something can be done. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
65. 10 Care Plan Must Have’s Preventing avoidable declines. Managing risk. Addressing resident strengths. Using standards of practice in the care planning process. Evaluating treatment objectives and outcome. Respecting right to refuse treatment; offering alternatives. Using an inter/trans disciplinary approach. Involving family and other resident representatives. Assessing and planning to meet the needs of new admits. Involving the direct care staff with care planning. Debbie Ohl & Associates LTC Consultants & Educators MDSCare PlanBuilder.com ThinkTheThoughts.com
66. Six general care planning areas Functional Status Rehabilitation/Restorative Nursing Health Maintenance Medications Daily Care Needs Discharge Potential Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
76. Components of the Care Plan Care Plan Statement 1 7 6 2 5 3 4 Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
77. Problem / Need Strength Scope, Severity, Stability CAA Interventions Approaches Clear Concise Do-able Done Review Dates & Places Nurse’s Notes Progress notes IDT notes Goal (s) Related Linked Measurable Reasonable Do-able Responsibilities Oversight Delivery Content Contains Issue Reason Impact 4Quadrants Risk Strengths Resident Input Fix ability Fix it Improve it Maintain it Control it Slow the decline Minimize/prevent complications What does the resident want?? Use the 4 Quadrant What physically mentally socially emotionally? Ask each discipline: what can you offer What does the resident want?? Delivery means insuring consistent implementation Oversightmeans monitoring for effectiveness Review Date based on SSS Interim Or Expected to be met Care Plan Guidance Resident Input
78. 3. Developing Goals Goals must be measurable enough to readily identify if the plan is working. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
79. 2. Resident Voice Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com What I see as my main problem. What I need to do. Why it’s important to me.
80. 4. Target Dates Meet Goal or Check Progress These need to be based on the scope, severity and stability of the particular problem. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
81. Consider the Scope, Severity, and Stability Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
82. Not in handouts The Ohl Modified Enforcement MatrixDetermining SSS of Problem for care planning
83. 5. ApproachesDetermining Interventions & Actions Interventions must reflect the relationship to the problem and goal. Each team member should ask: Is there anything I can offer? Do I have ideas for others that may be of use? What does the resident want? Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
84. 6. Monitoring a. Deciding on Accountability The discipline with the greatest ownership for the problem holds the accountability for plan implementation and modification between scheduled reviews. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
85. 6. Monitoring b. Implementation Before implementing, consensus must be sought with resident, family, and those responsible for implementation. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com
86. Care Plan Formats Common Plan “I” Plan Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com PGI Reads like a book Or Changes language content of common plan
87. “I” care plan sample SKIN Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com I-Format Care Plans http:// paculturechangecoalition.org I am at risk for skin breakdown because of my decreased mobility. I had an open area on my coccyx, which I obtained while in the hospital. It has improved to just a reddened area. I want to keep healing. Assist me to reposition every two hours if I have not done so on my own. Remind me to keep off my back as much as possible when I am in bed. I have a special pressure-reducing cushion on my chair, which needs to be straightened, before I sit in it every morning. My bed has a pressure-reducing mattress. I take a multivitamin to help with skin healing. I concentrate on making sure I eat proteins at every meal. Remind me that protein will help in healing. GOAL: I wish to remain free of skin breakdown.
88. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com COMMUNICATION/MEMORY: I used to communicate well and enjoy a hearty conversation. Humor has always been a part of my communication style. I have become much weaker as my health has declined. Sometimes I find it hard to even to answer I am tired. Occasionally I have episodes of confusion. Sometimes I do not know where I am and I become frightened. Please provide orientation during these times and when you are providing my care. Let me know who you are and what you are going to be doing. I usually recognize my children and my spouse. Holding my wife’s hand comforts me. When I am confused and frightened, I may strike out at you. Use calm gentle touch and hand massage while providing me reassurance. *GOAL: I don’t want my memory loss and confusion to interfere with my ability to accept the care I need. I do not want to hurt my caregivers.
89. Comfort (Rhode Island Quality Partners) I take regular medication for pain. Sometimes I need extra boost of medication. I also benefit from stretching so I like to attend the morning exercise group. The massage therapist seems me every Friday for an hour. Massage makes all the difference. Goal: To be free from breakthrough pain in my back
90. Debbie Ohl & Associates LTC Consultants & Educators MDSCarePlanBuilder.com ThinkTheThoughts.com Taken from web site on I care plans
91. Care Plan with Pain as the Root Problem Components of Pain Care Plan: Analgesia, Quality of Life, Ability to Function
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94. Assessment of Care Plan Activities Acute problems are addressed timely. Care plans geared to preventing avoidable declines? Care plans consistently manage resident risk factors in a timely manner? Care plans recognize and build on resident strengths? Goals measurable? Goals achievable? Goals met ? The IDT work together? Some team members write their own care plans for fear they will otherwise be cited? Documentation reflects status and/or rationale on each care plan goal? Direct care staff on all shifts and units are informed about the care plan goals and interventions? The direct care staff can explain what the goals are and why they are doing what they are do?
95. Person Centered Care Planning What do we live for, if it is not to make life less difficult for each other? George Eliot
Editor's Notes
The MDS 3.0 has been designed toimprove the reliability, accuracy, and usefulness of the MDS.The MDS 3.0 has been designed to include the resident in the assessment process, and to use standard protocols used in other settings.
Other Patterns: restraints, catheters, medication
Top DeficienciesNot giving care & services to get or keep the highest quality of life possible. Care planning hits:A complete care plan not developed to meet all of a resident's needs, with timetables and actions that can be measured.Not prepared timelyNot created with team, resident, significant others input.Not care plannedwith the care team.Check and updates missing, not timely.Professional services that follow each resident's written care plan not provided.The emphasis on quality of life is designed to give the resident, the human being, the person a say and how they choose to live out their life. Our new mission is PERSON FIRST care planning. Keeping this in mind may lessen the frustrations, anxieties, and regulatory fears we will surely face as we transition into the next generation of care planning.
While we are proficient at developing care plans that address resident needsand sometimes their wants.With the implementation of the MDS 3.0, we are charged with advancing our care planning skills yet again by allowing the resident a real voice in their care. We must honor the resident’s perspective and respect their desires if we are to promote the best quality of life they are capable. It may be helpful in understanding this to look at the difference between care provided and the life being lived. Care provided is a hands on, best practice approach to maintain and improve functional status and medical conditions. The life experienced is the manner and way the person is living.
Is an issue or a problem the same thing? CPGs: can perfection be generated?CPS: could you please stopPGQ-9 wrinkle reducing creamEBPs: every body playsBIMS: believe in miraclesPCPA drug that fries brain the cellsA way to remember what needs to be addressed on the pocPerson centered plans
Discipline Specific ProfessionalsWho will do what, when, how and where regarding the MDS completion and triggered CAA?Have you considered the setting for obtaining data collection?How will the professional team coordinate the information?Wish = desire, hope, yearningPreference = choice, preferred actionAdninistration / staff: culture change A shift in emphasis: Change existing mission and vision statement? “listen, learn, connect”.Regualtors: face the same dilemma s he facility. Black and white may now often be gray.
The components of well thought out care plan remain the same. The methods and formats might be different depending on how your organization decides to get the job done.The format most of us our familial with is the PGI method. Give me one benefit, one negative?There is also the emergence of the “I” format which can be seen the PGI format or the narrative.Give me one benefit, one negative?Later we will explore these options more.
The final program objective.PCP (cause and impact)= Physical, cognitive, psychosocial or PMS/e =physical, mental, social, emotionalCAA additions: pain, Discharge planning.Accommodation of need: adjust, adapt, modify
Federal involvement in nursing homes began with the passage of the Social Security Act in 1935. there were only public poor houses the majority of people were aged. The legislators did not want these places used to care for the elderly. Social Security Act established a public assistance program for the elderly which proliferated the growth of voluntary and proprietary nursing homes.1950, the Social Security Administration required states participating in the program to establish licensing programs, although the requirement did not specify what the standards or enforcement. 1956 were found to be substandard; staff was poorly trained or untrained and few services were provided. 1965 Medicare and Medicaid federally funded programs for nursing homes were significantly expanded; standards were uniformly put in place for nursing homes participating in the federal program.1970 and 1971 front page:fire killing more than 30 residents in Ohio, food poisoning in a Maryland home killing 36 residents, and numerous horror stories about care atrocitie1972comprehensive welfare reform funded state survey and certification activities in an effort to establish and enforce uniform standards and conditions. emphasis was on the institutional framework rather than on the resident’s care70’s and early 80’s, the Patient Care and Services Survey was born to rectify this problem. controversy over the legitimacy. having a policy was no longer enough, it had to be implemented, reviewed and revised to get results; paper compliance in the form of policy and procedure was nearing its end. Use of paper, in the form of a care plan, was the new gage for insuring resident care.The move from paper to person in determining compliance has been a long road of transitions and lessons learned... 20 years.
Federal involvement begins with passage of Social Security Act in 1935.
Result: mechanical process with conflicts, omissions, contradictions and animosity among team members.
What one value would be most important for you if you were living in a nursing home? Why? How could the facility accommodate it?If they could not how would that impact you PMS/E?
The shear number of these terms can be overwhelming, confusing and intimidating. The terminology is important to understand in terms of education for new and existing staff and as you begin to change out exiting policies and procedures.
CAA process for MDS 3.0 is not that different from the RAP process of MDS 2.0. Since there are no specific forms required with MDS 3.0, the facility has greater freedom to use a wider range of resources when making CAA decisions. However, if facilities are using resources other than those provided by CMS in Appendix C, they must be able to show the resources that were used in this new decision-making process and they must keep up with changing best practices , cpg’s and the like.Promote identification of underlying cause(s), risks, complications: previous baseline, presence of potentially reversible causes, Consider fixability factors: improve, manage, prevent goal driven.Establish correlations among multiple triggered CATs: cause impact PMS/e, associational cases and effects.Critical thinking is essential.
When RAPs were triggered a plan was developed or a decision made based on opinion or facts at hand without much further digging. Even when additional information was obtained it was often used or correlated. RAPS were predominantly reactive, spontaneous decisions. If the RAP triggered most often care plan was put in place. We addressed the outward symptom.i.e. IncontinenceCAA’s reflect the next step in our evolution as clinicians. They are more proactive. We talk to the resident rather than at them. We learn to think critically. The CAAs drive home assessment for underlying causes and contributors getting to the root cause.i.e. Incontinence
Appendix C CAA resources Although there are no mandated forms, CMS does supply facilities with CAA Resources in Appendix C. The appendix includes care area specific tools that the assessor can use for each of the 20 care areas. Each tool is between three to five pages long, guides the interdisciplinary decision-making, and provides a place to document the process. The benefit of using the tools in Appendix C is that it gives a comprehensive, reliable assessment that has good rater reliability. if facilities are using resources other than those provided by CMS in Appendix C, they must be able to show the resources that were used in this new decision-making process.Considering using forms in appendix C.Let’s look at an example from the RAI manual example. Falls 4-48.SMART: Specific, Measurable. Appropriate, Realistic, Times
What is you predominant thought about creating care plans under the MDS 3.0How does this make you feel?
Coming off of auto pilot, moving from rote to real, meaning our habit for a very long time has been if it triggers, care plan it just to be safe,Problem solving rather than problem management. Ask why incontinent and can it be reversed or minimized. I.e. Incontinent = reactive plan: toilet plan, fall and skin prevention, smell ok
COULD DOOften referred to as best practices they provide instruction on course of action.
SHOULD DOExamples of a reliance on "the way it was always done" can be found in almost every profession, even when those practices are contradicted by new and better informationelements in using the best evidence to guide the practice of any professional include the development of questions using research-based evidence adapt to minimize consequencesI.e. Non-compliant diabetic = resident center plan says will follow diet Person centered care plan would say? What do you need to know to address this?
MUST DO. i.e. coumadin and falls with head bump.
Displays the structure of a particular decision, and the interrelationships and interplay between different alternatives, decisions, and possible outcomes.Formal stepwise process used in coming to a conclusion or making a judgment.Schematic way of representing alternative sequential decisions and the possible outcomes from these decisions.A systematic method of managing a problem by graphically organizing the probabilities of outcomes of alternative treatments. At each decision node or branch a possible alternative is matched with its relative worth, quality of life, freedom from disability, and other factors on which a prognosis may be based.
Summarize what you have learned so far:
RAI x 15 years- paradigm shift 10 years.Define each of these terms in a sentence: collaborate with someone other than facility mate.Get in groups of 3-5 people and compare definitions. What did you learn?Write the first thought that comes into your mind when you think person centered care planning.
Small group discussion Compare and contrast.ResidentProfessionally driven, addresses what the resident needs.Individualized, but not personalizedFacility routineAbout doing things for or to residentPersonResident driven, addresses what the resident preferences related to their needs.Individualized and personalized.Resident routineAbout being with resident
Person-centered care is an idealistic approach to resident care thatbecame common around 1985. It was designed to allow people with developmental disabilities to have a voice in their lives and to facilitate self determination. By the late 1990’s the concept had filtered into other areas of health care.
No person-centered planning process should ever be initiated without a commitment from the key stakeholders, including service systems, to honor the process, take action and follow through on agreements. Simply saying that we are being person centered does not make us person centered in our care planning efforts. Person centered care is an empathic, common-sense approach to personalize care and de-institutionalize the environment that has been present in nursing facilities for decades. The irony of mandated requirements has driven facilities into a very structured system centered approach to care in order to remain in compliance. At the same time, these mandates are now requiring flexibility and system changes to meet individual preferences by using the MDS 3.0 as the vehicle for change.
CAA on self> Did you look beyond the superficial to cause?
BasicsClarify Your Thinking: look-out for vague, fuzzy, formless, blurred thinking. Stick to the Point:for fragmented thinking, thinking that leaps about with no logical connections. Start noticing when you or others fail to stay focused on what is relevant.Question Questions: Listen to how people question, when they question, when they fail to question. Look closely at the questions asked. What questions do you ask, should you ask?Be Reasonable: Be on the lookout for reasonable and unreasonable behaviors — yours and others. Look on the surface. Look beneath the surface. Listen to what people say. Look closely at what they do. Notice when you are unwilling to listen to the views of others, when you simply see yourself as right and others as wrong. Ask yourself at those moments whether their views might have any merit.Change in habit from RAPs rote to real, problem solving rather than problem management documenting to doing RAP behavior screams all dayCAA screams all day R/T R/I R/F
SWOT Plan
Multi Isolated, all mineInter Segmented, mine and yoursTrans Integerated, ours
Discuss 3 to 5 CAA’s functions of the CAAsPromotes identification of root cause(s), risks, complications. The RAPs did too but we were at the beginning of the learning curve and just adding another step in the assessment process began the shift in the paradigm.Issues verse problemsReactive v. problem solving care plansCorrelates triggering relationships and implications among multiple triggered CATs:Reflects functional impact to encouraging a centralized, more concise care planning process rather than a piece meal plan with multiple duplications, conflicts and stand alone disciplines. Old care planning was fear driven worry about surveyor acceptance. New care planning is person driven. It’s a shift in thinking for EVERONE.CAAs create an opportunity to sort cause from outcome. Contributing to problem identification and therefore a more focus care plan that promotes highest function with added benefit of promoting interdisciplinary rather than a multidisciplinary approach (which was a result of the first care expectations in the 70s)Advances recognition of resident strengths, preferences, wishes.The more focused emphasis of the MDS 3.0 on resident involvement using their voice as part of the process significantly facilitates and gives credence to the decision making process which may be outside the textbook, thus the evidence based practices which consider client wishes in determining the course of action and the goals.Consider correctability/fixabilityCritical thinking is the determinant for effective decision making.CAAs when used with critical thinking establish correlations among multiple triggered CATs: cause impact PMS/e, associational cases and effectsPromote identification of underlying cause(s), risks, complications: previous baseline, presence of potentially reversible causes. Engenders a proactive plan not a reactive plan.Consider fixability factors: improve, control, minimize decline, prevent complicationsSupports logical care plan linkageCoherent, reliable flow that reflect clear relationships between problem goal, interventions, time lines.Let’s take a quick look at the care plan components and how they correlate on the next slide 11.
1. Identify relevant triggers: what is the relationship of these triggers, ae they related or aren’t they and why. Assess do not assume.Identify type of trigger: potential problem, broad screen, prevention of problem, or rehabilitation potential. Identify the possible causes, contributing factors, and risk factors : Think holistically: PMSEAnalyzing and draw conclusions: Think critically! What are the cause and effect relationships, can they be changed, eliminated, how can they best be addressed? Think in terms of if, then. 5. Develop a PERSONALIZED, resident-specific care plan based directly on conclusions including insight of IDT members, resident, significant others.EXPERIENTIAL EXERCISE:Complete modified CAA on self.Address underlying problemsUnderstand nature of conditionConsider causes and contributorsHighlight and underscore strengthsCome to a decision providing rationale about the need to act or not act
What is the relationship between the BIMS, CPS and MMSE?
In testing 90 percent of residents were able to complete the BIMS. The CPS will still be computed for purposes of walking back info to RUGs III until 10/2011
Used by primary care clinicians in diagnosing depression as well as selecting and monitoring treatmentTwo components of the PHQ-9: • Assessing symptoms and functional impairment to make a tentative depression diagnosis • Deriving a severity score to help select and monitor treatment Complete PHQ on self
CAA EXPECTATION #1Promotes identification of cause and effect relationships, contributing and complicating factors and risk identificationCAA EXPECTATION #2Correlates triggering relationships and implications among multiple triggered CATs.
Functional Status: The conditions identified by the RAI should be clearly linked to the problematic issues/conditions addressed on the care plan. PROBLEM and Impact2. Rehabilitation/Restorative Nursing: A resident’s potential for physical, occupational, speech, psychological, respiratory, and other types of rehabilitation should be assessed and addressed by care planning. 3. Health Maintenance: monitoring disease processes that are currently being treated. The IDT may also decide whether or not to list on the care plan a problematic issues/conditions that no longer affect the resident, are controlled, or need no monitoring. Other areas of health maintenance may include terminal care and special treatments such as peritoneal dialysis or ventilator support. 4. Discharge Potential: Discharge potential for each resident needs to be assessed at admission, annually, and as needed. 5. Medications: The nursing home initially and periodically must conduct comprehensive assessments of a resident’s needs including ADE and ADR MMR6. Daily Care Needs: needs wants times etcmethods
List 4 of 9 content areas for care plan to meet standards of practice.
Recent study OIG: Care plans, goals, diagnosis, planned interventions, and projected outcomes were absent between 18 percent and 45 percent of the time. many of the care plans reviewed did not convey the specific information necessary to carry out the necessary care and services.
What does this mean? What does your voice say? What would that look like if it were occurring?It’s about being heard.Exercise: last time you had difficulty understanding or being understood.
Consider the scope, severity, and stability of the identified problems and needs to facilitatepriority problem recognition and balanced care plans. We sometimes try to address everything all at once because we are worried if it’s not on the plan we will get a deficiency……..which sets everybody up for failure.Placing too much data on the care plan can doom it to failure. Sometimes you cannot deal with one problem until you have solved another!When this is the case, provide a note of explanation as to your thinking and awareness of the problems to avoid problems with surveyors. Use the same scope and severity scale applied by surveyors (when citing deficiencies) to help you prioritize care planning needs and actions, along with your input onthe stability of the problem, goal, and / or plan.
Determining interventions. Each team member should ask: Is there anything I can offer to help with this problem? Do I have ideas that may be of use?.Interventions must reflect the relationship to the problem and goal. This is automatic if you have considered the preceding rules.
The discipline with the greatest ownership for the problem must take the responsibility to insure the plan is being properly implemented. The discipline should also be evaluatingeffectiveness of the plan between team meetings. The frequency of the evaluation will be dependent on the scope, severity and stability of the problem/need.
Before implementing plans consensus must be sought with resident, family, and those responsiblefor implementation. Hopefully that will be a formality if involvement was sought and obtained priorto plan development…….. a feasible plan will most likely have fallen into place.
The primary purpose of documentation and recordkeeping systems is to facilitate information flow that supports the continuity, quality, and safety of care. Since recordkeeping systems serve multiple purposes (e.g., legal requirements, regulatory compliance, accreditation, accountability, financial billing, and others) a summary, centralized in one location can keep conflicts to a minimum.