TIP OF THE WEEK

10 signs your QI efforts for pressure ulcers may not be working

 

1. Caregivers do not notice (or document) developing stage one pressure ulcers. Early detection (noticing red areas or other signs of skin breakdown, i.e., changes in skin temperature, bogginess, etc.) of Stage 1 ulcers is vital in preventing the harder to treat higher-stage ulcers. All residents should receive a weekly skin inspection of all parts of the body and any skin abnormalities should be documented. If developing ulcers aren't documented until they become a Stage 2 or higher, they will be much more difficult to treat and heal, and will likely be accompanied by more pain and other negative side effects.

 

2. Your definition of “high risk” does not include all the risk factors. The MDS (and your QI/QM reports) considers a resident at high risk for pressure ulcer development if he/she meets any one of the following criteria: comatose, bed or chair bound, limited transfer capability, or has malnutrition. Clinical guidelines suggest that there are many other risk factors for pressure ulcer development, so you should use a comprehensive risk assessment tool on every resident at admission, quarterly, and with any significant change in condition.

 

3. The pressure ulcer team doesn't complete pressure ulcer risk assessments frequently enough. Remember that the key to pressure ulcer prevention is to identify a resident’s risk factors, and put into place some interventions to help lessen the effects of those risk factors. Be sure you assess risk on a routine basis, including newly admitted residents.

 

4. The pressure ulcer team doesn't differentiate between pressure-reducing and pressure-relieving materials. These products provide varying levels of pressure relief, and should be used on residents who require that level of relief or reduction. Properly assess residents' needs and provide the appropriate surface to help prevent pressure ulcer development.

 

5. Staff nurses over-rely on the designated wound-care nurse. Your floor staff should take an active role in pressure ulcer prevention and treatment, rather than allowing assessments and orders to fall on the designated treatment nurse. Encourage all caregivers to take “ownership” of the prevention and treatment process.

 

6. You simply accept the number of wounds in your building. As long as wounds aren’t developing “in-house,” often there is the temptation to overlook the quality measure reports. With appropriate treatment, however, the number of existing wounds should decline, not remain at a consistent high level. Also, remember that consumers now have access to information via the Internet, so you should be prepared to discuss your QM scores with potential residents and families.

 

7. Dietary doesn’t have a current list of residents with pressure ulcers. Nutritional consults and interventions are vital to wound healing. Be sure your dietitian stays up-to-date on the skin status of each of the residents.

 

8. Residents are not assessed for wounds prior to admission. If you don't know that a resident who is being admitted has an existing pressure ulcer (or is at high risk for pressure ulcers), you cannot put immediate interventions in place upon admission. Remember that pressure ulcers can develop or worsen in two hours or less, so you do not want to delay interventions.

 

9. Wound-care nurse does not follow current clinical guidelines. Your designated wound care nurse should be a clinical expert when it comes to appropriate treatments for wounds. As recommendations and therapies change, he or she should stay apprised of any new clinical guidelines and treatment options.

 

10. Care plans are not being followed. Periodically assess your high-risk residents to be sure their care plans are being followed. For example, is staff compliant with turning schedules, positioning devices, incontinence care, moisture barrier creams and nutritional supplements and snacks?

 

NPI: Get It. Share It. Use It.

 

There are less than 90 days until the National Provider Identifiers (NPI) compliance date of May 23, 2007. It is estimated that it may take at least this much time to implement the NPI into your business practices. Failure to prepare could result in a disruption in cash flow. Will you be ready to use your NPI? Time is running out!

 

Updating National Plan and Provider Enumeration System (NPPES) Information

All health care providers, including Medicare providers, should include their legacy identifiers as well as associated provider identifier type(s) on their NPI applications. If a provider has already completed an application and did not submit a legacy identifier, this provider should go back and update its information in NPPES on the Web site at https://nppes.cms.hhs.gov. While doing so, providers should also validate other data in NPPES, such as address, contact person information, etc. and update anything that has changed.

 

Sharing NPIs

Once providers have received their NPIs, they should share their NPIs with other providers with whom they do business, and with health plans that request their NPIs. In fact, as outlined in current regulation, providers must share their NPI with any entity that may need it for billing purposes -- including those who need it for designation of ordering or referring physician. Providers should also consider letting health plans, or institutions for whom they work, share their NPIs for them.

 

New frequently asked questions (FAQs) posted

CMS has posted new NPI FAQs on its Web site. Questions include:

• For Medicare provider enrollment purposes, will group practices need to submit new CMS-855Rs for every member of the group practice in order to let Medicare know their NPIs?

 

• Will health plans link the NPIs of group practices to the NPIs of the health care providers who are members of the group practices?

 

• Who needs an NPI? Who is not eligible to apply for an NPI? What if I have a Drug Enforcement Administration (DEA) number? What if I only bill on paper? What if I do not submit claims to Medicare?

 

• Can my office Employer Identification Number (EIN) be used instead of a National Provider Identifier (NPI)?

 

• When do I need to use my National Provider Identifier (NPI)?

 

• Is a corporation that owns pharmacies that have National Provider Identifiers (NPIs) required to have an NPI in order to receive payments on behalf of the owned pharmacies?

 

To view these FAQs, please go to the CMS dedicated NPI Web site at www.cms.hhs.gov/NationalProvIdentStand and click on Educational Resources. Scroll down to the section that says “Related Links Inside CMS” and click on Frequently Asked Questions. To find the latest FAQs, click on the arrows next to “Date Updated.”

 

Upcoming WEDI Events

Workgroup for Electronic Data Interchange (WEDI) has several NPI events scheduled in the upcoming month. Visit http://www.wedi.org/npioi/index.shtml to learn more about these events. Please note that there is a charge to participate in WEDI events.

 

Sharing NPIs with Medicare

In addition to updating critical data and legacy identifiers in the NPPES, Medicare providers should include both their NPIs and their Medicare legacy numbers in their Medicare claims. This will help Medicare build its NPI crosswalk by enabling Medicare to link providers’ NPIs to their Medicare legacy identifiers. Also, when Medicare providers make changes to their Medicare enrollment information, they are now required to furnish their NPIs when making those changes. Providers applying for Medicare enrollment must furnish their NPIs on their enrollment applications. These actions inform Medicare of providers’ NPIs. There are no additional actions that Medicare providers need to take to inform Medicare of their NPIs.

 

Still Confused?

Not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found at the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS Web site. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203.

 

Getting an NPI is free -- not having one can be costly!

 

 

 

 

IN THE NEWS

 

IN-HOME CARE COULD CUT OUTLAYS

February 25, 2007 – Cincinnati Enquirer – If there's one change that could be done quickly and with little controversy, it's moving more Medicaid patients from institutions to home health care.

 

Former Gov. Bob Taft encouraged in-home care -- in a program called "Home First" -- in his last budget passed in June 2005, allowing more people to be moved out of nursing homes and treated at home. Last year, nearly 1,000 Ohioans took advantage of the pilot program, saving an estimated $60 million in more costly nursing-home care. One senator has proposed expanding that program.

 

Nursing-home care is nearly five times more expensive for the elderly and mentally challenged than hiring nurses to care for those who are able to live at home, according to a recent study. Tending a person for a year using home care costs about $11,800 per year, while an institution runs about $56,000 per year, according to the Ohio Council for Home Care. Read more >>.

 

 

EXPECT RISE IN NURSING-HOME COSTS, PRICES

February 26, 2007 – The Columbus Dispatch – Now that some Medicaid recipients are eligible for assisted living and now that Medicaid will pay for their care, the costs will increase greatly. Why? Because now that the state and federal governments control the money for care, they will mandate what they have forced on nursing homes.

 

Almost immediately, they will probably require assisted-living facilities to pay the franchise permit fee of $6.25 per day for each licensed bed, occupied or not, which amounts to $2,281.25 for each bed per year! It would cost a 50-bed facility $114,062.50 per year! Then they will require all the direct-care staff to be state-tested nursing assistants. The cost increase would be dramatic, as the supply of those assistants is limited and the demand greatly increased. These increases may be minimal compared with what may be required of the facilities’ physical structures. Sprinklers, emergency generators, 8-foot hallways, enunciator panels and smoke-detection equipment cost money. Is it any wonder the government pays $500 for a toilet seat? Read more >>

 

 

OHIO KEPRO EVENTS

 

QUALITY IMPROVEMENT: TAKING IT TO THE NEXT LEVEL

Objectives:

• Identify the basic principles of quality improvement
• Describe the role of data collection in the quality improvement process
• Discuss ways to improve team performance
• Identify strategies to improve the effectiveness of team leaders and team members

WHO SHOULD ATTEND? Nursing home administrators, directors of nursing, clinical managers, direct care professionals, QI team members

 

Continuing education credits for nurses and NAB credits for administrators are pending. Please contact Donna Maynard at 1.800.385.5080 to learn the program’s status.

 

Download the flyer for more information
Register online today

 

View all Ohio KePRO educational opportunities for nursing homes >>

 

 

COMMUNITY OF PRACTICE CONFERENCE CALLS

 

Pressure Ulcers	Pain	Restraints
Call 1 Tuesday, March 13 – 10:00 a.m. or Thursday, March 15 – 2:00 p.m.	Call 1 Tuesday, March 27 —10:00 a.m. or Thursday, March 29 — 2:00 p.m.	Call 1 Tuesday, April 3 – 10:00 a.m. or Thursday, April 5 — 2:00 p.m.
Call 2 Tuesday, April 17 — 10:00 a.m. or Thursday, April 19 — 2:00 p.m.	Call 2 Tuesday, April 24 — 10:00 a.m. or Thursday, April 26 — 2:00 p.m.	Call 2 Tuesday, May 1 — 10:00 a.m. or Thursday, May 3 — 2:00 p.m.

 

Dial-In: 1.800.895.1715

Conference ID: COP

For more information, please contact the Nursing Home Team at 1.800.385.5080

 

 

 

INDUSTRY EVENTS

 

Roadmap for Change: A Practical Guide for Caring in a New Way
March 20, 2007, Villa Milano Banquet and Conference Center, Columbus Ohio
Registration fee: $75

 

Navigating the MDS Through the Ohio Medicaid Reimbursement System
Ohio Department of Job and Family Services
June 11, 2007 or August 23, 2007
Call Cheryl Robertson at (614) 466-9088 for more information.

 

Tracking Trends: Impacting the Practice of Medicine

Jointly sponsored by The Academy of Medicine of Cleveland & Northern Ohio, Academy of Medicine Education Foundation, and St. Vincent Charity Hospital. March 9, 2007, 9:00 a.m.-4:00 p.m., Embassy Suites, Independence, Ohio. Call 216.520.1000 for more information or to register by phone or visit www.amcnoma.org.

 

 

 

Medicare Learning Network: Learning resources and products for the healthcare professional.

 

Alzheimer’s Association Training Events

 

AOPHA Events

 

Case Western Reserve University School of Medicine Courses

 

Kendal® Outreach

 

Ohio Department of Health, Technical Assistance Program – New Programs

 

Ohio Health Care Association Events

 

 

 

An archive of The Nursing Home Weekly Update is available on our Web site. Click here >>