The Director - Spring 2012 - (Page 41)
Dr. Richard Stefanacci is associate professor of health policy at University of the Sciences in Philadelphia, PA, and chief medical officer of The Access Group in Berkeley Heights, NJ. He is a certified medical director.
• Percent of long stay residents assessed and given, appropriately, the pneumococcal vaccine • Percent of long stay residents with a urinary tract infection • Percent of low-risk residents who lose control of their bowels or bladder • Residents who have/had a catheter inserted and left in their bladder • Percent of residents who were physically restrained • Percent of residents whose need for help with daily activities has increased • Percent of long stay residents who lose too much weight • Percent of residents who have depressive symptoms These 17 quality measures can be placed in 8 categories: • Pain • Pressure Ulcers • Vaccinations • Urinary Issues • Restraints • Weight Loss • Depression • Worsening of daily activities, including falls The collection of data for use in the quality measures is such as to prevent potential issues with the look-back period. For example, for the chronic care measures, calculations are based on any resident with a full or quarterly MDS in the target quarter. And for post-acute care measures, calculations are based on any resident with a 14-day PPS MDS in the two consecutive target quarters. It’s
important that DONs and their staff understand the specifics of what their home is responsible for in each of these eight areas. Pain Pain is often referred to as the fifth vital sign. Given its impact on quality of life, it is not surprising that pain is the subject of three of the 17 quality measures.
ain is often referred to as the fifth vital sign. Given its impact on quality of life, it is not surprising that pain is the subject of three of the 17 quality measures.
treatment for pain—specifically the percentage of residents on a scheduled pain medication regimen on admission who self-report a decrease in pain intensity or frequency. This quality measure is not counted for residents that report no pain on initial assessment, as it requires the opportunity for decrease pain intensity or frequency. Thus, if pain is reported to be absent or at the lowest level possible on initial assessment, there would be no ability to see a decrease in either frequency or intensity of pain, so this particular quality measure would not apply. If pain is not treated, a resident may not be able to perform daily routines, may become depressed, or may have an overall poor quality of life. This percentage could include some residents who are getting or have been prescribed treatment for their pain, but who refuse pain medicines or choose to take less. Some residents may choose to accept a certain level of pain so they can stay more alert.2 Pressure Ulcers There are two separate quality measures for pressure ulcers—one each for short stay and long stay residents. A pressure ulcer or sore is a skin wound. Pressure sores usually develop on bony parts of the body such as the tailbone, hip, ankle, or heel. They typically are caused by constant pressure on one part of the skin. Pressure sores are sometimes called
One of these quality measures for both short stay and long stay residents is the percentage of those who self-report moderate to severe pain. CMS has stressed that residents should be checked regularly by nursing home staff to see if they are experiencing pain. Another quality measure looks at
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Table of Contents for the Digital Edition of The Director - Spring 2012
The Director - Spring 2012
Letter From the President
Ask Dr. Si
Tools for Growing as a Don
Best Practice for Pain Identification in Cognitively Impaired Nursing Home Residents
Just Released: Medicare Nursing Home Quality Measures
The Director - Spring 2012