RE: Skilled or Not Skilled?

[Winona M. Phelps]

"If the inherent complexity of a service prescribed for a patient is such that it can be performed safely and/or effectively only by or under the general supervision of skilled nursing or skilled rehabilitation personnel, the service is a skilled service..." 

Ideas for you for your patient: skilled nursing interventions on a daily basis for pain management, assessment and development of her plan of care, behavior management interventions- possibly including medications as well as approaches, respiratory assessments (why is she on O2? - COPD?, infection?, etc.-follow-up), look at the possibility of PT/OT doing some range of motion/upper body exercises, etc. while in bed, nutrition/hydration assessment and management.

 Here is the reference (cited above) for you:

http://www.cms.gov/manuals/102_policy/bp102c08.pdf    See 30.2.2

Always show what you're doing in descriptive, measurable documentation in the medical record so as to paint the picture of your skilled interventions and your patient's response(s).

 

Winona Phelps, RN

 

 

-----Original Message-----
From: Tanya Jordan [mailto:[EMAIL PROTECTED]
Sent: Thursday, February 26, 2004 7:17 AM
To: List Server
Subject: Skilled or Not Skilled?

I have a resident that is Medicare skilled presently, Her 5 day assessment was just completed. She had the qualifying stay in the hospital and she was receiving PT/OT. However, she was experiencing alot of pain. A bone scan was done on her this week and she has several fractures from a fall prior to admission. We knew she had the rib fractures but not the others. She has been placed  on bedrest, and therapy D/Cd her today. She is receiving a Durgesic patch, and Percocett for pain that is not controling her pain, we are consulting the doctor to day for better pain management., she has O2, is on a speciality mattress to prevent breakdown, and has behavior issues due to dementia.

I want to keep her skilled for pain management, but I havent been able to find in the Medicare manual what qualifies as skilled pain management.  HELP!!!!!

Tanya

Tanya Jordan, RNAC
Homewood Retirement Centers
Williamsport, MD
Fax 301-582-1819

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