First, you would NOT do the OMRA since the resident's Medicare skilled stay ended
before 8 days after all therapy ended. You did not say where the resident was in his
stay so don't know if you need to complete a 30 day. If his skilled stay ended on or
before day 30, no 30-day assessment is required and your 14 day PPS assessment would
cover all of the skilled stay days for this resident.
I would not count a change in bath/shower days as a physician's order. Others may
disagree, but I believe it not appropriate to count orders that could be nursing
orders without a physician's signature.
I would not count a healed stoma site as a surgical wound. Page 3-166 of the RAI
manual states under Surgical wounds, "This category does not included lhealed surgical
sites, stomas, or lacerations that require suturing or butterfly closure as surgical
wounds."
-----Original Message-----
From: [EMAIL PROTECTED]
Sent: May 4, 2004 7:44 AM
To: [EMAIL PROTECTED]
Subject: A few questions......
My mind is blanking today - could someone give me input?
First, resident had last covered day of Therapy on 4/28. We continued to cover this
resident for Medicare due to the skilled need of IV Lasix daily (push). I set the
OMRA for 5/6 and combined it with the 30-day. Today the IV Lasix is discontinued,
resident stable, so made today the last covered day of Medicare. OMRA does NOT need
done, right? And if I do not do it, does the Therapy RUG score stay until that last
covered day?
Secondly, when an order is written to change bath and shower days from one to two per
week or two to one per week, do we count that as a Physicians order under P8? Today's
rounding doctor said he will not sign them as there should be a policy on
baths/showers so that these orders could more or less be written as a nursing measure.
(?)
And a gray area - resident had a tracheostomy. Currently has no trach, only the
stoma. We can't count trach care so do we capture the care that we do under "surgical
wound care"?
I have been working TOO many hours and this info is all running together. Thanks for
ANY help you could provide.
Bonnie
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/----------------------------------------------------------
The Case Mix Discussion Group is a free service of the
American Association of Nurse Assessment Coordinators
"Committed to the Assessment Professional"
Be sure to visit the AANAC website. Accurate answers to your
questions posted to NAC News and FAQs.
For more info visit us at http://www.aanac.org
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