However, what if the resident had say a wound on the lower extremety that the physician felt would benefit from more frequent whirlpool baths. If the Physician orders whirlpool baths daily, it would not be up to nursing to go back to once a week whirlpools without the physician's recommendation, right? Also, tracheostomy care (J1p)would be coded even if it was only a healed stoma. The term tracheostomy literally translates "new permanent opening in the trachea". Our nursing jargon has termed the appliance as the trach, but it is not technically correct.
Jeana ----- Original Message ----- From: "carol maher" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Tuesday, May 04, 2004 10:11 AM Subject: Re: A few questions...... > 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 > /---------------------------------------------------------- > 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 > -----------------------------------------------------------/ > > /---------------------------------------------------------- > 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 > -----------------------------------------------------------/ /---------------------------------------------------------- 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 -----------------------------------------------------------/
