Home Health Reference Tool For Nurses Foundation Management Services, Inc. 2010. All rights reserved. Unauthorized reproduction is strictly prohibited. (10/09)
Table of Contents 2 Page Medicare Eligibility and Coverage 3-15 Accreditation vs. Licensure/ 16 Certification OASIS: 17-45 Time Points Due Dates Case-Mix Items in Numerical Order Insulin and Diabetic Care 46-47 Wound Assessment 48-59 Pain Assessment 60-62 Nutritional Assessment 63-65 Laboratory Reference 66-70 Fall Risk Assessment 71 Infusion Therapy and Meds 72-81 Drug Calculation Formulas IV Flow Rate Calculations Infusion Therapy Tips A Guide to Food and Drug Interaction Infection Control and Exposure 82-90 Control About TB Hand Hygiene Standard Precautions Disposition of Special Waste Bag/Box Techniques Car Stock
What happened? Patient was discharged. Now readmitting. Going into the hospital for admission greater than 24 hours (for reasons other than diagnostic testing). Still in hospital over Recert (patient remains in hospital on day 60 of episode). Return to home from hospital within same episode. Return to home from hospital within same episode but also within 5-day window at end of episode (Recertification time frame). SCIC during episode OASIS Time Points What form? Start of Care (M0100-RFA 1) Transfer to Inpatient Facility (M0100-RFA 6 or 7) Amend Transfer to Inpatient Facility to Discharge from Agency (M0100-RFA 7) Resumption of Care within 48 hours of return to home (M0100-RFA 3) Resumption of Care (M0100- RFA 3) within 48 hours of return home. Recertification Follow-up (M0100-RFA 5) or Resumption of Care (M0100- RFA 3) if SCIC is due to hospitalization Recertification/Follow-up (M0100-RFA 4) 17
OASIS Quick Reference Due Dates Start of Care (SOC) - RFA 1 Referral to Admission (M0030) < 48 hours (M0090) assessment complete in 5 days of SOC date (M0030) Resumption of Care (ROC) - RFA 3 Perform assessment within 48 hours of hospital discharge (M0090) assessment complete within 2 calendar days of the ROC date (M0032) Recertification (Follow-up) Assessment - RFA 4 Every 60 days from SOC date (M0030), performed no earlier than day 56 and no later than day 60 (M0090) assessment completed during days 56-60 Significant Change In Condition (SCIC) - RFA 5 Following a significant change in condition (a major decline or improvement in patient s condition) Complete Follow-up Assessment (RFA 5) if SCIC occurs any time other than day 56-60; complete Resumption of Care (RFA 3) if SCIC occurs due to hospitalization (M0090) assessment completed in 2 days Discharge (RFA 9) /Transfer (RFA 6 or 7) /Death (RFA 8) (M0090) within 48 hours of knowledge FOR ALL TIME POINTS Paperwork due per agency policy Encode assessment & submit data within 30 days of (M0090) 18
Four-Stage System for Assessment of Pressure Ulcers Based on tissue layers involved Stage 1 Stage 2 Stage 3 Stage 4 Non-blanchable erythema of intact skin, the heralding lesion of skin ulceration. In individuals with darker skin, discoloration of the skin, warmth, edema, induration, or hardness may also be indicators. Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents as an abrasion, blister, or shallow crater. Low to moderate drainage. Full-thickness skin loss involving damage to or necrosis of subcutaneous tissue, that may extend down to, but not through underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue. Moderate to heavy drainage. Full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures (such as tendon or joint capsule) Undermining and sinus tracts may also be associated with Stage 4 pressure ulcers. Extreme to nonexistent drainage. NOTE: With necrotic tissue, staging cannot be confirmed until the wound base is visible. 48
Classification of Wounds by Thickness Partial Thickness and Full Thickness Wounds: Terms used to classify wounds whose primary cause is something other than pressure Describing a wound as a partial or full-thickness identifies the depth of the wound. It does not identify the condition of intact skin, the identifiable layers of tissue exposed (e.g., bone) or the color of the exposed wound bed. Leg ulcers-partial or full thickness wounds:vascular leg ulcers- Venous, Arterial; Neuropathic leg ulcers-diabetic Lacerations-Partial or full thickness wounds Surgical wounds-full thickness wounds Skin tears-partial thickness wounds Partial thickness wounds (PTW) Full thickness wounds (FTW) Extend through the epidermis and into, not through, the dermis. Heal by re-epithelialization Extend through both epidermis and dermis, may involve subcutaneous tissue and muscle and possible bone. Heal by granulation, contraction, epithelialization 49