Intake and output monitoring
You should monitor residents who have fluid imbalances or are at high risk of dehydration by calculating intake and output (I&O) each shift. Take I&O monitoring seriously. Set a realistic intake goal for each shift. Most fluid is consumed on the day shift, with the least consumed on nights. Thus, set a specific goal for each shift. Setting a goal will tell the nurse at a glance whether the resident has consumed enough fluid on his or her shift. If not, the CNA should encourage fluids before leaving for the day. When establishing goals for fluid intake, fluid is usually divided as follows:
- Day shift: 1/2 of total 24-hour fluid goal
- Second shift: 1/3 of total 24-hour fluid goal
- Third shift: 1/6 of total 24-hour fluid goal
For residents with a fluid restriction, total fluid allowance for each shift can be distributed in the same quantity listed above. Modify the amounts listed as necessary to personalize fluid intake to the resident’s individual needs.
Trainer’s tip: Residents who may require I&O monitoring
I&O monitoring is a simple procedure that does not require a physician’s order. Sadly, nurses sometimes do not take this important intervention seriously. Write the need for I&O monitoring, as well as any special approaches or resident preferences, on the care plan. If the resident is known to be at high risk of dehydration upon admission, begin a temporary care plan to address this risk.
Facility personnel should routinely monitor fluid balance (I&O) for the following:
- All residents receiving tube feedings
- Residents with catheters
- Residents with urinary tract infections
- Residents with physician orders for fluid restrictions or orders to force (encourage) fluids
- Residents with specific physician orders for additional liquid (fluid)
- Residents who are known to be dehydrated or who are at risk for dehydration
- Residents with certain heart and kidney conditions that are at high risk for fluid imbalance
- Residents receiving intravenous fluids or parenteral nutrition therapy
- Any resident who develops a fever, vomiting, diarrhea or a nonfebrile infection, unexplained weight loss or gain, pedal edema, neck vein distension, or shortness of breath
This is an excerpt from HCPro’s book, The Long-Term Care Nursing Desk Reference, Second Edition, by Barbara Acello, MS, RN.
How to deal with healthcare ratings
Editor’s note: This article was written by guest blogger Anthony Cirillo, FACHE, ABC, a healthcare marketing and experience management expert and elder advocate. For more information about the author, please see our About page.
USA Today recently reported that one in five U.S. nursing homes consistently receive poor ratings for overall quality under the Five-Star Quality Rating System. That is not surprising since the system rates on a bell curve. Some facilities, no matter how well they perform, will receive one star.
That started a sea of gripes, most notable how resident, family, and staff satisfaction surveys are not included in the Five-Star Quality Rating System. In June of 2009, research and consulting firm Holleran found little to no association between a facility’s rating on the five-star scale and the resident’s or family’s level of satisfaction with the facility.
Yes the system is flawed. But one thing is certain. Ratings are here to stay. Hospitals and physicians also get entwined in the ratings quagmire.
People are reading the ratings. People are talking to each other. And that may be good or bad for you. Want to do something about it? Tell your story and engage your ambassadors.
Tell Your Story
There are hundreds of small miracles that happen in all kinds of healthcare facilities every day. Most are stories which are usually undocumented. People are moved by stories. It is not enough to write stories but you need to establish a culture where employees are bringing stories to administration and marketing. Then write and run with them.
Spread Your Story
You don’t need a social media rehash here but suffice to say that there are a myriad of ways to push your story to the public. The beauty is that stories of a great patient experience in a hospital or a resident experience in an assisted living facility are human-interest pieces not overt selling tools. It’s not about your infection rates, latest technologies, or whiz-bang doctors. It’s about everyday people. Good stories are spread. Good stories are believed. Good stories have a halo effect on your brand.
Identify Your Ambassadors
Who is passionate about your services? Who passionately recommends you? Who offers unsolicited advice? Who comes to your defense? These are potential ambassadors for your brand. They might be an employee, a board member, a volunteer, a patient, a resident, or a family member. They may have surfaced through a letter they write to you, an op-ed piece in the newspaper, or in an on-line chat. Engage them.
The following are several other ways you can leverage word of mouth for your organization:
- Engage influencers
- Give something away
- Adopt causes strategically
- Bring communities together
I will elaborate on these in another post. In the meantime, don’t gripe about the latest and greatest ratings. Just craft your story and cede your army of ambassadors to spread it through that old reliable word of mouth.
One in five nursing homes received poor overall quality rating
Based on government data compiled in 2008 and 2009, one in five of the country’s nursing homes repeatedly received poor ratings for overall quality in Nursing Home Compare’s Five-Star Quality Rating System, according to USA Today.
The analysis of the data, which was completed by USA Today, showed the majority of the nursing homes that consistently received a one or two star overall rating were owned by for-profit companies. All 50 states and the District of Columbia had at least one facility with a poor rating on more than one occasion. The poorest-rated facilities possessed an average of 14 deficiencies.
Obama releases FY 2011 budget with no reductions in SNF funding
President Obama’s proposed budget for Fiscal Year (FY) 2011, which he released February 1, doesn’t include any cuts to SNF funding amidst the proposal’s roughly $900 billion allotment to the Department of Health and Human Services (HHS). Just over half of the HHS budget serves Medicare, which would increase to $489 billion thanks to the anticipated $722 million in waste and fraud recoupment, according to The Washington Post.
Medicaid funding for states stands at $290 billion in the budget, in addition to an extra $25 billion to allow for a six month extension of the temporary increase in the Federal Medical Assistance Percentage. The House and Senate will take President Obama’s proposed FY 2011 budget into consideration as they draft their own budgets in the coming months.
CMS releases remaining RAI chapters
CMS posted the remaining sections of the new Resident Assessment Instrument (RAI) User’s Manual on their Web site January 27, allowing long-term care providers to view the manual for the MDS 3.0 in its entirety.
The recently released sections include Chapter 2 – Assessments for the RAI, Chapter 4 – Care Area Assessment (CAA) Process and Care Planning, and Appendix C – CAA Resources. In addition to the final RAI User’s Manual sections, CMS also posted a new version of the MDS 3.0 item subsets and a file that lists the changes that have been made to each of the individual item subsets from the previously-posted versions. CMS also removed the MDS 3.0 Item Matrix from the list of available downloads, but the content of this matrix can be found in Appendix F of the RAI User’s Manual.
Chapters 1, 3, and 5 and Appendices A through H of the new RAI User’s Manual were released November 24 and Chapter 6 was released January 6.
“Now that the complete manual is available, it is the time for providers to read it and continue to highlight the changes and make notes to prepare themselves for the upcoming implementation date,” says Randy Kozeal, owner and manager of LTC Midwest, LLC, in Wilber, NE.
Although reviewing the manual in preparation for the changes under the MDS 3.0 is imperative for a successful transition to the new assessment instrument in October, providers should be on the lookout for potential manual revisions. During a January 21 SNF Open Door Forum, CMS official Tom Dudley mentioned there may be revisions to the manual in the upcoming months.
“Based on feedback they receive on the manual, they plan to issue an update prior to the March train-the-trainer session for the state RAI coordinators and surveyors,” says Rena Shephard, MHA, RN, RAC-MT, C-NE, president of RRS Healthcare Consulting Services in San Diego.
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