Real Time AbstractionReal Time AbstractionA Multidisciplinary A Multidisciplinary

ApproachApproach

Multidisciplinary TeamMultidisciplinary Team

Clinical Care Excellence TeamClinical Care Excellence Team Nurse ManagerNurse Manager Staff NurseStaff Nurse Charge NurseCharge Nurse Abstractors/CodersAbstractors/Coders PharmacyPharmacy Social Worker/Utilization ReviewSocial Worker/Utilization Review RespiratoryRespiratory Quality Risk ManagerQuality Risk Manager Admission Nurse/ Infection ControlAdmission Nurse/ Infection Control Surgical Team MemberSurgical Team Member Registration/Insurance VerifierRegistration/Insurance Verifier

Admission Nurse RoleAdmission Nurse Role Patient Placement/EligibilityPatient Placement/Eligibility Completes Initial InterviewCompletes Initial Interview Complete skin assessmentComplete skin assessment Review all Present on Admission concernsReview all Present on Admission concerns Initiate the CMS indicators when appropriateInitiate the CMS indicators when appropriate Note and communicate risk for HAC Note and communicate risk for HAC Review all admissions completed on the off shifts for proper Review all admissions completed on the off shifts for proper

documentationdocumentation Medication reconciliation at AdmissionMedication reconciliation at Admission Completes Admission worksheet and reports CMS indicator Completes Admission worksheet and reports CMS indicator

issues to staff nurseissues to staff nurse Report admitting diagnosis to coders Report admitting diagnosis to coders Fax admission checklist to Medical Record 922-5279Fax admission checklist to Medical Record 922-5279

Charge Nurse RoleCharge Nurse Role Attend daily Multidisciplinary Meeting at 10:00amAttend daily Multidisciplinary Meeting at 10:00am Report on tentative discharge dates.Report on tentative discharge dates. Monitor Staff Nurse documentation for CMS Monitor Staff Nurse documentation for CMS

compliance.compliance. Ensure follow through by staff nurses of items Ensure follow through by staff nurses of items

presented at Multidisciplinary Meeting.presented at Multidisciplinary Meeting. Staff nurse to report pending issues to charge nurse .Staff nurse to report pending issues to charge nurse . Communicates if needed with physicians to ensure Communicates if needed with physicians to ensure

compliance with CMS indicators.compliance with CMS indicators. Reviews daily census reports with History and daily Reviews daily census reports with History and daily

vitals of all patients on floor.vitals of all patients on floor. Maintains White message board in break room dailyMaintains White message board in break room daily

Staff NurseStaff Nurse Clinical Time with patientClinical Time with patient

Reports on patient to Multidisciplinary team at 10:00am.Reports on patient to Multidisciplinary team at 10:00am.

Clinical documentationClinical documentation

Review Admission Nurse Checklist and follow-up on pending issues that Review Admission Nurse Checklist and follow-up on pending issues that have been identified.have been identified.

Obtains physician orders to comply with CMS indicators using standing Obtains physician orders to comply with CMS indicators using standing orders or evidence based order sets.orders or evidence based order sets.

Views message board-post-it in EMR for issues from abstractor. Place Views message board-post-it in EMR for issues from abstractor. Place action taken with date and time.action taken with date and time.

Follows up on actions needed from message board in EMR on Follows up on actions needed from message board in EMR on documentation required and or seeks physician orders to comply with documentation required and or seeks physician orders to comply with CMS indicators.CMS indicators.

Rounds on patientRounds on patient

AbstractorsAbstractors Daily review of inpatients EMR and surgical Daily review of inpatients EMR and surgical

schedule and ensure compliance with CMS schedule and ensure compliance with CMS Indicators.Indicators.

Attend daily Multidisciplinary meeting at 10:00 Attend daily Multidisciplinary meeting at 10:00 and report and follow-up on pending and report and follow-up on pending documentation issues.documentation issues.

Comment in EMR on message board –Post-it Comment in EMR on message board –Post-it documentation issues.documentation issues.

Report any significant changes in care plan or Report any significant changes in care plan or diagnosis to coders and multidisplinary team.diagnosis to coders and multidisplinary team.

E-mail outstanding issues to nursing E-mail outstanding issues to nursing supervisor/charge.supervisor/charge.

CoderCoder

Assign a working DRG at admission based Assign a working DRG at admission based on admitting diagnosis and history and on admitting diagnosis and history and physical.physical.

Attend Multidisciplinary Meetings, present Attend Multidisciplinary Meetings, present preliminary coding of cases to abstractors.preliminary coding of cases to abstractors.

Post changes to DRG through review of Post changes to DRG through review of chart or through communication with chart or through communication with abstractor in EMR through Post-it.abstractor in EMR through Post-it.

PharmacistPharmacist

Medication Reconciliation Review at Medication Reconciliation Review at Admission, transfers and dischargeAdmission, transfers and discharge

Attend Multidisciplinary MeetingsAttend Multidisciplinary Meetings Communicate medication changes Communicate medication changes

with physicians that are needed to with physicians that are needed to meet CMS indicator medication meet CMS indicator medication requirements.requirements.

Social Worker/ Utilization ReviewSocial Worker/ Utilization Review

Social Issues and PlacementSocial Issues and Placement Attend all Multidisciplinary MeetingsAttend all Multidisciplinary Meetings Ensure documentation of Care Conferences in Ensure documentation of Care Conferences in

patient chart.patient chart. Confirm and communicate insurance data and Confirm and communicate insurance data and

eligibility.eligibility. Report Insurance StatusReport Insurance Status Appropriate use of level of care to ensure best Appropriate use of level of care to ensure best

reimbursement.reimbursement. Assign tentative discharge date and relays to Assign tentative discharge date and relays to

team.team. Help team achieve discharge dateHelp team achieve discharge date

Multidisciplinary Team MeetingsMultidisciplinary Team Meetings

Admission ChecklistAdmission Checklistfrom Admission Nurse Program SAM-MCfrom Admission Nurse Program SAM-MC

COMMUNICATIONCOMMUNICATION

Communication will be the Key to Communication will be the Key to SuccessSuccess

CommunicationCommunication

Standardize communication Standardize communication Use SBAR and standarized taxonomyUse SBAR and standarized taxonomy S- situation; whats the problemS- situation; whats the problem B- background; the context, objective B- background; the context, objective

data, the numbersdata, the numbers Assessment: whats the problem?Assessment: whats the problem? Recommendation; what do we need to do Recommendation; what do we need to do

and when? How are we going to fix it? and when? How are we going to fix it? What is needed from physicianWhat is needed from physician

COMMUNICATIONCOMMUNICATION

Saves time for physicians, patients Saves time for physicians, patients and staffand staff

Clear way to communicateClear way to communicate Avoid staff and physician frustrationAvoid staff and physician frustration Eliminate unnecessary informationEliminate unnecessary information

(hear-say, and opinions)(hear-say, and opinions)

SBARSBAR

COMMUNICATIONCOMMUNICATION

Display results of CMS Indicator Display results of CMS Indicator Scores and publically reported Scores and publically reported measures in all break rooms so all measures in all break rooms so all staff aware of our standing and staff aware of our standing and update monthly.update monthly.

Continued education on CMS Continued education on CMS Indicators and future indicators.Indicators and future indicators.

Result PostingsResult Postings

TeamworkTeamwork

Enhance performance and ensure Enhance performance and ensure the best quality of care by teamthe best quality of care by team

All of team on same pageAll of team on same page No idea or suggestion discouragedNo idea or suggestion discouraged Every team member has a voiceEvery team member has a voice Brainstorm to achieve best outcome.Brainstorm to achieve best outcome. Administrative support of teamAdministrative support of team Include patient concernsInclude patient concerns

GoalGoal

Quality Care and the best evidence based Quality Care and the best evidence based practices given for our patients.practices given for our patients.

100% Compliance with CMS Indicators100% Compliance with CMS Indicators Obtain highest level of reimbursementObtain highest level of reimbursement Achieve above State and National scores Achieve above State and National scores

on publically reported measures.on publically reported measures. Patient, Physician, and Staff SatisfactionPatient, Physician, and Staff Satisfaction

Work In ProgressWork In Progress Bi-Weekly CMS Fallout meeting with nursing Bi-Weekly CMS Fallout meeting with nursing

supervisors/Charge abstractors and quality.supervisors/Charge abstractors and quality. Keep identify what is working and not working or Keep identify what is working and not working or

barriers to compliance.barriers to compliance. Hospitalist added to multidisciplinary daily Hospitalist added to multidisciplinary daily

meeting.meeting. Hospitalist follow-up with attending on issues Hospitalist follow-up with attending on issues

identified at meeting.identified at meeting. Address fallout's real-time with staffAddress fallout's real-time with staff Continue letters to physicians on fallout's.Continue letters to physicians on fallout's. CPOE/EBOSCPOE/EBOS

Where are we now.Where are we now.

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Thank YouThank YouFor your time and attentionFor your time and attention