Technical Specs on Upcoming Changes to the MDS 10/1/2017 Presented - PDF document

2/22/2017 Technical Specs on Upcoming Changes to the MDS 10/1/2017 Presented by: Jane C. Belt, MS, RN, RAC-MT, QCP February 22, 2017 Faculty Disclosure • I have no financial relationships to disclose • I have no conflicts of interests to disclose • I will not promote any commercial products or services 2 1

2/22/2017 Requirements for Successful Completion • 1.0 contact hour will be awarded for this continuing nursing education activity • Criteria for successful completion includes attendance for at least 80% of the entire event. Partial credit may not be awarded • Approval of this continuing education activity does not imply endorsement by AANAC or ANCC (American Nurses Credential Center) of any commercial products or services American Association of Post-Acute Care Nursing (AAPACN)* is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. *AAPACN d/b/a American Association of Nurse Assessment Coordination 3 Learning Objectives • Delineate the new MDS 3.0 items in Sections N and P effective October 1, 2017 • Review specifications as to the item sets impacted by the new MDS 3.0 items • Discuss the importance and strategies about the new items and the influence they may have on your MDS accuracy and survey outcomes 4 2

2/22/2017 What’s New: Straight from CMS MDS 3.0 Technical Information December 22, 2016 • A new version (V2.01.0) of the MDS 3.0 Data Specifications was posted. This version scheduled to become effective October 1, 2017. This DRAFT version incorporates the changes identified for the DRAFT version (v1.15.0) of the MDS 3.0 item sets. New items have been added to Sections N and P, and there are a number of new Section S items as well. December 1, 2016 • A new DRAFT version (v1.15.0) of the MDS 3.0 item sets was posted and scheduled to become effective October 1, 2017 5 6 3

2/22/2017 Updating OBRA • Congress passed legislation to amend the Federal Government Code of Regulations (Chapter 42 of the Health Code), section 483 dealing with Skilled Nursing/Nursing Facility • Those changes resulted in revisions to: – Requirements of Participation (10/4/2016) and were massive – to be implemented in 3 phases: 1 = 11/28/16; 2 = 11/28/17; 3 = 11/28/19 AND – State Operations Manual (SOM), in particular Appendix P and Appendix PP (Guidance and Compliance) (Advance Copy 11/9/2016) AND 2/10/17 7 The Whys for Change Improvements in Care, Safety, and Protections for LTC Residents Policies are targeted • Reducing unnecessary hospital readmissions and infections • Improving the quality of care • Strengthening safety measures for residents Strengthening rights of residents • Staff members are properly trained on caring for residents with dementia and in preventing elder abuse • Staff members have the right skill sets and competencies to provide person-centered care 8 4

2/22/2017 The Whys for Change Discharge planning • Consideration of the caregiver’s capacity • Giving residents information they need for follow-up after discharge • Instructions are transmitted to any receiving facilities or services Infection prevention and control program • Requiring an infection prevention and control officer • Antibiotic stewardship program • Antibiotic use protocols • System to monitor antibiotic use 9 Quick Word about Section S • Reserved for state-defined items • No Section S in federal MDS, but appears if state has chosen to use the section - items defined by state States with Section S Items – October 1, 2017 Arkansas Maryland Ohio California Maine Pennsylvania Florida Mississippi South Dakota Illinois North Dakota Virginia Louisiana Nebraska Vermont Massachusetts New York West Virginia Connecticut has terminated all Section S items 10 5

2/22/2017 Section S Specs • Detailed Report – 397 pages and lists: – Item identification – Item text (label) – In which item subsets the item is activated – Item Values – Item Edits (errors) – Version Changes • If opening an MDS 10/1/17 or after, make certain to have a section S if you’re in a listed state 11 Section N – New Item in N0410 MDS 3.0 Nursing Home Comprehensive (NC) Version 1.15.0 Effective 10/01/2017 DRAFT 12 6

2/22/2017 N0410H. Opioids No changes for N0410 instructions • Number of days • Pharmacological classification – NOT how it is used • Look-back period 7 days or since admission/entry or reentry if less than 7 days • Enter “0” if medication not received by the resident in the last 7 days 13 N0410 Medications Received Where does the new N0410H appear? OBRA PPS Swing bed PPS NH PPS NH PPS Comprehensive (SP) (NP/PPS) (NP/PPS) (NC) SB OMRA- NH Start of NH start of NH Discharge Discharge Therapy/DC therapy/DC (ND, NOD) (SOD) (NSD) (NSD) SB OMRA Quarterly SB Discharge SOT/Discharge (NQ) (SD) (SSD) 14 7

2/22/2017 Why Was N0410H Added to MDS? Effective 11/28/2016 – Appendix PP SOM revisions • Quality of Care F309 – § 483.25(k) Pain Management. • The facility must ensure that pain management is provided to residents who require such services, consistent with professional standards of practice , the comprehensive person- centered care plan , and the residents’ goals and preferences. 15 Overview of Pain Recognition and Management • Factors affecting pain recognition: – Misunderstanding of indicators for, benefits and risks of, opioids and other analgesics; or – Mistaken belief that older individuals have a higher tolerance for pain; or that pain is an inevitable part of aging, a sign of weakness, or a way just to get attention – Communication issues due to illness or language and cultural barriers, need to be stoic about pain, and cognitive impairment 16 8

2/22/2017 Overview of Pain Recognition and Management • Known that opioids used for residents who are actively dying, those with complex, chronic pain syndromes (> 3 months) that have not responded to non-opioid analgesics or other measures • Opioids should not be prescribed as first-line treatment for chronic pain • Adverse consequences especially when resident is receiving other medications with significant effects on the cardiovascular and central nervous systems. – Careful dosing based on evaluating the drug effectiveness and occurrence of adverse consequences – Clinical record needs to reflect ongoing communication between the physician and the staff for optimal and judicious use of pain medications. 17 Monitoring, Reassessment, and Care Plan Revision • Monitoring over time helps identify how well pain is controlled relative to the resident’s goals • Ongoing evaluation of presence, increase or reduction of pain is vital as is status of causes, response to pain interventions, and possible presence of adverse effects of treatment • Adverse consequences related to analgesics can often be anticipated and to some extent prevented or reduced. For example, opioids routinely cause constipation, which may be minimized by appropriate bowel regimen 18 9

2/22/2017 Evidence About Opioid Therapy • Opioids can provide short-term benefits for moderate to severe pain • Scientific evidence is lacking for the benefits to treat chronic pain and are not well supported by evidence • Short-term benefits small to moderate for pain; inconsistent for function • Insufficient evidence for long-term benefits in low back pain, headache and fibromyalgia 19 More New Items in Section N N0450A. Did the resident receive antipsychotic medications since admission/entry or reentry or the prior OBRA assessment N0410B. Has a gradual dose reduction (GDR) been attempted? N0410C. Date of last attempted GDR continued 20 10

2/22/2017 N0450A., N0450B., N0450C. continued 21 N0450 (continued) N0450D. Physician documented GDR as clinically contraindicated N0410E. Date physician documented GDR as clinically contraindicated continued 22 11

2/22/2017 N0450D. and N0450E. 23 Which MDSs Have N0450? OBRA • Comprehensive OBRA • Quarterly 24 12

2/22/2017 Why Do You Suppose N0450 Added? Continued CMS Quality Initiative of Reducing Antipsychotics Requirements of Participation revisions Appendix PP continued updating 25 National Partnership to Improve Dementia Care 2011Q4 = 23.9% -32.4 % 2016Q3 = 16.1% 26 13

2/22/2017 Added to Appendix PP Problems with adverse events related to medications warrants close monitoring • OIG report on Adverse Events (AEs): – Occurs in 1 of 5 SNF residents – 37% related to medications – 66% of medication-related AEs were preventable – Often occurs due to substandard treatment or insufficient monitoring – Use of multiple medications complicates the determination of the primary cause of events 27 Phase 1 – § 483.45 Pharmacy Services • Requires a drug regimen review (DRR) that includes a resident’s MEDICAL RECORD monthly • Pharmacist must report: any irregularities (includes, but not limited to any drug that meets the “unnecessary drug” criteria) – Report (written) must include at least resident’s name, relevant drug, and irregularity – Must be sent to attending, director of nursing, and medical director, who must act on said report 28 14