transcript
- Slide 1
- Swallowing Disorders Height and Weight Weight Change
Nutritional Approaches SECTION K SWALLOWING/NUTRITIONAL STATUS June
9, 2015 1-3PM
- Slide 2
- Objectives Understand that Section K is intended to assess the
many conditions that could affect the residents ability to maintain
adequate nutrition and hydration Understand how to code Section K
correctly Understand what needs to be on the care plan
- Slide 3
- K0100: Swallowing Disorder Ask resident about difficulty
swallowing and each symptom during 7 day look-back period Observe
when eating, drinking, or swallowing Interview staff Review medical
record
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- K0100: Swallowing Disorder Do not code if interventions
successful Code a symptom even if it occurred only once Check all
that apply during 7 day look-back period
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- K0200: Height & Weight Consistent facility policy and
procedure Mathematical rounding, nearest inch/pound A. Height Most
recent Admission/Entry or Reentry (If last ht. recorded was more
than 1 yr. ago, measure the ht. again) B. Weight Most recent in
last 30 days On subsequent assessments, if last recorded weight
>30 days prior to ARD, or previous weight not available, weigh
again If multiple weights in preceding month, most recent weight
Unable to weigh, use Dash (-)
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- K0300: Weight Loss K0310: Weight Gain Two Snapshots in time: 30
Days, 180 Days New Admission Ask resident, family, or significant
other Consult residents physician Review transfer documentation
Compare admission weight to previous weight of 30 & 180 days If
less, calculate % weight loss If more, calculate % weight gain
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- K0300: Weight Loss K0310: Weight Gain Subsequent Assessments
Compare weight in current observation period to weight in
observation period 30 days ago in observation period 180 days ago
If less, calculate % weight loss If more, calculate% weight
gain
- Slide 8
- K0300: Weight Loss Calculate Percentage (5%) in past 30 days
Mathematical round weight before calculating Multiply previous
weight by 0.95 to determine resident weight after 5% weight loss
Example: 160 pounds x 0.95 = 152 pounds A resident whose weight
drops from 160 to 152 lbs or less has experienced 5% or more weight
loss
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- K0300: Weight Loss Calculate Percentage (10%) in past 180 days
Mathematical round weight before calculating Multiply previous
weight by 0.90 to determine resident weight after 10% weight loss
Example: 160 pounds x 0.90 = 144 pounds A resident whose weight
drops from 160 to 144 lbs or less has experienced 10% or more
weight loss
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- K0310: Weight Gain Calculate Percentage (5%) in past 30 days
Mathematical round weight before calculating Multiply previous
weight by 1.05 to determine resident weight after 5% weight gain
Example: 160 pounds x 1.05 = 168 pounds A resident whose weight
increases from 160 to 168 lbs or more has experienced 5% or more
weight gain
- Slide 11
- K0310: Weight Gain Calculate Percentage (10%) in past 180 days
Mathematical round weight before calculating Multiply previous
weight by 1.10 to determine resident weight after 10% weight gain
Example: 160 pounds x 1.10 = 176 pounds A resident whose weight
increases from 160 to 176 lbs or more has experienced 10% or more
weight gain
- Slide 12
- K0300: Weight Loss Code whether planned/managed or
unplanned/unmanaged Loss of 5% or more in last month OR Loss of 10%
or more in last six months Code 0. No or unknown Not experience
defined weight loss Prior weight not available Code 1. Yes,
physician-prescribed weight-loss regimen Code 2. Yes, not on
physician-prescribed weight-loss regimen
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- K0310: Weight Gain Code whether planned/managed or
unplanned/unmanaged Gain of 5% or more in last month OR Gain of 10%
or more in last six months Code 0. No or unknown Not experience
defined weight gain Prior weight not available Code 1. Yes,
physician-prescribed weight-gain regimen Code 2. Yes, not
physician-prescribed weight-gain regimen
- Slide 14
- K0510.Nutritional Approaches
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- K0510: Nutritional Approaches Column 1. While Not a Resident
Column 2. While a Resident 7 day look-back period Prior to
admission/entry or reentry 7 day look-back period After
admission/entry or reentry Review medical record for 7 day
look-back period All nutrition and hydration received at nursing
home, hospital as outpatient or inpatient.
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- K0510: Nutritional Approaches A. Parenteral/ IV feeding
Supporting documentation reflecting need for additional fluid
intake for nutrition or hydration or prevention of nutrition need
or dehydration. IV fluids or hyperalimentation, including TPN,
administered continuously or intermittently IV fluids KVO (Keep
Vein Open) IV fluids in Medication Piggybacks Hypodermoclysis and
subcutaneous ports in hydration therapy IV fluids to prevention of
dehydration
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- K0510: Nutritional Approaches A. Parenteral/IV feedings do not
include: IV medications IV fluids used to reconstitute or dilute
meds IV flushes IV fluids administered: In conjunction with
chemotherapy or dialysis as routine part of operative or diagnostic
procedure or recovery room stay
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- K0510: Nutritional Approaches - Diets C. Mechanically altered
Specifically prepared to alter the texture or consistency of food
to facilitate oral intake. Examples include: soft solids, pureed
foods, ground meats, thickened liquid. Not automatically a
therapeutic diet. Enteral feeding formulas Do not code as
mechanically altered diet
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- K0510: Nutritional Approaches - Diets D. Therapeutic Diet
intervention ordered by health care practitioner as part of
treatment for disease or clinical condition manifesting altered
nutritional status, to eliminate, decrease, or increase certain
substances in the diet (e.g. sodium, potassium) Supplements not
automatically classify diet as therapeutic Enteral feeding formulas
Code as therapeutic diet only if used to manage problematic health
conditions (e.g. residents with diabetes)
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- Scenario Mr. K. has been able to take some fluids orally,
however, due to his progressing MS, his dysphagia is not allowing
him to remain hydrated enough. Therefore, he received the following
fluid amounts over the last 7 days via supplemental TFs while in
the hospital and after he was admitted to the NH. While in the
HospitalWhile in the NH Mon400ccMon510cc Tues520ccTues520cc
Weds500ccWeds490cc Thurs480cc Total1900ccTotal1500cc Coding:
K0710B1 would be coded 1, 500cc/day or less. K0710B3 would be coded
1, 500cc/day or less
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- Continued Rationale: The total fluid intake within the last 7
days while Mr. K. was not a resident was 1,900cc
(400cc+520CC+500cc+480CC = 1,900cc) Average fluid intake while not
a resident totaled 475cc (1,900cc divided by 4 days) 475cc is less
than 500cc, therefore code 1, 500cc/day or less is correct for
K0710B1, While NOT a Resident. The total fluid intake within the
last 7 days while Mr. K. was a resident of the NH was 1,520cc
(510cc+520cc+490cc = 1,520). Average fluid intake while a resident
totaled 507cc (1,520cc divided by 3 days). 507cc is greater than
500cc, therefore code 2, 501cc/day or more is correct for K0710B2,
While a Resident. The total fluid intake during the entire 7 days
(includes fluid intake while he was in the hospital AND while he
was in the NH) was 3,420cc (1,900c+1,520cc). Average fluid intake
during the entire 7 days was 489cc (3,420 divided by 7 days). 489cc
is less than 500cc, therefore code 1,500cc/day or less is correct
for K0710B3, During Entire 7 Days.
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- Care Plan Considerations State what swallowing/eating problems
the elder has and interventions to prevent complications Provide
what interventions are in place to prevent weight loss. This needs
to be looked at on admission in order to prevent any weight loss.
Include what the dietitian recommends. Also include interventions
for any significant weight gain
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- Care Plan Considerations continued If tube feeding is required
be specific with the care needed This is also where you would put
there favorite foods, when they want to eat, the foods they
dislike, and what they want for snacks and when Always remember to
care plan expected weight loss, example weight loss is expected D/T
diuresis because of fluid retention and use of diuretics.
- Slide 25
- Questions? Ill take the next few minutes to answer any
questions you might have
- Slide 26
- Thank you!! Please feel free to contact me Shirley L. Boltz, RN
RAI/Education Coordinator 785-296-1282
shirley.boltz@kdads.ks.gov