MINIMUM DATA SETS (MDS)MINIMUM DATA SETS (MDS)

DEBRA VERNA, RN, LNHADEBRA VERNA, RN, LNHA

Nine Federal MDS Tags

1. F272- Resident Assessment using the RAI2. F273-Admission Assessment3. F274 SCSA (Significant Change in Status Assessment)4. F275 Annual Assessment5. F276-Quarterly Assessment6. F278-Accuracy of Assessment7. F279-Comprehensive Care Plans8. F286-Maintain 15 months of MDS data9. F287-Encoding & transmitting of MDS

F286 F286 (MDS Use)(MDS Use)

Effective March 1, 2009Effective March 1, 2009

Storage of paper copy of MDS for Storage of paper copy of MDS for facilities using facilities using allall electronic records electronic records is no longer required. is no longer required.

Maintaining the 15 months of MDS Maintaining the 15 months of MDS data is still required. data is still required.

MDS records must still be accessible MDS records must still be accessible to clinical staff, the State and CMS.to clinical staff, the State and CMS.

Deficiencies related to MDS have made

the top 10 list for last 3 years.

2006

F272 - Resident Assessment using the RAI cited 44.40 % of TN facilities

F279-Comprehensive Care Plans cited 34.10 % of TN facilities

F278-Accuracy of Assessment cited 22.20 % of TN facilities

2007

F279-Comprehensive Care Plans cited 40.50 % of TN facilities

F278-Accuracy of Assessment cited 35.30 % of TN facilities

F272 - Resident Assessment using the RAI cited 28.40 % of TN facilities

2008

F278-Accuracy of Assessment cited 40.20 % of TN facilities

F272 - Resident Assessment using the RAI cited 37.90 % of TN facilities

F279-Comprehensive Care Plans cited 29.50 % of TN facilities

*2009

F272- Resident Assessment using the RAI cited approx. ½ of nursing homes being surveyedas of this date 44.40%

F279-Comprehensive Care Plans cited 32.400 % of TN facilities

F278-Accuracy of Assessmentcited 20.60 % of TN facilities

_____________________________________________________________________________________

2006 2007 2008 2009

F272 44.40% 28.40 % 37.90 % 44.40% F278 22.20 % 35.30 % 40.20 % 20.60 %

F279 34.10 % 40.50 % 29.50 % 32.40 %

__________________________________________________________________

The information in the clinical record The information in the clinical record

must support must support not conflictnot conflict with the MDS with the MDS

and and

the information must be substantiated.the information must be substantiated.

The Administrator, Director of The Administrator, Director of Nursing, Regional Administrator, Nursing, Regional Administrator, Regional Nurse Consultant and the MDS Regional Nurse Consultant and the MDS Coordinator were informed of theCoordinator were informed of the

IMMEDIATE JEOPARDYIMMEDIATE JEOPARDY

MDS Accuracy has an effect MDS Accuracy has an effect on:on:

Resident’s Care PlanResident’s Care Plan PaymentPayment Quality Indicators/Quality MeasuresQuality Indicators/Quality Measures

Excerpts from actual IJ level Excerpts from actual IJ level deficienciesdeficiencies

Cited atCited at

F272, F278, and F279F272, F278, and F279

F272 JF272 J

Based on medical record review, facility Based on medical record review, facility policy review, facility documentation policy review, facility documentation review, and interview, the facility failed to review, and interview, the facility failed to assess unsafe behaviors for one resident assess unsafe behaviors for one resident (#5) who was ventilator/trach dependent (#5) who was ventilator/trach dependent of five residents reviewed on the facility's of five residents reviewed on the facility's respiratory unit, placing Resident #5 in respiratory unit, placing Resident #5 in immediate jeopardy.immediate jeopardy.

F278 JF278 J Based on observation, record review, and Based on observation, record review, and interview, it was determined the facility interview, it was determined the facility failed to ensure Residents were accurately failed to ensure Residents were accurately assessed. The failure of the facility to assessed. The failure of the facility to accurately assess pressure wounds and accurately assess pressure wounds and acute changes in condition resulted in acute changes in condition resulted in IMMEDIATE JEOPARDY for 2 of the 14 IMMEDIATE JEOPARDY for 2 of the 14 Residents on the sampleResidents on the sample

F279 KF279 KExample #1Example #1

Based on observation, interview and Based on observation, interview and record review it was determined that record review it was determined that the facility failed to develop a the facility failed to develop a comprehensive care plan for 10 (#5, comprehensive care plan for 10 (#5, #15, #19, #22, #24, #29, #38, #41, #15, #19, #22, #24, #29, #38, #41, #45 & #50) of 51 Residents sampled, #45 & #50) of 51 Residents sampled, placing Residents #22, #24, #29, & placing Residents #22, #24, #29, & #38 in Immediate Jeopardy .#38 in Immediate Jeopardy .

F279 J F279 J Example #2Example #2

Based on medical record review and Based on medical record review and interviews, it was determined the facility failed interviews, it was determined the facility failed to develop a comprehensive care plan for to develop a comprehensive care plan for behaviors for 2 Residents (#17 and #5) of 21 behaviors for 2 Residents (#17 and #5) of 21 sampled Residents. The failure of the facility sampled Residents. The failure of the facility to care plan wandering behavior and to to care plan wandering behavior and to implement interventions resulted in implement interventions resulted in IMMEDIATE JEOPARDY for Resident #17. The IMMEDIATE JEOPARDY for Resident #17. The Chief Financial Officer, the Administrator, the Chief Financial Officer, the Administrator, the Director of Nursing (DON), and the Minimum Director of Nursing (DON), and the Minimum Data Set Coordinator were informed of the Data Set Coordinator were informed of the IMMEDIATE JEOPARDY.IMMEDIATE JEOPARDY.

Behaviors Behaviors

Relative Relative

to to

MDSMDS

MDS Section E:MDS Section E:Mood & Behavior PatternsMood & Behavior Patterns

Who gathers the data? Who gathers the data?

Assessors don’t diagnosis, only Assessors don’t diagnosis, only record what they have seen. record what they have seen.

E1. Indicators of Depression, E1. Indicators of Depression, Anxiety, Sad MoodsAnxiety, Sad Moods

Verbal expressions of distressVerbal expressions of distress

Sleep cycle issuesSleep cycle issues

Sad, apathetic, anxious appearanceSad, apathetic, anxious appearance

Loss of interestLoss of interest

E2. Mood PersistanceE2. Mood Persistance

Be sure to include night shift when Be sure to include night shift when talking to stafftalking to staff

For all behavior issues, check that the For all behavior issues, check that the documentation is in place, like behavior documentation is in place, like behavior flow sheets, care plan, nurses’ notesflow sheets, care plan, nurses’ notes

It is essential the documentation is It is essential the documentation is reflective of what is being reflective of what is being communicatedcommunicated

E3. Change in MoodE3. Change in Mood

Compare today’s mood with mood of Compare today’s mood with mood of last assessmentlast assessment

No changeNo change ImprovedImproved DeterioratedDeteriorated

E4 Behavioral SymptomsE4 Behavioral Symptoms

Harmful to self, residents or staffHarmful to self, residents or staff Behaviors may occur at different times of dayBehaviors may occur at different times of day Need input from all shifts & disciplinesNeed input from all shifts & disciplines Program to minimize, alternate or eliminate Program to minimize, alternate or eliminate

disruptive behaviors. disruptive behaviors. Care plan needs to be in place. Care plan needs to be in place. Observe the behavior, not the intent (doesn’t Observe the behavior, not the intent (doesn’t

mean to hurt someone, just afraid.)mean to hurt someone, just afraid.)

E4 E4 (a).(a). Behavioral Symptoms Behavioral SymptomsFrequencyFrequency

Need documentation. If not in place, put Need documentation. If not in place, put in place.in place.

Is there a restraint in use? Resident in Is there a restraint in use? Resident in geri-chair to keep from exhibiting geri-chair to keep from exhibiting behavior behavior

Was behavior easily altered? Was behavior easily altered? Was resident easily distracted/redirected? Was resident easily distracted/redirected? Persistent behavior?Persistent behavior?

E4 E4 (b)(b) Behavioral Symptoms Behavioral Symptoms AlterabilityAlterability

Include:Include: NumbersNumbers FrequencyFrequency Intensity &/orIntensity &/or AlterabilityAlterability

Review documentation, observation, talk to Review documentation, observation, talk to staff. Look at last quarterly.staff. Look at last quarterly.

MDS Section F: MDS Section F: Psychosocial Well- beingPsychosocial Well- being

Who fills this section out? Who fills this section out? SW and nursing need to work SW and nursing need to work

together and agree on same together and agree on same assessment.assessment.

F1. Sense of F1. Sense of Initiative/InvolvementInitiative/Involvement

Observation, interviewObservation, interview Observations of cognitively impairedObservations of cognitively impaired Discrepancies may exist between Discrepancies may exist between

how resident sees self and staff how resident sees self and staff observations. observations.

Code what you observe not what Code what you observe not what resident thinks. resident thinks.

F2 Unsettled RelationshipsF2 Unsettled Relationships

How does the resident interact with How does the resident interact with others?others?

Observe and interviewObserve and interview Observe the resident. Observe the resident. Talk to staff and family. Talk to staff and family. You are looking for an overall picture, You are looking for an overall picture,

a consensus view.a consensus view.

F3. Past RolesF3. Past Roles

Observe and interviewObserve and interview Document resident’s recognition or Document resident’s recognition or

acceptance of feeling regarding acceptance of feeling regarding previous roles or status now that previous roles or status now that they are in a nursing home.they are in a nursing home.

Behavior Management Behavior Management ProgramsPrograms

Does your facility have a Behavioral Does your facility have a Behavioral Management Program?Management Program?

Does your staff know what the program Does your staff know what the program consists of and which residents are on the consists of and which residents are on the program?program?

Is the Behavioral Management Program Is the Behavioral Management Program incorporated in the resident Care Plan?incorporated in the resident Care Plan?

Who monitors and evaluates the program?Who monitors and evaluates the program? Does your program work? Does your program work? How do you determine that it is working?How do you determine that it is working?

Mood-BehaviorMood-BehaviorForms/ToolsForms/Tools

Antipsychotic Medication Antipsychotic Medication Quarterly Evaluation/AIMSQuarterly Evaluation/AIMS

Psychoactive Medication Psychoactive Medication Monthly Flow RecordMonthly Flow Record

Behavior Intervention MoBehavior Intervention Monthly Flow Recordnthly Flow Record

Anti-Anxiety Side Effect Anti-Anxiety Side Effect SheetSheet

Anti-Depressant Side Anti-Depressant Side SheetSheet

Anti-Psychotic Side EffectAnti-Psychotic Side Effect

Psychoactive MedicatiPsychoactive Medication Use Reference Caron Use Reference Cardd

Non-Pharmacologic InNon-Pharmacologic Intervention Record for tervention Record for Targeted Behavioral Targeted Behavioral SymptomsSymptoms

Antipsychotic MedicatAntipsychotic Medication Quality Assuranceion Quality Assurance Sheet Sheet

Unnecessary MedicatiUnnecessary Medication/Quality Assurance on/Quality Assurance Evaluation SheetEvaluation Sheet

Caution:Caution: Some facilities use tools to assist in data collection Some facilities use tools to assist in data collection

and reflection of care provided.and reflection of care provided.

Blank, incomplete or inaccurate information Blank, incomplete or inaccurate information reflected on tools could also reflect/indicate non-reflected on tools could also reflect/indicate non-compliance. compliance.

Incorporate additional tools only if they are clearly Incorporate additional tools only if they are clearly beneficial in facilitating documentation and clinical beneficial in facilitating documentation and clinical decision-making.decision-making.

*Use tools discerningly.*Use tools discerningly.

The Resident Assessment The Resident Assessment InstrumentInstrument

RAIRAI ASSISTS STAFF TO LOOK AT ASSISTS STAFF TO LOOK AT

RESIDENTS HOLISTICALLYRESIDENTS HOLISTICALLY STRENGTHENS TEAM STRENGTHENS TEAM

COMMUNICATIONCOMMUNICATION PROVIDES STRUCTURE in LTC FOR A PROVIDES STRUCTURE in LTC FOR A

PROBLEM IDENTIFICATION PROCESSPROBLEM IDENTIFICATION PROCESS

The Resident Assessment The Resident Assessment InstrumentInstrument

RAIRAI

Surveyors use RAI/MDS assessments Surveyors use RAI/MDS assessments to assist in determination of accurate to assist in determination of accurate and comprehensive assessments of and comprehensive assessments of the condition of the resident.the condition of the resident.

The MDS does not relinquish the The MDS does not relinquish the facility’s responsibility to document a facility’s responsibility to document a more detailed assessment of more detailed assessment of resident.resident.

MDS Coordinators must:MDS Coordinators must:

Observe residentObserve resident Talk with resident, caregivers, Talk with resident, caregivers,

housekeepers, dietary staff, familyhousekeepers, dietary staff, family Observational and Communication Observational and Communication

skills are essentialskills are essential

Assists Staff to Look at Assists Staff to Look at Residents HolisticallyResidents Holistically

Residents are individuals for whom Residents are individuals for whom quality of life and quality of care are quality of life and quality of care are equally significant and necessary.equally significant and necessary.

It is important for staff to gather It is important for staff to gather definitive information on a resident’s definitive information on a resident’s strengths and needs.strengths and needs.

Staff must be able to track changes Staff must be able to track changes in the resident’s status.in the resident’s status.

Strengthens Team Strengthens Team CommunicationCommunication

The process of problem identification is The process of problem identification is integrated with sound clinical integrated with sound clinical interventions by an interdisciplinary team.interventions by an interdisciplinary team.

The RAI process assists staff to evaluate The RAI process assists staff to evaluate goal achievement.goal achievement.

With strengthened communication, all With strengthened communication, all necessary resources and disciplines will be necessary resources and disciplines will be used to ensure that residents achieve the used to ensure that residents achieve the highest level of functioning possible, and highest level of functioning possible, and maintain their sense of individuality.maintain their sense of individuality.

PROVIDES STRUCTURE in LTC FOR A PROVIDES STRUCTURE in LTC FOR A PROBLEM IDENTIFICATION PROCESSPROBLEM IDENTIFICATION PROCESS

Assessment- Assessment- Evaluate all observations, Evaluate all observations, information and knowledge about a information and knowledge about a resident; finding out who the resident is.resident; finding out who the resident is.

Decision-makingDecision-making- Determining the - Determining the severity, functional impact, and scope of severity, functional impact, and scope of the resident’s problems; finding out the the resident’s problems; finding out the “what’s” and “why’s” of the resident’s “what’s” and “why’s” of the resident’s problems.problems.

PROVIDES STRUCTURE in LTC FOR A PROVIDES STRUCTURE in LTC FOR A PROBLEM IDENTIFICATION PROCESSPROBLEM IDENTIFICATION PROCESS

(cont.) (cont.) Care PlanningCare Planning-Developing a course of -Developing a course of

action action that will move a resident toward a specific that will move a resident toward a specific

goal, utilizing the resident’s strengths and goal, utilizing the resident’s strengths and the interdisciplinary team expertise; building the interdisciplinary team expertise; building the “how” of resident care.the “how” of resident care.

ImplementationImplementation-Putting the care plan -Putting the care plan interventions into motion by staff interventions into motion by staff knowledgeable about the resident’s goals knowledgeable about the resident’s goals and approaches; carrying out the “how” and and approaches; carrying out the “how” and “when” of resident care.“when” of resident care.

PROVIDES STRUCTURE in LTC FOR A PROVIDES STRUCTURE in LTC FOR A PROBLEM IDENTIFICATION PROCESS (cont.)PROBLEM IDENTIFICATION PROCESS (cont.)

EvaluationEvaluation-Critically reviewing care -Critically reviewing care plan goals, interventions, and plan goals, interventions, and implementation in terms of achieved implementation in terms of achieved resident outcomes, and assessing resident outcomes, and assessing the need to modify the care plan to the need to modify the care plan to adjust to changes in the resident’s adjust to changes in the resident’s status.status.

Resident Assessment Protocols Resident Assessment Protocols (RAP) Process (RAP) Process

The RAP Guidelines are an aide, a tool, a The RAP Guidelines are an aide, a tool, a starting point. starting point.

Information in the RAP is used to Information in the RAP is used to supplement clinical judgment and supplement clinical judgment and stimulate creative thinking when trying stimulate creative thinking when trying to understand or resolve difficult or to understand or resolve difficult or confusing symptoms and their causes.confusing symptoms and their causes.

Resident Assessment Protocols Resident Assessment Protocols (RAP) Process (RAP) Process

Participation in this process by Participation in this process by all all members of the interdisciplinary members of the interdisciplinary team will assist in assuring that a team will assist in assuring that a meaningful assessment of the meaningful assessment of the resident is completed.resident is completed.

This will then lead to an appropriate, This will then lead to an appropriate, individualized plan of care.individualized plan of care.

Resident Assessment Protocols Resident Assessment Protocols (RAP) Process (RAP) Process

Each facility should establish a documentation Each facility should establish a documentation process that “works” for them.process that “works” for them.

Some facilities have developed tools to assist Some facilities have developed tools to assist in data collection and reflection of care in data collection and reflection of care provided.provided.

These tools can be used as a part of MDS These tools can be used as a part of MDS validation review.validation review.

Caution:Caution: Incorporate additional tools only if they are clearly Incorporate additional tools only if they are clearly

beneficial in facilitating documentation and clinical beneficial in facilitating documentation and clinical decision-making.decision-making.

Resident Assessment Protocols Resident Assessment Protocols (RAP) Process (RAP) Process

RAP “documentation” involves only RAP “documentation” involves only what should already be taking place:what should already be taking place: Clear assessmentsClear assessments Decision-making by staff knowledgeable Decision-making by staff knowledgeable

about the resident’s conditionabout the resident’s condition Care plans developed based on a Care plans developed based on a

comprehensive assessment of the comprehensive assessment of the resident’s needs, strengths, and resident’s needs, strengths, and preferences preferences

Care Planning ProcessCare Planning Process

Specific, Specific, individualized individualized approaches approaches must then be developed. must then be developed.

These are actually instructions for These are actually instructions for resident care and will provide resident care and will provide continuity of care by all staff. continuity of care by all staff.

These instructions should be These instructions should be short short and concise and concise so they can be easily so they can be easily understood by all staff.understood by all staff.

Care Planning ProcessCare Planning Process

The effectiveness of the care plan The effectiveness of the care plan must be continually evaluated, and must be continually evaluated, and modified as necessary.modified as necessary.

The care plan is designed to be an The care plan is designed to be an effective tool for providing effective tool for providing appropriate, individualized care.appropriate, individualized care.

Care Planning ProcessCare Planning Process

If used correctly, the entire care If used correctly, the entire care planning process will save time and planning process will save time and effort while improving resident effort while improving resident outcomes.outcomes.

It It should notshould not involve duplication of involve duplication of effort.effort.

Care Planning ProcessCare Planning Process

The resident, family, or resident The resident, family, or resident representative should be part of the representative should be part of the team discussion and care planning team discussion and care planning process whenever they choose. process whenever they choose.

Communication is the key to Communication is the key to effective care planning.effective care planning.

The care plan should present a The care plan should present a true picture of the resident’s true picture of the resident’s status.status.

Care Planning ProcessCare Planning Process

Surveying Surveying Quality Quality

ImprovementImprovement

Surveying Quality Surveying Quality ImprovementImprovement

Surveying the Quality Improvement Surveying the Quality Improvement process begins with reviewing the process begins with reviewing the Quality Indicator reports during the Quality Indicator reports during the offsite survey preparation.offsite survey preparation.

Quality Indicator ReportsQuality Indicator Reports

The QI reports are used to identify The QI reports are used to identify areas of potential problems or areas of potential problems or concerns that may require further concerns that may require further investigation .investigation .

The reports are not determinations of The reports are not determinations of facility compliancefacility compliance

Quality Indicator ReportsQuality Indicator Reports

Review the Facility Quality Indicator Review the Facility Quality Indicator Profile for any “flags” , and for Profile for any “flags” , and for Quality Indicators with a percentile Quality Indicators with a percentile rank of 75% or greater.rank of 75% or greater.

Quality Indicator ReportsQuality Indicator Reports

Review the Resident Level Summary Review the Resident Level Summary and pre-select residents for the and pre-select residents for the Phase I sample who have conditions Phase I sample who have conditions representing the care concerns representing the care concerns selected on the Facility Quality selected on the Facility Quality Indicator Profile.Indicator Profile.

Quality Indicator ReportsQuality Indicator Reports

The Quality Indicators cover the The Quality Indicators cover the following domains or broad areas of following domains or broad areas of

care:care:

Quality Indicator ReportsQuality Indicator Reports

Accidents Accidents

Nutrition/EatingNutrition/Eating

Behavior/Emotional PatternsBehavior/Emotional Patterns

Physical FunctioningPhysical Functioning

Activities Activities

Quality Indicator ReportsQuality Indicator Reports

Quality of LifeQuality of Life

Elimination/IncontinenceElimination/Incontinence

Skin CareSkin Care

Infection ControlInfection Control

Psychotropic Drug UsePsychotropic Drug Use

Cognitive PatternsCognitive Patterns

Quality Indicator ReportsQuality Indicator Reports

These areas of care or “domains” These areas of care or “domains” do do notnot represent every care category or represent every care category or situation that could occur in the long-situation that could occur in the long-term care setting. term care setting.

Quality Indicator ReportsQuality Indicator Reports

They do represent common They do represent common conditions and important aspects of conditions and important aspects of care and life to residents. care and life to residents.

Quality Indicator ReportsQuality Indicator Reports

The Quality Indicators and Quality The Quality Indicators and Quality Indicator Reports are not considered Indicator Reports are not considered as a single source of information but as a single source of information but

are used in conjunction with all are used in conjunction with all pertinent information about a facility, pertinent information about a facility, such as Infection control, and Safety, such as Infection control, and Safety,

among others .among others .

Quality Indicator ReportsQuality Indicator Reports

Use of the Quality Indicators and their Use of the Quality Indicators and their reports in the survey process offer an reports in the survey process offer an additional source of information from additional source of information from which surveyors may make planning which surveyors may make planning decisions about the survey of a decisions about the survey of a provider and from which provider staff provider and from which provider staff can plan their internal quality can plan their internal quality improvement initiativesimprovement initiatives

SENTINEL EVENTSSENTINEL EVENTS

Are Quality Indicators that should Are Quality Indicators that should occur very infrequently in a facility. occur very infrequently in a facility.

The nature of these indicators is The nature of these indicators is serious enough to warrant an serious enough to warrant an investigation investigation EVEN IF IT OCCURS EVEN IF IT OCCURS ONLY ONCE .ONLY ONCE .

SENTINEL EVENTSSENTINEL EVENTS

Prevalence of fecal impactionPrevalence of fecal impaction Prevalence of dehydrationPrevalence of dehydration Prevalence of pressure sores Prevalence of pressure sores

(occurring in a Low Risk (occurring in a Low Risk Population.)Population.)

Surveying The Facility Quality Surveying The Facility Quality Improvement ProcessImprovement Process

The survey team determines if the The survey team determines if the facility:facility: Has identified quality deficienciesHas identified quality deficiencies Has developed and implemented a plan Has developed and implemented a plan

to address those quality deficienciesto address those quality deficiencies Has evaluated, or has a plan to Has evaluated, or has a plan to

evaluate, the effectiveness of the evaluate, the effectiveness of the planned implementationplanned implementation

Surveying The Facility Quality Surveying The Facility Quality Improvement ProcessImprovement Process

The goal for this part of the The goal for this part of the survey:survey:

To determine whether the facility has an To determine whether the facility has an effective method of identifying quality effective method of identifying quality deficiencies and dealing with them.deficiencies and dealing with them.

Surveying The Facility Quality Surveying The Facility Quality Improvement ProcessImprovement Process

Does the facility have a QA/QI Does the facility have a QA/QI Committee which addresses quality Committee which addresses quality concerns and do staff know how to concerns and do staff know how to access that process?access that process?

Is the QA/QI Committee responsive to Is the QA/QI Committee responsive to QA concerns submitted to it?QA concerns submitted to it?

Surveying The Facility Quality Surveying The Facility Quality Improvement ProcessImprovement Process

Are facility staff members aware of the quality Are facility staff members aware of the quality assurance improvement plan?assurance improvement plan?

Has the plan been implemented as a routine part of Has the plan been implemented as a routine part of resident care? resident care?

Communication, implementation, monitoring and Communication, implementation, monitoring and evaluation are keys to the quality improvement process.evaluation are keys to the quality improvement process.

ResourcesResources

Treatment of Pressure UlcersTreatment of Pressure UlcersClinical Guideline Number 15 Clinical Guideline Number 15

AHCPR Publication No. 95-0652:AHCPR Publication No. 95-0652:

December 1994December 1994 http://http://www.ncbi.nlm.nih.gov/books/bv.fcgi?www.ncbi.nlm.nih.gov/books/bv.fcgi?ridrid=hstat2.chapter.5124=hstat2.chapter.5124

The National Pressure Ulcer Advisory The National Pressure Ulcer Advisory Panel Panel www.npuap.orgwww.npuap.org

Resources Resources (cont.)(cont.)

RAI Appendix HRAI Appendix HWeb Site InformationWeb Site Information

Contains websites addresses and links for:Contains websites addresses and links for: MDS 2.0MDS 2.0 MDS Correction PolicyMDS Correction Policy SNF PPSSNF PPS Swing BedSwing Bed State Operations ManualState Operations Manual CMS Quarterly Provider UpdateCMS Quarterly Provider Update http://www.azdhs.gov/als/ltc/postmans/raiappendixhttp://www.azdhs.gov/als/ltc/postmans/raiappendix

h.pdfh.pdf

Resources Resources (cont.)(cont.)

State MDS/RAI CoordinatorState MDS/RAI Coordinator Debra Verna, RN, LNHADebra Verna, RN, LNHA

Phone: 865-588-4401Phone: 865-588-4401 E-Mail: E-Mail: Debra.Verna@state.tn.usDebra.Verna@state.tn.us