Q&A: What are some best practices for providing a welcoming and thorough clinical orientation for nurses and unlicensed staff? 

Question: What are some best practices for providing a welcoming and thorough clinical orientation for nurses and unlicensed staff?  Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: AAPACNS’s Onboarding Essentials: Welcoming Staff to Promote Retention Tool provides education for department managers and administration as well as tools leaders can use …

Q&A: Does anyone have a list of criteria that must be met for a patient to be coded for “at risk for malnutrition” at I5600?

Question: Does anyone have a list of criteria that must be met for a patient to be coded for “at risk for malnutrition” at I5600? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: Like any other diagnosis, the physician determines whether the resident is at risk for malnutrition. …

Q&A: For planned discharges, if interviews on the OBRA Discharge assessment have not been completed by the time the resident discharges, do all interview questions need to be dashed?

Question: For planned discharges, if interviews on the OBRA Discharge assessment have not been completed by the time the resident discharges, do all interview questions need to be dashed? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: For planned discharges, the BIMS and PHQ-9 would need to …

Q&A: A resident discharged from therapy services, but nursing is educating her on how to perform self-catheterization, which is new for her. How is this coded on the MDS to support skilled care?

Question: We have a resident who discharged from therapy services, but nursing is educating her on how to perform self-catheterization, which is new for her. How is this coded on the MDS to support skilled care? Answer from Jeff Taylor: Resident education/training is one of the indirect skilled nursing services …

Q&A: What does a facility have to do to maintain compliance if they use bedrails or grab bars?

Question: What does a facility have to do to maintain compliance if they use bedrails or grab bars? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: F700 in Appendix PP of the State Operations Manual has specifics for what a facility must do if bedrails, grab bars, or assist …

Q&A: Weight loss was not coded on the prior comprehensive assessment, although it was indicated in the resident’s nutritional assessment. Does this qualify for a significant correction or just a modification?

Question: Is a Significant Correction to a Prior Comprehensive (SCPA) required if on the last comprehensive, a Significant Change in Status Assessment (SCSA) in May 2022, the registered dietitian failed to select weight loss on the assessment although it was indicated in their nutritional assessment? Does this qualify for a …

Q&A: We have a resident that is in our facility for skilled services under Medicare Part A. The family took the resident out for a funeral, and she did not return within 24 hours. Is this a Medicare Part A discharge?

Question: We have a resident that is in our facility for skilled services under Medicare Part A. The family took the resident out for a funeral, and she did not return within 24 hours. Is this a Medicare Part A discharge? Answer from Jeff Taylor: This would not be a …

Q&A: Would this be considered a fall? A staff member reached out to grab a resident as he was losing his balance, but he was able to catch himself by placing a hand down on the bed.

Question: Would this be considered a fall? A staff member reached out to grab a resident as he was losing his balance, but he was able to catch himself by placing a hand down on the bed. Answer from Janine Cortesa, RN, BSN: Yes, this is considered an intercepted fall, …

Q&A: How long do facilities have to maintain QAPI records?

Question: How long do facilities have to maintain QAPI records? Answer from Alexis Roam, MSN, RN, RN-BC, DNT-MT, QCP-MT: I recommend that you check the facility’s policy on document management to see if QAPI/QAA records are included. If the policy doesn’t address this, contact the facility’s legal counsel. Also connect …

Q&A: A resident on a skilled Medicare Part A stay passed away on day seven following admission. Does the 5-Day PPS assessment have to be moved to the day prior to the death in facility (DIF), or can a separate DIF tracking record and a separate 5-Day be set on day seven?

Question: A resident on a skilled Medicare Part A stay passed away on day seven following admission. Does the 5-Day PPS assessment have to be moved to the day prior to the death in facility (DIF), or can a separate DIF tracking record and a separate 5-Day be set on …