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The Basics
Abnormals
Preparing the Patient
Coordination of Care
Fun with FA
100
Amedisys policy and COP guidelines mandate that all discipline assessments are completed within this time frame.
What is 72 hours following referral?
100
PULSE: Less than 60 beats per minute and greater than 100 beats per minute at rest RESPIRATIONS: Less than 12 breaths per minute or greater than 20 breaths per minute at rest BLOOD PRESSURE: Systolic less than 90 mm Hg/ Diastolic less than 50 mm Hg or Systolic greater than 180 mm Hg/ Diastolic greater than 100 mm Hg ORAL TEMPERATURE: Less than 96 degrees (°F) or greater than 100 degrees (°F). OXYGEN SATURATION: Less than 90% (requires order for pulse oximetry for assessing discipline) PAIN: pain that is unusual for the patient, severe pain or pain that is considered to be unacceptable to the patient. WEIGHT GAIN: > or = 3 lbs in 24 hours or 5 lbs in 7 days OR a general trend of recent weight gain with correlating symptoms in a patient with CHF BLOOD SUGAR: per parameters stated on 485 SIGNS/SYMPTOMS OF ANTICOAGULANT TOXICITY
What are abnormal findings that need to be reported to the physician/clinical manager and documented in the clinical record along with actions taken and patient's response?
100
When discharge planning is started.
What is at the initial PT, OT or ST visit?
100
This is how often PTA or COTA supervisories are required per Amedisys policy.
What is every 30 days? BONUS: Why is there a supervisory section on the PT and OT evaluation?
100
This is when Functional Assessment visits need to occur for PT, OT and ST.
What visit occurs on or close-to the 13th combined therapy visit, the 19th combined therapy visit, the 30th day for each separate therapy discipline, and at discharge?
200
Each discipline agent is required to follow these.
What are the orders on the plan of care/485/supplemental orders?
200
Patient safety issues such as poor patient hygeine, unkempt/unsafe environment, inability of patient to afford proper care/prescriptions/food, or inadequate patient supervision.
What are some indications for MSW consult and team follow up?
200
Discharge planning is reviewed/reinforced by these team members.
What is every rehab team member?
200
This is how often PTA and COTA need to give report to their supervising PT.
What is weekly on each patient or more frequently if there is a change in the patient's status? BONUS: Where do we document this care coordination?
200
This is the procedure that a PT, OT or ST needs to follow if the FA data does not auto-populate within a Functional Assessment note on the POC.
What is delete the visit, request the patient by MR number, and re-transmit?
300
A summary of care for all disciplines is available to the physician at this interval.
What is every 60 days (or at the end of each episode of care or upon discipline discharge)?
300
The place where abnormal findings and follow-up are documented when a billable PT/OT/ST visit did NOT occur.
What is a clinical note addendum? BONUS: Why do we use the clinical note addendum instead of the regular visit note or other visit form?
300
Discharge is discussed during these visits.
What is at every therapy visit?
300
This is how often supervising PT and OT's need to cosign PTA and COTA notes.
What is weekly?
300
These are the components within each Functional Assessment note that need to be present to satisfy the Medicare requirement.
What are 1.) skilled intervention, 2.) measurement of the effectiveness of the interventions, 3.) description of the progress/or lack of progress toward goals, 4.) justification for ongoing skilled care and 5.) updated plan of care as indicated?
400
This needs to be entered in the medical record at the completion of a discipline plan of care, preferably as a part of a skilled, planned visit.
What is a discharge summary?
400
Mild reaction: • Shakiness and nervousness. • Sweaty, cold, and clammy skin. • Sudden hunger. • Rapid heart rate. • Feelings of weakness or feeling lightheaded. • Blurred or double vision. • Headache. • Tingling or numb lips or tongue. • Nausea. • Nightmares or crying out during sleep. Severe reaction: a. Confusion. b. Personality changes, acting differently than usual. c. Poor coordination, clumsiness. d. Slurred speech. e. Twitching muscles. f. Pounding heart. g. Increased weakness. h. Convulsions. i. Drowsiness, loss of consciousness.
What are signs/symptoms of hypoglycemia? BONUS: What do you do if a patient exhibits these signs/symptoms?
400
This is how the therapy team provides evidence of effective teaching that is consistent with the plan of care and appropriate to the patient/caregiver's abilities.
What is documentation of the patient/caregiver being able to verbalize or demonstrate instructions or procedures? BONUS QUESTION: How does the rehab team ensure a standard of care in regard to education content and breadth?
400
This is how often a PT, OT or ST needs to give report to their clinical manager.
What is daily? BONUS: Why?
400
Missed or inadequate FA visits result in this.
What are non-billable therapy visits?
500
These orders need to be present if a patient is on an anticoagulant.
What is an order stating who will monitor PT/INR in the absence of skilled nursing? BONUS: Name at least 5 signs/symptoms, safety issues or potential complications of anticoagulant toxicity.
500
This trend requires an assistant to report to the supervising PT, OT or ST so the physician may be contacted for patient-specific parameters.
What should an assistant do when vital signs or other findings are consistently outside of reporting parameters, impeding therapy interventions, but the patient is asymptomatic?
500
These documents are used to reflect that the patient/caregiver was informed of an upcoming and planned discharge.
What is the HHABN or the EDN (NOD)? BONUS: How many hours before discharge or decrease in frequency of services do these forms need to be issued?
500
This is when a PTA or COTA needs to inform the supervising PT or OT that the pt is getting close to meeting their rehab goals.
What is ASAP? BONUS: Who else needs to know?
500
This is how therapists can help coordinate multidisciplinary care and avoid non-billable visits resulting from poorly timed FA visits.
What is check their schedule comments? BONUS: What else can the therapy team do to help ensure proper timing of FA visits?