Eating/Oral hygiene/PLOF
PLOF: Sue came in with RA and hand deformities at baseline. She required a caregiver to feed her d/t impairments.
Upon assessment, Sue needed assistance with feeding, as she was unable to hold utensils.
What is the QI score? What AE could be offered to the patient during her ARU stay?
Eating: Code 01, Dependent
AE: built up handle.
Mortimer has left sided weakness after a stroke. Once in the bathroom, he manages to pull down his pants and underwear without assistance, and perform hygiene after a bowel movement, but needs assistance pulling up his pants once complete.
03- Partial Assist
Eleanor has a severe and progressive neurological condition that has affected her endurance as well as her fine and gross motor skills. Eleanor showers while sitting on a tub bench and washes her arms and chest. A helper then must help wash her with the remaining parts of her body due to fatigue. Eleanor uses a long-handled sponge to rinse herself but tires half-way through the task. The helper dries Eleanor's entire body.
02- Substantial Assist
The therapist felt it was not safe to attempt another walking assessment of 150 feet, because Alex was to becoming unsteady and fatigued.
Walking 150 feet: 88, not attempted due to medical conditions
Rationale: Patient unable to walk 150 feet due to fatigue and safety concerns but was walking that distance before, code 88.
T/F:
The HOB being elevated is required to obtain a true assessment of a patient?
False.
HOB elevation can only be assessed if the patient has a hospital bed at home.
Coding Tip:
If the clinician determines that bed mobility cannot be assessed because of the degree to which the head of the bed must be elevated because of a medical condition, then code the activities GG0170A, Roll left and right, GG0170B, Sit to lying, and GG0170C, Lying to sitting on side of bed, as 88, Not attempted due to medical condition or safety concern.
Patient is an 80-year-old female admitted to your unit post COVID pneumonia. Patient is alert and oriented and lived alone. In talking with the family, the daughter reported that the patient does very well. The daughter states she has had to help the patient with her medication management as well as her finances and paying bills over the past 6 months.
Code 2, Needed Some Help, if the patient needed partial assistance from another person.
The certified nursing assistant provides steadying (touching) assistance as the patient lowers their underwear and then transfers onto the toilet. After voiding, the patient requires min assist to cleanse peri area. The patient then stands up from the toilet as the helper steadies them. The patient pulls up their underwear as the helper steadies them to ensure the patient does not lose their balance.
04 Supervision, Steadying/ touching assist.
Keith transfers to the shower with partial assistance from a helper. A helper then gathers and hands him supplies as he washes, rinses and dries his arms and chest. Keith refuses to wash the rest of his body, or allow the helper to do so
05-setup assistance
After a rest, the therapist asks Tim to attempt to walk 50 feet with 2 turns. The patient required min assist initially, then as the walking continued, the patient required moderate to maximal assist, requiring max assist for the turns. At 40 feet, the therapist requested the rehab tech to provide a close follow with the W/C. At 60 feet, the patient was too tired to continue and quickly sat down in the chair.
Walking 50 feet with 2 turns: 01 Dependent
T/F:
The responses for gateway admission and discharge wheelchair items (GG0170Q1 and GG0170Q3) do not have to be the same on the admission and discharge assessments?
True
A helper scoops each bite of food for Michele, after which Michele brings the utensil to her mouth, chews the food and swallows it. Michele drinks from a cup without assistance.
03-Partial assistance
Bella requires the assistance of two people to come to a sitting position from lying due to weakness and balance and uses a squat pivot to transfer to the wheelchair. He is unable to safely stand. (multiple answers STS only)
Sit to stand- 88 - Not attempted due to medical condition/safety concerns, he is unable to safely stand even with assist and uses a squat pivot.
Nate collects his bathing supplies and places them on his lap as he wheels into the bathroom. he washes all of his body parts while sitting in the wheelchair at the sink. A helper washes, rinses and dries Nate's buttocks for him.
03-partial assistance
Tim has bilateral upper extremity tremors, lower extremity weakness, and Parkinson’s disease. The PT guides and steadies the patient, rolling the walker forward while cueing the patient to take larger steps. The patient requires steadying assist at the beginning of the walk and progressively requires some of their weight to be supported for the last two feet of the 10-foot walk. Overall, the assistant provides less than half of the effort.
Walking 10 feet 03, partial moderate assist
T/F:
The Car transfer item include transfers the patient’s ability to transfer in and out of the passenger seat, opening/closing the car door, fastening/unfastening the seat belt.
False:
The Car transfer item does not include transfers into the driver’s seat, opening/closing the car door, fastening/unfastening the seat belt.
The Car transfer item includes the patient’s ability to transfer in and out of the passenger seat of a car or car simulator.
Gary sits in his wheelchair to perform oral hygiene. A helper turns on the water, adjusts the temperature and applies toothpaste to his toothbrush. Gary then brushes his teeth without any physical assistance
05- Set-up assistance
Shirley uses a rolling walker to ambulate to the bathroom. Once in the bathroom, she transfers to and from a raised toilet seat without additional assistance. A member of housekeeping staff flushes the toilet for Shirley
06- independent
Picking up object: Mr. P has a neurologic condition that has resulted in balance problems. He wants to be as independent as possible. Mr. P lives with his wife and will soon be discharged from IRF. He tends to drop objects and has been practicing bending or stooping from a standing position to pick up small objects, such as a spoon, from the floor. An occupational therapist needs to remind Mr. P of safety strategies when he bends to pick up objects from the floor, and she needs to steady him (touching assistance) to prevent him from falling
Coding: GG0170P would be coded 04, Supervision or touching assistance'
Rationale: A helper is needed to provide verbal cues and touching or steadying (touching) assistance when Mr. P picks up an object because of his coordination issues.
64 year old Greg was independent at baseline and working as a contractor. He has had multiple back surgeries and came to the hospital for spinal fusion.
Upon initial assessment, pt c/o 7/10 pain while attempting to roll to each side and was able to roll one quarter of the way, requiring the PT to assist with rolling his trunk and legs to maintain spinal precautions.
what is his QI score for rolling L and R?
What recommendations would you provide to the pt for home to assist with maintaining his spinal precautions?
Rolling L & R? Code 2
T/F:
If a mechanical lift is used to assist in transferring a patient for a chair/bed-to-chair transfer and two helpers are needed to assist with the mechanical lift transfer then code 88 not attempted due to medical or safety concerns?
False:
Code as 01, Dependent, even if the patient assists with any part of the chair/bed-to-chair transfer.
A patient was admitted to an acute care hospital after experiencing a stroke. Prior to admission, they used a walker to walk from room to room. In the morning, the patient’s caregiver would provide steadying assistance to the patient when the patient walked from room to room because of joint stiffness and severe arthritis pain. Occasionally, the patient required steadying assistance during the day when walking from room to room. Most of the day, patient was independent.
Code 2, Needed Some Help, if the patient needed partial assistance from another person.
Score the Transfer!
Once standing, a helper provides contact guard assistance to George as he ambulates to the bathroom with a rolling walker and sits down. After using the toilet, George stands without assistance and uses the safety bars to support himself while performing hygiene. He has difficulty pulling up his pants, and despite cues, the helper must assist with pulling up his pants. He ambulates back to bed using the RW as the helper provides contact guard assistance.
04-supervision
*Be careful not to merge toilet transfer and toilet hygiene!
the OT assists Marge into the shower at a partial assist level. Once seated, Marge is able to wash, rinse and dry her upper and lower body without assistance. She requires assistance washing and drying her back.
06-independent
*shower transfer does not effect score
*washing the back is not included in shower tasks.
The patient is recovering from a stroke resulting in motor issues and poor endurance. The patient’s home has 12 stairs, with a railing, and they need to use these stairs to enter and exit the home. The patient’s physical therapist uses a gait belt around the patient’s trunk and supports less than half of the effort as the patient ascends and then descends 12 stairs. At the top of the stair, the patient has to sit and rest. The patient requires max assist to stand back up, but then can walk down the stairs with rail with cues and minimal physical assist.
How would you code 12 steps? Could you code 4 steps and 1 step as well?
12 steps code 03, Partial/ moderate assist Code 4 step and 1 step? Yes, you could, but make sure the amount of assist is the same. Could the patient do better if just given 1 step? That score may differ so be careful when deciding how to score these. May be best to separate out the tasks. Rationale: Patient required partial assist to go up and down steps. Do not consider the sit to stand required after the rest.
T/F:
When reviewing the patient’s medical records, interviewing staff, and observing the patient, be familiar with the definition of each the activity. For example, when assessing Roll left and right (item GG0170A), determine the level of assistance required to roll from lying on the back to the left side and right side and then return to lying on the back.
True