Resident Centered Care And Quality of Life Flashcards
(152 cards)
1
Q
Dentition
A
The makeup of a set of teeth including their kind, number, arrangement, and usability.
2
Q
Dehydration
A
A loss of the body’s normal water content which can affect both physical and mental functions. Individuals with brain, kidney, or gastrointestinal disease may find it difficult to maintain a normal amount of water in the body without the aid of medications.
3
Q
Controlled Substance
A
A drug, substance, or immediate precursor is included in schedules 1 to 5 of the Controlled Substance Act.
(morphine, acetaminophen w/ codeine, oxycodone)
4
Q
Continence
A
The ability to self-regulate bladder and bowel elimination.
5
Q
Consultant Pharmacist
A
Pharmacist who is contracted by the nursing home to do drug regimen reviews and provide other services.
6
Q
Chemical Restraint
A
A psychoactive drug used by a facility for discipline or convenience and not for medical treatment.
6
Q
Chronic
A
Continuing over a long period of time or recurring frequently.
________ _______ often begin inconspicuously and symptoms are less pronounced than in acute conditions.
6
Q
Centers for Medicare and Medicaid Services
(CMS)
A
Federal agency responsible for administering the Federal Medicare & Medicaid programs.
Headquarters is located in Baltimore.
6
Q
Charge Nurse
A
The nurse in charge or supervising a particular part of a facility for a given time shift.
7
Q
Case Mix
A
A system that uses resident attributes (e.g., functional status in activities of daily living or cognitive ability) to classify residents for purposes such as reimbursement.
8
Q
Care Plan
A
A plan designed to meet all of a residents identified physical, mental, emotional, cognitive, & functional needs.
Generally the result of assessment & collaboration by an interdisciplinary team (IDT) of provider staff.
Also known as: Plan of Care
9
Q
Behavioral Intervention
A
Non-drug interventions used to change the residents behavior or environment to lessen or accommodate the residents behavioral symptoms.
10
Q
Aspiration
A
The inhaling of foreign objects, such as food or beverages if swallowed incorrectly, into the lungs: results in the introduction of bacteria from the mouth and stomach into the lungs which can lead to pulmonary bacterial infection known as aspiration pneumonia.
11
Q
Antianxiety Medications
A
Psychoactive medications given to reduce anxiety.
e.g., Ativan, valium, xanax
12
Q
Annual Assessment
A
An _______ __________ of a resident’s physical, mental, emotional, cognitive, & functional status.
13
Q
Ambulatory
A
Able to walk with or without difficulty or help.
14
Q
Adverse Drug Reaction
(ADR)
A
An unintended response to a drug that is injurious or harmful to health & which occurs at normal doses.
15
Q
Advanced Directive
A
Written instructions from residents about the management & provision of care if they become incapacitated (e.g., living will, DNR, durable power of attorney for healthcare)
16
Q
Administer
A
The direct application of a vaccine or a prescribed drug or device, whether by injection, ingestion, or any other means to the body of a resident.
17
Q
Activity Therapist
A
An allied health professional trained to develop & provide leisure time activities for facility residents.
18
Q
Activities of Daily Living
(ADLs)
A
Individual self-performance skills needed in everyday life such as ambulation, locomotion, eating, toileting, grooming/personal hygiene, and bathing.
19
Q
Federal law requires all nursing homes to be surveyed annually between how many months?
A
9 to 15 months from the last survey date.
20
Q
What is abuse?
A
Willful intent to cause harm. May be resident to resident or staff to resident harm.
21
Q
What is harm?
A
Negative effects that have occurred to a resident, infringement of a resident’s rights, or compromising a resident’s ability to meet their highest practicable level of physical, mental, or psychosocial well-being.
22
What is a Guardian?
A legal representative, appointed by a court, to make decisions for a person not competent to make their own decisions.
Generally have all of the legal rights normally granted to competent residents.
23
Gerentology
The study of aging from the broadest perspective. Examines not only the clinical & biological aspects of aging but also psychosocial & historical conditions.
24
Geriatric Medicine
(geriatrics)
The medical knowledge of physical disability in older persons-- including diagnosis, treatment, & prevention of disorders.
Recognizes aging as a normal process, not a disease.
25
Geriatrician
Physician that specializes in geriatric medicine.
1 & 3 year training programs are available for this.
26
What is gait?
How a person walks.
27
Extrapyramidal Symptoms
(EPS)
Abnormal movements of the mouth or tongue, pill-rolling, tremors, rigid movements, mask-like face, constant movement of legs or body, tics, blinking, pacing, eyes rolled up, & drooling.
28
Extended Survey
A federal survey conducted within 14 days of a finding of substandard care during a standard federal survey.
29
What is energy metabolism?
The process in the body of breaking down calories consumed into useable energy to allow the body to perform normal body functions.
29
What is the Enforcement Grid in regard to survey?
A table developed by CMS that defines severity and scope of federal deficiencies & indicates whether plans of correction & remedies are necessary.
30
Drug Utilization Review
(DUR)
The study of drug use patterns in a facility.
31
Drug Review Regimen
(DRR)
The review of drugs being used by a resident to determine effect & potential for harmful effects.
32
What is a Drug?
Any substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease or other conditions in a person.
Any substance other than a device or food intended to affect the structure or any function of the body of a person.
32
What is a Drug Irregularity?
A drug that is given w/o a medical reason, in an excessive or inadequate dose or duration of therapy.
Dose modification or discontinuation is indicated.
The consulting pharmacist should address potential problem at time of monthly review.
33
What does it mean to dispense?
To deliver a prescribed drug to an ultimate user, including the compounding, packaging, & labeling necessary to prepare the prescribed drug
34
Director of Nursing
(DON)
A registered nurse (RN) responsible for supervising the activities, functions, & training of nurse personnel.
35
What is the Dietary History?
A review of a resident's usual food intake patterns, including any food preferences, chewing, swallowing problems, or difficulties w/ self-feeding that might affect overall food intake.
36
What is Hospice Care?
Supportive care provided to terminally ill patients and their families in the final six months (Medicare definition) of a patient's life. This care is managed and coordinated by a certified Medicare ______ provider.
37
What is a hypnotic medication?
A psychoactive medication given to sedate or calm (e.g., Sonata, restoril, ambien)
37
What is Immediate Jeopardy in relation to survey?
A situation in which a provider's noncompliance with one or more regulations has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.
38
What is an "incidence" related to MDS?
A type of CSRA QI that describes what has taken place with a resident over the course of the last two MDS or OASIS assessments.
39
What is incontinence?
Lacking voluntary control over the bladder or bowel. In most people, it can be treated and controlled, if not cured. Specific changes in body function, often resulting from disease or the use of medications, are the cause of incontinence.
40
Individual Program Plan
(IPP)
A written statement of the services to be provided, as developed by an IDT, and based on a comprehensive functional assessment of an individual's active treatment needs.
41
What is informed consent?
The person giving consent receives information necessary to make a health care decision, including information about the benefits, reasonable risks, alternatives, the right to refuse, and consequences of any treatment or service.
42
What is an Initial Survey?
An on-site federal survey to determine whether a provider meets the requirements to begin participating in the Medicare and/or Medicaid programs.
42
Instrumental (Independent) Activities of Daily Living
(IADLs)
Activities that include meal preparation, house work, managing finances or medications, telephone use, shopping, and transportation (how one moves up and down stairs, how one moves in and out of cars)
43
What is a Licensed Practical Nurse?
(LPN)
A person licensed as a practical nurse by state statute. An ___ performs simple acts in the care of convalescent, subacute or chronically ill residents under the specific direction of a RN, physician, podiatrist, or dentist.
43
What is the Interdisciplinary Team?
(IDT)
A facility team that allows the involvement of multiple medical disciplines in providing patient care; can consist of all or some of the following professionals: physician, nurse, social worker/case manager, dietician, therapist, pharmacist, etc.
44
What is "licensure" in regards to a facility?
The granting of a license to a provider that has been determined to meet a state's requirements for operation.
45
What is Long Term Care?
(LTC)
A general term that is used to describe care in nursing homes.
Also used to describe a broader continuum of care for chronic and disabled persons that include nursing homes, assisted livings, board and care facilities, and community care such as home health agencies.
46
What is Medicaid?
A state program that provides medical services to clients of the state public assistance program and, at the state's option, other needy individuals, as well as supplements hospital and nursing facility (NF) services mandated under Medicaid.
States may decide on the amount, duration, and scope of additional services.
47
What is Medical Nutrition Therapy?
(Also known as Therapeutic Diet)
A diet ordered by a physician as part of treatment for a disease or clinical condition, or to eliminate, decrease, or increase specific nutrients in the diet.
48
What type of institutions does MCR cover?
Hospitals, hospices, nursing homes, and home health agencies.
48
What is Medicare?
A federal insurance program providing a wide range of benefits for specific periods of time through providers and suppliers participating in the program.
49
Who is entitled to MCR benefits?
Benefits are payable to most people over 65, social security beneficiaries under 65 entitled to disability benefits, and individuals needing renal dialysis or renal transplantation.
50
How is payment made for MCR services?
Payment for services is made by the federal government through designated fiscal intermediaries (FIs) and carriers to the providers and suppliers.
51
What is a Medication Error?
Medications not given as intended by a prescriber, as required by the drug manufacturer, or according to acceptable professional standards.
51
What is a Minimum Data Set?
(MDS)
A federally mandated resident assessment instrument is used to assess resident physical, mental, emotional, cognitive, and functional limitations and strengths.
Must be administered to all residents in MCR or MCD-certified facilities at the time of admission, annually, quarterly, and when a significant change in a resident's condition occurs.
52
What is misappropriation?
The deliberate misplacement, exploitation, or wrongful, temporary, or permanent use of a resident's belongings or money without the residents consent.
53
What is neglect?
Failure to provide goods and services to prevent resident harm.
54
What is Nosocomial Infection in the Long Term Care Facility?
An infection that develops after admission to the LTCF. Infections that are incubating at the time of admission, or develop within 48 to 72 hours of admission, usually are community-acquired or hospital-associated if the person was transferred from a hospital.
55
What is the Nurse-Aide Competency?
Federal and/or state training and capability requirements needed for employment of nurse aides in nursing homes.
55
Nurse Aide or Nursing Assistant?
(NA)
An unlicensed caregiver, under professional nurse supervision, who provides nursing and personal care.
55
What is the Nurse Aide Registry?
A listing of nurse aides who have met Federal and/or State training and competency requirements needed for employment as nursing aides.
55
What is a Nurse Practitioner?
A registered nurse who meets additional state requirements to meet this designation. In some states, NPs may act as physician extenders to conduct certain activities such as ordering tests and medications.
56
Nursing Home Administrator
(NHA)
Nursing Facility Administrator
(NFA)
The person charged to operate a nursing home and licensed by the state. "As the nursing home evolved, the title of the person was changed from operator to nursing home administrator.
A few states changed NHA to NFA. The term NF has not become popular and NH is used more often.
57
What is Nursing Home Quality Improvement Initiative?
A program of the CMS and U.S. Department of Health and Human Services that compiles information about nursing home residents on eight situations/conditions called quality measures (QMs) and makes the information available to consumers.
58
Occupational Therapist
(OT)
A person licensed, certified, or registered under state statutes to perform as an OT.
Generally certified by the American Occupational Therapy Association (AOTA)
59
Occupational Therapy
Specializes in the adaptive use of the upper extremities for performing various tasks... evaluating and treating functional impairments in the ADLs.
Play a vital role in evaluating the independent living environment when a resident is ready to discharge home.
60
What is the Ombudsman?
Paid or voluntary staff that investigate nursing home complaints from residents and their families and act as resident advocates addressing the concerns of NH residents.
Many Ombudsman programs are associated with state departments or boards of aging.
61
What is One to one programming?
Refers to programming provided to residents who will not, or cannot, effectively plan their own activity pursuits, or residents needing specialized or extended programs to enhance their overall daily routine and activity pursuit needs.
61
Omnibus Budget Reconciliation Act of 1978
(OBRA)
Changes to the Federal Social Security Act that significantly changed how nursing homes and home health agencies are regulated for MCR and MCD certification.
62
Online Survey/Certification and Reporting
(OSCAR)
CMS database that includes MCR & MCD certified facility demographic information, results of on-site surveys, and aggregate nursing home resident characteristics for comparison with state and national peer information.
63
What is Outcome in regards to care?
The status of care provided to a resident.
64
What are Physical Restraints?
Devices that prevent or restrict resident movement. A device or manual method that works to treat a medical symptom(s) but is attached to or adjacent to the individual's body so that freedom of movement or normal access to one's body is restricted.
65
What is Palliative Care?
Management & support provided for the reduction or abatement of pain, for other physical symptoms, and for psychosocial and spiritual needs of individuals with a terminal illness and includes physician services, skilled nursing care, medical services, and social services, but does not mean treatment provided to cure a medical condition or disease or to artificially prolong life.
Often used in place of Hospice Care.
65
What is Percentile Rank in regards to QIs?
For the CHSRA QIs, a means of ranking providers based on how they compare with each other on each separate QI. The higher a provider's percentile ranking, the more apt the provider is to have a care concern.
65
What are Person Appropriate Activities?
Refers to the idea that each resident has a personal identity and history that involves more than just his/her medical illnesses or functional impairments.
65
What is a Physical Therapist?
A person licensed, certified, or registered by state statute to perform as a PT.
Generally certified by the American Physical Therapy Association (APTA).
66
What is a Physician Assistant?
(PA)
A person licensed or certified by state statute to perform as a physician assistant.
67
What is Physical Therapy?
Focuses on evaluating and treating musculoskeletal disorders...
geared toward improving ambulation, joint mobility, and balance; strength training; fitting and using artificial limbs; training to use canes and walkers.
As Leann said- everything below the waist.
68
What is a Plan of Correction?
(POC)
A provider's plan for how and when it will correct federal deficiencies and/or state violations.
68
Post-Acute Care
Care for residents who are admitted to a facility following an acute care hospitalization.
Care may involve high-intensity rehab or clinically complex care.
Most post-acute care resident stays are for less than 30 days. Some lead to LTC admissions for chronic care.
68
Post-Survey Revisit
An on-site provider visit intended to verify correction of deficiencies and/or violations cited during a survey.
68
Preadmission Screening/Annual Resident Review Reports
(PASRR or PASARR)
Federally required screening of all nursing home residents, prior to admission to determine if the individual residents are mentally ill or mentally retarded.
It also deems whether they require specialized services and are fit to live in a nursing home.
68
Pressure Sore/Ulcer
An inflamed lesion of the skin or internal mucous tissue caused by pressure or friction.
Classified in Stages: 1-4 (4 is most severe)
68
What is Prevalence?
A type of QI or QM that provides a description of a resident or patient at a point.
69
Program of Activities
Includes a combination of large and small group, one-to-one, and self-directed activities; and a system that supports the development, implementation, and evaluation of the activities provided to the residents in the facilities.
69
What is a Prior Assessment?
The assessment that occurs in the most recent four months (46-165 days) preceding the target assessment.
70
What is the Provider Initiative Project?
(PIP)
A quality indicator information system for long term care developed by the Center for Health Systems Research and Analysis (CHSRA) at the University of Wisconsin-Madison that utilizes MDS assessment data.
70
What is Psychoactive Medication?
Medications used to change, modify, or alter an individual's behavior or mood. This general term includes antianxiety, antidepressant, antipsychotic, and hypnotic medications.
70
What are Psychotropic Medications?
Psychoactive medications used to change, modify, or alter an individual's behavior or mood. This general term includes antianxiety, antidepressant, antipsychotic, and hypnotic medications.
71
What is the QI Domain?
For the CHSRA QIs, the broad areas of care that represent the common conditions and important aspects of care and life to nursing home residents. Each domain is represented by one or more QIs.
71
What is Quality Assurance?
A provider program to monitor and study the quality of the services it delivers, and to make recommendations for improvement. A designated quality assurance committee usually coordinates this activity.
72
What are Quality Indicators?
(QIs)
CHSRA's indicators of provider level and resident level status derived from MDS (OASIS) information. The QIs are pointers or signage posts of potential and/or provider care problems. QIs are used by surveyors to help structure the survey process and can be used by providers to help monitor and improve their own performance.
73
What are Quality Measures?
(QMs)
Publicly reported information made available by CMS to help consumers assess the quality of nursing home care.
Many of the QMs are based on, and virtually identical to, QIs.
74
What are the two categories of quality measures?
1) conditions relevant primarily to long-term residents (chronic care), including decline in late loss ADLs, pressure sores, residents with pain, physical restraints, and prevalence of infections
2) short-stay (temporary) residents, specifically prevalence of delirium, residents with pain, and improvement in walking.
74
Quality of Care
General area of the federal nursing home requirement that addresses specific areas.
75
Quality of Life
General area of the federal nursing home regulations that address resident life issues such as dignity, participation in activities, social services, accommodation of needs, and the facility's environment such as lighting, sound, temperature, and homelike environments.
76
What is the Quarterly Assessment?
MDS assessments required each quarter for all resident in Medicare and/or Medicaid facilities.
76
Range of Motion
(ROM)
The extent or magnitude of a resident's joint movement.
77
What is a Registered Dietician?
The health professional designated to oversee food and nutrition services in acute and long-term care settings by both CMS and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
Has received a degree in nutrition science, completed a 1000-hour dietetic internship, and passed a comprehensive national registration exam- minimum of 15 CEUs must be obtained and maintained in order to be credentialed.
78
What is a Recreational Therapist?
(RT)
A person certified, by a recognized certifying organization, to perform as a recreational therapist.
78
Registered Dietician
(RD)
A person registered as a dietician by state statute or the American Dietetics Association.
78
Registered Nurse
(RN)
A person registered as a nurse by state statute.
79
Registered Pharmacist
(RPh)
A person registered as a pharmacist by state statute.
80
What are Regulations?
Federal requirements promulgated to "flesh out" the statutory requirements in the Social Security Act
81
What are Resident Assessment Protocols?
(RAPs)
Eighteen problem-oriented guides for care planning with "trigger" conditions to signal the need for additional assessment and review (e.g., activities RAP, mood state RAP, pressure ulcer RAP, etc.)
81
What is the Resident Assessment Instrument?
(RAI)
A tool to help facilities identify residents' needs and strengths and develop an appropriate care plan. The federal ___ system includes: the MDS, RAPS, and utilization guidelines.
81
Resident Centered Care
Practices that encourage residents to be involved in making decisions about their care and daily activities; examples of resident-centered dietary functions include cook-to-order eating schedules, resident-involved menu planning, and buffet style or family dining meal service.
82
Resource Utilization Groups
(RUGS)
A collection of nursing facility resident classification systems used in a variety of case mix indexed reimbursement systems.
Using assessment tools like the MDS 2.0, these systems group residents by expected level of resource utilization, usually based upon staff time measurements per resident per day.
Relative resource utilization is reflected in a case mix index (CMI) value assigned to each RUG cell.
83
What is the "Scope" in regards to survey.
The extent or magnitude of deficient facility practice on resident outcome.
There are three levels of _____ as described in the Enforcement Grid.
83
Sentinel Health Events
Significant conditions or events that exist for only a single case or a few cases. For the CHSRA QI, they may represent a significant problem that needs to be investigated (fecal impaction, dehydration, pressure ulcers--low risk)
83
What is "severity" in regards to survey?
The effect or seriousness of deficient facility practice on resident outcome. There are 4 levels of _______.
84
Shelf-Stable Food
Preserved (often canned or boxed) food that is able to be stored at room temperature for long periods and made ready for service in an emergency situation without the use of electricity.
85
Short Term Stay
Admission and discharge of a nursing home resident that occurs in less than 14 days.
86
Significant Medication Error
___________ _______ __________ that causes a resident discomfort and/or jeopardizes his/her health and safety.
86
Significant Change of Condition
A major decline or improvement in a resident's status that will not normally resolve itself without further intervention by staff or by implementing standard disease-related clinical interventions, that has an impact on more than one area of a resident's health status and requires interdisciplinary review or revision of the care plan, or both.
86
Side Effect
Undesirable side of a medication that causes minimal discomfort in some people. Undesirable
86
Significant Change in Condition
A substantial modification in a resident's physical, mental, emotional, cognitive, or functional status that requires a new assessment using the MDS instrument, and also generally requires notification of the resident's attending physician, family, or guardian.
87
Significant Weight Loss
The threshold used to determine when an intervention and documentation is required to prevent under-nutrition from excessive weight loss.
88
What are the significant weight loss thresholds?
5% in 30 days
7.5% in 90 days
10% in 180 days
89
Social Security Act
Federal statutory law that includes the requirements for participation in MCR & MCD programs
89
Skilled Nursing Facility
(SNF)
A nursing home that meets the requirements for Medicare certification as defined in 1819(a) of the Federal Social Security Act.
The term used by most states to define the type of nursing home that is licensed to provide the highest level of care.
90
Speech Pathologist
(SP)
A person licensed, certified, or registered by state statute to perform as a speech pathologist.
91
Speech Therapist
(ST)
A person licensed, certified, or registered by state statute to perform as a speech therapist.
92
Speech-Language Pathology
Encompasses evaluation and treatment of speech, language, and cognitive disorders... treats several kinds of disorders such as aphasia, dysarthria, and dysphagia
93
Standard Survey
An on-site federal survey of nursing homes conducted every 9-15 months to determine compliance with federal regulations for MCR and/or MCD
93
Statement of Deficiency
(SOD)
A written summary of noncompliance with regulations found during a federal provider survey or complaint investigation.
SOD are written on a CMS 2567 form
93
Substandard Care
Substandard quality of care is any deficiency in 42 CFR 483.13-- Resident Behavior and Facility Practice, 42 CFR 483.15--Quality of Life or 42 CFR 483.25--Quality of Care that constitutes immediate jeopardy to resident health or safety; or a pattern of or widespread actual harm or safety; or a pattern of or widespread actual harm that is not immediate jeopardy; or a widespread potential for more than minimal harm that is not immediate jeopardy, with no actual harm.
93
Subacute
Type of nursing home care that is generally considered above skilled nursing but below acute hospital care.
93
On the Enforcement Grid, substandard care equates to what boxes?
F, H, I, J, K, and L
93
Substantial Compliance
Minor deficiencies or violations, but a facility generally meets the intent of federal or state regulations.
93
What is a Target Assessment?
The most recent full or quarterly assessment that is available for the time in which the QM score is calculated.
93
On the Enforcement Grid, Substantial Compliance equates to what boxes?
A, B, and C
94
Terminal Care
Care provided to a dying resident that may or may not include hospice care.
95
What is the consistency of ground food?
The size of apple seeds.
95
What is the consistency of pureed food?
The consistency of smooth mashed potatoes.
95
What is the consistency of chopped food?
The size of green peas.
95
Texture Modification
Changing the consistency of food offered to a resident to help accommodate difficulties in chewing or swallowing.
96
What is a Threshold?
A set point for each CHSRA QI at which the liklihood of a problem is sufficient to warrant further investigation. There may also be a concern below the threshold especially if the percentile rank is close to the threshold.
97
What is the threshold point generally set at?
90th percentile
97
Unnecessary Drug
Any of the following:
Drug that is given w/o medical reason
Drug given in excessive dose
Drug given for an excessive amount of time
Drug w/o accurate monitoring
Drug given with side effects and/or adverse reactions indicate the drug should be reduced or discontinued
98
What are Universal Precautions?
Measures taken to prevent transmission of infection from contact with blood or other body fluids or materials having blood or other body fluids on them.
98
Waiver
The granting of an exemption from a federal or state regulation.
98
Variance
The granting of an alternate requirement in place of a federal or state regulation.
98
Violation
A written summary of noncompliance with regulations found during a state provider survey or complaint investigation.
The document is called a Notice of Violation.
151
152
What is Xerostomia?
Dry mouth. Can cause digestion concerns, tooth decay, candidas, difficulty swallowing
