What is trending on the PIN ListServ?

INQUIRY: CAH Change in Status Process 

• Obs to IP does not require a new admission but it does require an order from the provider.  if you are going to SB from either of these, then you do need a new order as well as admission.  If you go from IP to Obs you will need to fill out a condition code 44
•  No need to discharge between observation and inpatient, that just requires an order and a change in the patient status. The CoPs require a discharge summary from the inpatient stay - so the inpatient stay needs a H&P and DC summary.  The Swing Bed stay is a separate admission and requires a separate DC summary (new H&P is not required) and new orders. 

• We do not discharge between Obs to Inpatient - charges are adjusted on back side by the business office.  Was not our first choice but was encouraged to do so because of chart issues. We do, however, fully discharge when patient transfers from inpatient to swing bed. Every time you discharge and re-admit a patient, you risk making a transcription error - even with the electronic document.  For that reason, we determined to do what was best for the patient and ensure quality of care.   We greatly appreciate HIM and the Business Office staff's work on the back end in order to ensure this process works.  

• We do a full discharge and admission with each change in status. For us (as a CAH) the only one that does not require a new encounter is ER to OBS.  

• We only change the status in our financials when going from the ED to OBS or Inpatient or vice versa. When going skilled or non-skilled they are discharged and readmitted. We do require provider orders for each change in status.
   

 

• We use HealthStream and like it.  It tracks completion and sends reminders to staff when an assignment is due.  
•  We have a training module that we developed and update on an ongoing basis. Annually we print the module and distribute to all staff to read. There is also a post test that is done. The module is also used for new employee orientation. We have new staff read and test with the module when first hired since we only hold orientation class bi-monthly. That way they have some info to get started. This works pretty well. 

• We use Healthstream as well.  It has a wealth of good courses available for purchase but also allows you to build your own.  The tracking and reminder tools are good. Healthstream is designed to do a lot MORE than small hospitals need, so as an administrator it's easy to get lost in all the tools and options.  But once you learn how to navigate the tools and keep it simple, it's a great system.

• We also use Healthstream. We are a small facility but enjoy the variety of classes and record keeping services that the system provides.

• We use Relias.  It is more long term care focused but works for hospital too.

•  We are using Relias.  There are 500 classes and employees can self assign classes if they want to.  There is enough variation that employees don't get to bored with the same thing.  They can work through the courses quickly or take their time as needed. 

   

   

•  We use Relias Learning for mandatory in-services as well as continuing education for staff. There are several additional tools included also.

   

   

•  We use Relias and it is working for us.  We are also able to go in and assign monthly CNA courses for use to renew their license.  Many great courses to choose from.   

   

   

INQUIRY: Nursing Report to Board Members     

Would like to have some information about what information you report off to the Board Members

• I go over the quality report and have been doing this for a couple years.   A nurse has always presented this information to our BOD.  The Board here never wanted a "nursing" report.  During the time that I am there, they may ask me a nursing question but that is all.

• This is the Quality Dashboard that I developed to communicate how we are doing on certain measures. The data is updated monthly and this document is included in the Board's packet. If they have questions we discuss it in the meeting or if I have a specific concern or improvement then I will discuss it. It is color coded so they can see quickly how we are doing with each measure. You are welcome to use this and adapt it to your needs. If fact I think I developed this one using ideas from someone else.  Dashboard 

• It is interesting how everyone operates a bit differently - I give the board a report on anything of interest from the different clinical entities. For example last evening, I reported on the new PA student who will be coming, the Immunization survey, our Antibiotic Stewardship program progress, organ donation, patient comments and any capital purchase requests. We also address HCAPHS quarterly, the dashboard gives them the infection rates.Each time is different depending on what is happening in each of the departments. They receive all the meeting notes in packets also which they can review and ask questions.
•  I report to the board annually.  They want to hear about staffing and its challenges, QA/QI, HCAHPS, utilization, and they always end with the question "What is your biggest challenge as of today"