Percentage of Short-Stay Residents Who Made Improvements in Function (Part 1)

May 2016 - Over the last few weeks, I’ve been expanding on the new claims-based quality measures CMS will soon begin to include in their Nursing Home Compare 5-star Ratings calculation. It’s now time to dive into to the MDS-measured metrics, the first being the Percentage of short-stay residents who made improvements in function.

Again, we are looking at residents whose NF stay was less than, or equal to, 100 days. Residents receiving hospice care, or who have a life expectancy of less than six months, are excluded.

The percentage is calculated based on improvement in 3 specified ADLs from the 5-day assessment to the Discharge assessment (at which return to the nursing home is not anticipated).

There are currently eleven ADLs tracked on the MDS.

1. Bed mobility
2. Transfers*
3. Walk in room
4. Walk in corridor*
5. Locomotion on unit*
6. Locomotion off unit
7. Dressing
8. Eating
9. Toilet use
10. Personal hygiene
11. Bathing

Of these 11, CMS has decided to use the 3 listed below as quality indicators for short-stay measures.

• Transfers-how resident moves between surfaces including to or from bed, chair, wheelchair, standing position. Excludes to/from bath and toilet.
• Walk in corridor-how resident walks in corridor on unit
• Locomotion on unit-how resident moves between locations in his/her room and adjacent corridor on same floor. If in wheelchair, self-sufficiency once in chair.

At first glance, you may be thinking this is therapy’s arena. While therapy is obviously a very important factor in gaining ADL improvement, pharmacy contributes to a significant aspect you don’t want to overlook. For instance, let’s say you have a resident with chronic kidney disease rehabbing to home. Unless their physician just happens to keep up on all the latest Nursing Home Compare 5-star Rating quality measure metric changes (hey, it could happen), are they really concerned with how the resident scored in locomotion on their 5 day and discharge MDS assessments? And the OT, while certainly concerned with ADL improvements, probably doesn’t have the medical knowledge necessary to tie the resident’s performance to their medications and lab values.

Do you know who can bridge this gap? Ding, Ding, Ding- one of GrandView Pharmacy’s Board-Certified Geriatric Pharmacists. Not only are our Pharmacists familiar with the regulatory changes affecting your facility, but they are reviewing the resident’s chart upon admission, routinely throughout their stay, with significant changes, and upon the NF’s request. They are able to say to themselves, “Hey, this resident’s hemoglobin was down at their last draw; and hmm, they’ve been declining in therapy too. I will recommend a medication adjustment to get their red blood cell count up, allowing more oxygen to circulate the blood and boost their energy. This should make them feel better, allow them to get the maximum benefits from therapy, improve their ADL scores, and move towards a successful discharge. The facility will be happy too because the excellent care they provide will be reflected in their 5-star rating!”

Not only is it vital for the Pharmacists to review the resident’s labs like in the above example, or with anticoagulants (you don’t want the resident at increased risk for a bleed or hematoma while they’re trying to improve their transfers and gait), but they also work to reduce medication side-effects which can have significant impact on ADLs.

Anticholinergics are a widely used class of drug, treating a broad range of ailments from incontinence to depression. They work to block the action of the neurotransmitter acetylcholine in the brain. However, because acetylcholine is involved in many major bodily functions, the effects spread throughout the entire body, which can lead to a number of unwanted side effects. Some are mild, temporary, and are reduced once the person adjusts to the medication. Some are more serious. They range from dizziness and blurred vision to cognitive impairment. As you are probably already aware, the elderly population are at higher risk from experiencing significant side effects. Our pharmacists will monitor these effects, and, if needed, make recommendations for changes in therapy.

In my next blog, we’ll discuss how GrandView Pharmacy also has the ability to take this monitoring one step further.

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