RESTORATIVE NURSING: IS YOUR PROGRAM POSITIVELY IMPACTING QUALITY MEASURES

1. RESTORATIVE NURSING:IS YOUR PROGRAM POSITIVELY IMPACTING QUALITY MEASURES LeadingAge Maryland October 31, 3017

2. Restorative Nursing Program • Restorative nursing program refers to nursing interventions that promote the resident’s ability to adapt and adjust to living as independently and safely as possible. This concept actively focuses on achieving and maintaining optimal physical, mental and psychosocial functioning.

3. Restorative Nursing Program • Quality Measures refer to one of the three items that are used to determine a providers 5 star quality rating. They are the direct result of items that were coded on the MDS 3.0 assessment tool. Quality measures are also included in the survey process and triggers must be addressed.

4. Restorative Nursing Program • Restorative nursing programs can result in a direct positive impact on the following quality measures: • Increased assistance needed for ADLs • Excessive weight loss • Resident reports of moderate/severe pain • High risk pressure ulcers • Falls and falls with major injury • Low risk loss of bowel and bladder continence

5. Restorative Nursing Program • Restorative nursing programs have the potential for indirect positive impact on quality measures including depressive symptoms and psychotropic medications.

6. Restorative Nursing Program • Restorative Nursing Programs (RNP) can be: • Provided by designated and distinct team members • Provided by nursing assistants • Initiated in conjunction with rehabilitation therapy services (rehabilitation low) • Initiated at the discharge of rehabilitation therapy services (Part B rehabilitation therapy services) • Initiated during a long term care stay when functional needs are noted as either restorative or maintenance services

7. Restorative Nursing Program • RAI (Resident Assessment Instrument) Manual Requirements/Guidelines • Team members providing the restorative nursing program services must be educated about the services • Measureable objectives and interventions present and care planned • A licensed nurse must supervise the restorative nursing program service delivery • Evidence of periodic evaluation of the service delivery effectiveness must be noted in the medical record • Documentation of the delivery of the services must be provided and present

8. Restorative Nursing Program • Restorative Nursing Program Services • Services include all of the following: • Active and Passive Range of Motion • Ambulation • Communication • Eating/Dining and/or Swallowing • Transfers • Bed Mobility • Splint and/or Brace Assistance • Dressing and/or Grooming • Amputation/Prosthesis care

9. Restorative Nursing Program • Restorative Nursing Program Services • Each RNP service includes activities that will either improve or maintain resident functional abilities and/or self-care. • Services may be appropriately provided with residents with a diagnosis of dementia or Alzheimer’s Disease. • RNP services may be delivered as “fun activities”. • RNP services may delivered in groups. • Ratio cannot exceed 4 residents to 1 team member. • RNP service must be appropriate for group delivery. • RNP services may be delivered by team members who have been educated • RNP services ARE NOT routine/general nursing care

10. Restorative Nursing Program • Delivery of RNP Services • RNP services may be delivered on any/all shifts. • Include a process to report between shifts what was delivered on the prior shift. • RNP coordinator should monitor quality measures and ADL documentation for potential resident functional needs. • Physician orders are not required unless electronic medical record requires it. • Rehabilitation therapy services should refer to but not manage the RNP. • Rehabilitation therapists can provide restorative services but not restorative nursing services.

11. Restorative Nursing Program • Restorative Nursing Program Services • Range of motion includes: active assisted, active and passive. • Delivery of both types of range of motion result in the delivery of only one RNP service – range of motion. • Cannot combine the two range of motion services to result in required number of days to impact the RUG level • Bed mobility and ambulation services delivered in the same time period result in the delivery of only one RNP service. • Toileting programs (bowel and/or bladder) may be considered RNP services.

12. Restorative Nursing Program • Restorative Nursing program and Quality Measures • Triggered quality measures must be investigated and addressed • Addressing resident functional changes can initiate with rehabilitation therapy and progress to restorative nursing • Restorative nursing programs in either restorative or maintenance forms will address quality measures and comply with the regulatory requirement to attain or maintain highest practicable level of function

13. Restorative Nursing Program • Your presenter has been: • Sophie A. Campbell, MSN, RN, • CRRN, RAC-CT, CNDLTC • Director, Clinical Advisory Services • Baker Tilly Virchow Krause, LLP • Sophie.campbell@bakertilly.com