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Interdisciplinary Assessments. KNR 279. burlingame email.

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burlingame email
burlingame email
  • All of health care is computerizing its documentation systems which has allowed the calculations of outcomes on a system wide (national) basis. If recreational therapists do not start filling out the interdisciplinary assessments for the areas that are within our scope of practice, you are right, we will die a slow and painful death. However, there are many parts of these computerized interdisciplinary tools that are within our standard scope of practice. We used to say if it wasn’t written, it didn’t happen. Now, if it was not entered into these few interdisciplinary documents, it did not happen, even if we write it down in the electronic or paper charts.
interdisciplinary assessments1
Interdisciplinary Assessments
  • WHO – ICF (Next)
  • RAI/MDS (Nursing homes, today)
  • IRF-PAI (Rehab facilities, today)
    • FIM
  • Still need specific discipline assessments
rai mds
RAI/MDS
  • Resident Assessment Instrument (RAI)
  • Minimum Data Set (MDS Version 2.0)
  • Interdisciplinary assessment & care planning process
  • Used in long term care
  • Standardized
  • Computerized
  • National data base
rai mds cont
RAI/MDS (cont.)
  • 1987 Omnibus Budget Reconciliation Act (OBRA)
  • First implemented in 1990
  • Computerized in mid 1990’s
  • VA required use in NH units in 2001
  • See MDS handout
    • Identifies: Needs, strengths, preferences, description of functional skills, directs content of care plan, identifies need for further assessment
rai mds cont1
RAI/MDS (cont.)
  • RT Section N
  • Also may be
    • AC: Customary routines
    • B: Cognitive patterns
    • C: Communication/hearing patterns
    • E: Mood & behavior patterns
    • F: Psychosocial well-being
rai mds cont2
RAI/MDS (cont.)
  • Section T: Supplemental Case Mix Demo
    • T1a: Recreation Therapy
      • Must be active treatment
      • Physician’s order
      • Provided by CTRS
      • Beyond activity program
rai mds cont3
RAI/MDS (cont.)
  • MDS completed
    • Sources: resident record, observation/interview, direct care staff, professionals, family
  • Triggers
    • Scores that indicate need for further or in depth assessment
  • Resident Assessment Protocols (RAP)
    • More detailed assessment process
    • Comes from triggers
    • 18 areas
rai mds cont4
RAI/MDS (cont.)
  • Quality Indicator (QI)
    • Potential problems related to health care services or quality of life
    • Identified through MDS
    • Additional treatment objectives based on QI data
  • Treatment plan based on
    • RAI (MDS + RAP)
    • QI
rai mds cont5
RAI/MDS (cont.)
  • Resource Utilization Guidelines
    • (RUGS III)
    • Summary of scores & places in 1 of 7 tx groups or categories
      • 1 Rehabilitation
      • 2 Extensive services
      • 3 Special care
      • 4 Clinically complex
      • 5 Impaired cognition
      • 6 Behavior problem
      • 7 Reduced physical function
rai mds cont6
RAI/MDS (cont.)
  • Perspective Payment System (PPS)
    • Not actual cost of care
    • Average cost for all residents in same RUGS III category
    • Based on particular part of country
  • Payment based on how MDS filled out
slide12
FIM
  • Functional Independence Measure
  • Used in rehabilitation
  • Basic indicator of severity of disability
  • Can be administered quickly
  • Can be administered to groups
  • Discipline free
fim cont
FIM (cont.)
  • 7 level scale
    • Dependence to independence
    • Ability to carry out activities independently
      • What usually does not what could do or what performed once
      • If difference in environments, use lowest score
      • Do not leave any area blank
fim areas
Eating

Grooming

Bathing

Dressing

Toileting

Bladder Mgmt

Bowel Mgmt

Transfers

Locomotion

Comprehension

Expression

Social Interaction

Problem Solving

See Handout

FIM Areas
alexian brothers
Alexian Brothers
  • FIM (Social Interaction)
  • RICFAS (Rehabilitation Institute of Chicago Functional Assessment Scale)
    • Domain: Community Integration
      • Recreation Resource Awareness
      • Leisure Skills
      • Community Recreation Reintegration
irf pai
IRF-PAI
  • Inpatient Rehabilitation Facilities Patient Assessment Instrument
  • New (1/2002)
  • Similar to long term care
  • Using FIM in clinical section
  • Assessment & reimbursement rate
irf pai1
IRF-PAI
  • TR typically looks at
    • Locomotion
    • Communication
    • Social cognition
    • Motor & cognitive skills in naturalistic setting (community reintegration outing)
    • No leisure
      • Often use LCM
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