Swallowing Disorders Height and Weight - PowerPoint Presentation

1. Swallowing DisordersHeight and WeightWeight ChangeNutritional ApproachesSection KSWALLOWING/NUTRITIONAL STATUS January 19, 2016 1-3PM

2. ObjectivesUnderstand that Section K is intended to assess the many conditions that could affect the resident’s ability to maintain adequate nutrition and hydrationUnderstand how to code Section K correctlyUnderstand what needs to be on the care plan

3. K0100: Swallowing DisorderAsk resident about difficulty swallowing and each symptom during 7 day look-back periodObserve when eating, drinking, or swallowingInterview staff Review medical record

4. K0100: Swallowing DisorderDo not code if interventions successfulCode a symptom even if it occurred only onceCheck all that apply during 7 day look-back period

5. K0200: Height & Weight Consistent facility policy and procedureMathematical rounding, nearest inch/poundA. HeightMost recent Admission/Entry or Reentry (If last ht. recorded was more than 1 yr. ago, measure the ht. again)B. WeightMost recent in last 30 daysOn subsequent assessments, if last recorded weight >30 days prior to ARD, or previous weight not available, weigh againIf multiple weights in preceding month, most recent weightUnable to weigh, use Dash (-)

6. K0300: Weight LossK0310: Weight GainTwo Snapshots in time: 30 Days, 180 Days New Admission Ask resident, family, or significant other Consult resident’s physicianReview transfer documentation Compare admission weight to previous weight of 30 & 180 days If less, calculate % weight lossIf more, calculate % weight gain

7. K0300: Weight LossK0310: Weight Gain Subsequent AssessmentsCompare weight in current observation period to weight in observation period 30 days ago in observation period 180 days agoIf less, calculate % weight lossIf more, calculate% weight gain

8. K0300: Weight Loss Calculate Percentage (5%) in past 30 daysMathematical round weight before calculatingMultiply previous weight by 0.95 to determine resident weight after 5% weight lossExample: 160 pounds x 0.95 = 152 poundsA resident whose weight drops from 160 to 152 lbs or less has experienced 5% or more weight loss

9. K0300: Weight LossCalculate Percentage (10%)in past 180 daysMathematical round weight before calculatingMultiply previous weight by 0.90 to determine resident weight after 10% weight lossExample: 160 pounds x 0.90 = 144 poundsA resident whose weight drops from 160 to 144 lbs or less has experienced 10% or more weight loss

10. K0310: Weight Gain Calculate Percentage (5%) in past 30 daysMathematical round weight before calculatingMultiply previous weight by 1.05 to determine resident weight after 5% weight gainExample: 160 pounds x 1.05 = 168 poundsA resident whose weight increases from 160 to 168 lbs or more has experienced 5% or more weight gain

11. K0310: Weight GainCalculate Percentage (10%)in past 180 daysMathematical round weight before calculatingMultiply previous weight by 1.10 to determine resident weight after 10% weight gainExample: 160 pounds x 1.10 = 176 poundsA resident whose weight increases from 160 to 176 lbs or more has experienced 10% or more weight gain

12. K0300: Weight LossCode whether planned/managed or unplanned/unmanagedLoss of 5% or more in last month ORLoss of 10% or more in last six monthsCode 0. No or unknownNot experience defined weight lossPrior weight not availableCode 1. Yes, physician-prescribed weight-loss regimenCode 2. Yes, not on physician-prescribed weight-loss regimen

13. K0310: Weight GainCode whether planned/managed or unplanned/unmanagedGain of 5% or more in last month ORGain of 10% or more in last six monthsCode 0. No or unknownNot experience defined weight gainPrior weight not availableCode 1. Yes, physician-prescribed weight-gain regimenCode 2. Yes, not physician-prescribed weight-gain regimen

14. K0510.Nutritional Approaches

15. K0510: Nutritional ApproachesColumn 1. While Not a Resident Column 2.While a Resident7 day look-back periodPrior to admission/entry or reentry7 day look-back period After admission/entry or reentryReview medical record for 7 day look-back periodAll nutrition and hydration received at nursing home, hospital as outpatient or inpatient.

16. K0510: Nutritional ApproachesA. Parenteral/ IV feeding Supporting documentation reflecting need for additional fluid intake for nutrition or hydration or prevention of nutrition need or dehydration. IV fluids or hyperalimentation, including TPN, administered continuously or intermittentlyIV fluids KVO (Keep Vein Open)IV fluids in Medication Piggybacks Hypodermoclysis and subcutaneous ports in hydration therapy IV fluids to prevention of dehydration

17. K0510: Nutritional ApproachesA. Parenteral/IV feedings do not include: IV medications IV fluids used to reconstitute or dilute medsIV flushesIV fluids administered:In conjunction with chemotherapy or dialysisas routine part of operative or diagnostic procedure or recovery room stay

18. K0510: Nutritional Approaches - DietsC. Mechanically altered Specifically prepared to alter the texture or consistency of food to facilitate oral intake. Examples include: soft solids, pureed foods, ground meats, thickened liquid. Not automatically a therapeutic diet.Enteral feeding formulasDo not code as mechanically altered diet

19. K0510: Nutritional Approaches - DietsD. Therapeutic Diet intervention ordered by health care practitioner as part of treatment for disease or clinical condition manifesting altered nutritional status, to eliminate, decrease, or increase certain substances in the diet (e.g. sodium, potassium)Supplements not automatically classify diet as therapeutic Enteral feeding formulasCode as therapeutic diet only if used to manage problematic health conditions (e.g. residents with diabetes)

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21. ScenarioMr. K. has been able to take some fluids orally, however, due to his progressing MS, his dysphagia is not allowing him to remain hydrated enough. Therefore, he received the following fluid amounts over the last 7 days via supplemental TFs while in the hospital and after he was admitted to the NH. While in the Hospital While in the NH Mon 400cc Fri 510cc Tues 520cc Sat 500cc Weds 500cc Sun 490cc Thurs 480cc Total 1900cc Total 1500ccCoding: K0710B1 would be coded 1, 500cc/day or less. K0710B3 would be coded 1, 500cc/day or less

22. ContinuedRationale: The total fluid intake within the last 7 days while Mr. K. was not a resident was 1,900cc (400cc+520CC+500cc+480CC = 1,900cc) Average fluid intake while not a resident totaled 475cc (1,900cc divided by 4 days) 475cc is less than 500cc, therefore code 1, 500cc/day or less is correct for K0710B1, While NOT a Resident.The total fluid intake within the last 7 days while Mr. K. was a resident of the NH was 1,520cc (510cc+520cc+490cc = 1,520). Average fluid intake while a resident totaled 507cc (1,520cc divided by 3 days). 507cc is greater than 500cc, therefore code 2, 501cc/day or more is correct for K0710B2, While a Resident.The total fluid intake during the entire 7 days (includes fluid intake while he was in the hospital AND while he was in the NH) was 3,420cc (1,900c+1,520cc). Average fluid intake during the entire 7 days was 489cc (3,420 divided by 7 days). 489cc is less than 500cc, therefore code 1,500cc/day or less is correct for K0710B3, During Entire 7 Days.

23. Care Plan ConsiderationsState what swallowing/eating problems the elder has and interventions to prevent complicationsProvide what interventions are in place to prevent weight loss. This needs to be looked at on admission in order to prevent any weight loss. Include what the dietitian recommends.Also include interventions for any significant weight gain

24. Care Plan Considerations continuedIf tube feeding is required be specific with the care neededThis is also where you would put there favorite foods, when they want to eat, the foods they dislike, and what they want for snacks and whenAlways remember to care plan expected weight loss, example weight loss is expected D/T diuresis because of fluid retention and use of diuretics.

25. Questions?I’ll take the next few minutes to answer any questions you might have

26. Thank you!!Please feel free to contact meShirley L. Boltz, RNRAI/Education Coordinator785-296-1282shirley.boltz@kdads.ks.gov