pediatric assessment tool revision project€¢hcpf internal case review step 4: tasks vs. modifiers...

Colorado Department of Health Care Policy and Financing

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Pediatric Assessment Tool

Revision Project

Presented by:

PAT Revision Workgroup August 28th, 2013


What are Home Health Services

Services provided by a RN, LPN and CNA within their specific DORA prescribed practice that can be safely and efficiently provided in the home

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Step 1: The Process

• Who, What, and When

• Plan of Action

Step 2: Limitations/Framework

• DORA (updated documents being reviewed)

• CNA Scope of Practice

• CO Medicaid Benefit Coverage Standard

• Skilled vs. Unskilled Care 3

PAT Revision Project


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PAT Revision Project

Step 3: Considerations

• Stakeholder feedback

• Home Health Agency concerns

• HCPF Internal Case Review

Step 4: Tasks vs. Modifiers

• CNA Skilled Tasks

• Client “Modifiers” affecting CNA care

• Consistency


CNA Tasks: Only includes tasks allowable under CNA Practice Act *Questions are valid for both related and unrelated caregivers

Modifiers: Identifying the client’s ability to function. Factors that add to the complexity of implementing skilled care

Scoring algorithm: New scoring system *Point system not attached to the following sections. A rating of 0-4 establishes levels of care only.

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Pediatric Assessment Tool Revision


A choice of a Moderate, Maximum, or Total Assistance will require supporting

documentation such as the completed 485 or clinic notes from a licensed professional;

this may include primary care providers, teachers, and/or therapists.

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Section I: CNA Tasks


Minimal Assistance: patient expends 75% or more effort

Moderate Assistance: patient expends 50-74% of effort

Maximum Assistance: patient expends 25-49% of effort

Total Assistance: patient expends <25% of effort

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CNA Tasks – Definitions of Assistance


Each ADL question

includes the list of factors that make it

skilled/ unskilled listed

next to the specific ADL

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Format Change


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Skilled Task: Ambulation

• Factors that Make Task Skilled: When the client is unable to assist or direct care or when hands on assistance is required for safe ambulation and client is unable to maintain balance or to bear weight reliably or has not been deemed independent with assistive devices ordered by a qualified physician.

• Factors that Make Task Unskilled: An unskilled provider may assist clients with ambulation who have the ability to balance and bear weight or when the client is independent with an assistive device.


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Skilled Task: Ambulation

1. Ambulation/Locomotion: Current ability to walk safely, once in a

standing position, or use a wheelchair, once in a seated position, on a variety of surfaces. Current ability is not age appropriate.

a. □ 0 - Able to independently walk/operate wheelchair on even and uneven surfaces and negotiate stairs with or without railings (i.e., needs no assistance or assistive device)

b. □ 1 – Client is able to ambulate/operate wheelchair with minimal assistance

c. □ 2 – Client is able to ambulate/operate wheelchair with moderate assistance

d. □ 3 – Client is able to ambulate/operate wheelchair with maximum to assistance

e. □ 5 – Client is completely dependent on and requires total assistance from others for all locomotion, not age appropriate


• Factors that Make Task Skilled: Client is unable to assist or direct care, broken skin or recently healed skin breakdown (less than 60 days). Client requires skilled skin care associated with bladder or bowel care or client has been assessed as having a high and on-going risk for skin breakdown.

• Factors that Make Task Unskilled: An unskilled provider may assist a client to and from the bathroom, provide assistance with bedpans, urinals and commodes; pericare, and/or changing of clothing and pads of any kind used for the care of incontinence.

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Skilled Task: GI/GU


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Skilled Task: GI/GU

2. Urinary Hygiene: Client’s current ability to maintain perineal hygiene safely to prevent skin breakdown and/or infection. Current ability is not age appropriate.

a. □ 0 - Able to manage toileting hygiene safely or has a catheter.

b. □ 1 - Client requires minimal assistance to complete toileting hygiene

c. □ 2 - Client requires moderate assistance to complete toileting hygiene

d. □ 3 - Client requires maximum assistance to complete toileting hygiene

e. □ 4 - Client is completely dependent on and requires total assistance from others for urinary hygiene, this includes changing diapers and perineal care associated with diaper changes.


3. Menses: Client has a menstrual cycle.

a. □ 0 – No, client is male b. □ 0 – No, client’s menstrual cycle is controlled/halted due to

medical or pharmaceutical intervention c. □ 0 – Yes, client is independent or requires minimal assistance

with needs d. □ 1 – Yes, client requires moderate to maximum assistance with

needs.

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Skilled Task: GI/GU


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Skilled Task: Catheter Care

• Factors that Make Task Skilled: Emptying catheter collection bags (indwelling or external) is considered skilled care only when there is a need to record and report the client’s urinary output to the client’s nurse. If the indwelling catheter tubing needs to be opened for any reason and the client is unable to do so independently.

• Factors that Make Task Unskilled: An unskilled provider may empty urinary collection devices, such as catheter bags as well as provide pericare for client with indwelling catheters.


4. Catheter Care:

a. □ 0 – No catheter

b. □ 1 Catheter may be emptied without a need to record output

c. □ 2 - Indwelling catheter tubing needs to be disconnected/reconnected

d. □ 3 - Indwelling catheter tubing needs to be disconnected/reconnected and catheter output recorded and reported to RN per physicians orders

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Skilled Task: Catheter Care


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Skilled Task: Bowel Care

• Factors that Make Task Skilled: Unable to assist or direct care, broken skin or recently healed skin break down (less than 60 days). Client requires skilled skin care associated with bladder care or client has been assessed as having a high and on-going risk for skin breakdown. There must be a documented decline in condition and/or on-going need documented in the client’s record.

• Factors that Make Task Unskilled: A Personal Care Provider may assist a client to and from the bathroom, provide assistance with bedpans and commodes; pericare, or changing of clothing and pads of any kind used for the care of incontinence.


5. Bowel Hygiene: Current ability to maintain perineal hygiene safely to prevent skin breakdown and/or infection. Current ability is not age appropriate.

a. □ 0 - Able to manage toileting hygiene safely

b. □ 1 - Client requires minimal assistance to complete toileting hygiene

c. □ 2 - Client requires moderate assistance to complete toileting hygiene

d. □ 3 - Client requires maximum assistance to complete toileting hygiene

e. □ 4 - Client is completely dependent on and requires total assistance from others for urinary hygiene; including changing diapers and perineal care associated with diaper changes.

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6. Bowel Frequency:

a. □ 1 – On average, client has a daily bowel movement

b. □ 2 – On average, client has a bowel movement more often than daily

c. □ 3 – On average, client has a bowel movement 3 to 4 times per day

d. □ 4 – On average, client has a bowel movement more than 5 times per day


• Factors that Make Task Skilled: Clients must have a relatively stable or predictable bowel program/condition and CNA must be deemed competent to provide the client specific program as ordered by a qualified physician. Use of digital stimulation and over the counter suppositories or over the counter enema (not to exceed 120ml) only when the CNA demonstrates competency according to the Home Health Agency’s policy & procedure. (Agencies may choose to delegate this task to the CNA)

• Factors that Make Task Unskilled: An unskilled provider may empty ostomy bags and provide assistance with other ostomy care only when there is no need for skilled skin care or for observation or reporting to a nurse. An unskilled provider shall not perform digital stimulation, insert suppositories or give an enema.

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Skilled Task: Bowel Program


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7. Bowel Program:

a. □ 0 - No bowel program and/or client receives an oral stool softener or laxative

b. □ 1 – Physician ordered bowel program consists of use of digital stimulation, over the counter suppositories, or over the counter enemas ordered on an as needed basis

c. □ 2 - Physician ordered bowel program consists of use of digital stimulation, over the counter suppositories, or over the counter enemas ordered at least on a weekly basis

d. □ 3 - Physician ordered bowel program consists of use of digital stimulation and/or a CNA with MED Authority administering over the counter suppositories or over the counter enemas ordered for every day


8. Ostomy for Bowel Elimination: Does this client have an ostomy for bowel elimination?

a. □ 0 - Client does not have an ostomy for bowel elimination

b. □ 1 - Client does have ostomy for bowel elimination

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Skilled Task: Bathing • Factors that Make Task Skilled: The presence of open Wound(s),

stoma(s), broken skin and/or active chronic skin disorder(s); client is unable to maintain balance or to bear weight reliably due to fragility of illness, injury or disability, history of falls, temporary lack of mobility due to surgery or other exacerbation of illness, injury or disability.

• Factors that Make Task Unskilled: Bathing is considered unskilled when a client needs minimal assistance with bathing, when the skin is unbroken and/or the client is independent with assistive devices.


9. Bathing: Current ability to wash entire body safely. Excludes grooming (washing face, washing hands, and shampooing hair). Current ability is not age appropriate.

a. □ 0 - Able to bathe self in tub/shower independently including getting in and out of tub/shower, or client can be verbally cued to bath in shower or tube with set-up

b. □ 1 Client requires minimal assistance, not age appropriate

c. □ 2 Client requires moderate assistance to complete bathing

d. □ 3 Client requires maximum assistance to complete bathing

e. □ 4 - Client is completely dependent on and requires total assistance from others to be bathed

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Skilled Task: Bathing


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Skilled Task: Skin Care

• Factors that Make Task Skilled: Client requires additional skin care that is prescribed by a qualified physician and/or dispensed by a pharmacy, when the client has broken skin, a Wound(s) or an active skin disorder and client is unable to apply product independently due to illness, injury or disability. There must be a documented decline in condition and/or on-going need documented in the client’s record.

• Factors that Make Task Unskilled: Skin care is unskilled when a client’s skin is unbroken, and when any chronic skin problems are not active. The skin care provided by an unskilled provider shall be preventative rather than therapeutic in nature and may include the application of non-medicated lotions and solutions, or of lotions and solutions not requiring a physician’s prescription.


10. Skin Care (choose up to two):

a. □ 0 – Client does not have a G-tube, J-tube, stoma, or broken skin

b. □ 1 - Has a G-tube, J-tube, stomas, or broken skin requiring care or simple dressing changes

c. □ 2 - Has G-tube, J-tub, stomas, or broken skin requiring physician ordered product by a delegated CNA or CNA with MED Authority

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Skilled Task: Skin Care


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Skilled Task: Dressing

• Factors that Make Task Skilled: Dressing is considered a skilled task when the CNA must assist with the application of anti-embolic or pressure stockings, placement of braces or splints that can be obtained only with a prescription of a qualified physician, or when the client is unable to assist or direct care. Services may also be skilled when the client experiences a temporary lack of mobility due to surgery or other exacerbation of illness, injury or disability.

• Factors that Make Task Unskilled: Dressing is considered unskilled when the client only needs assistance with ordinary clothing and application of support stockings of the type that can be purchased without a physician’s order.


11. Current Ability to Dress Safely (Mark up to two boxes): Current ability is not age appropriate:

a. □ 0 – Client able to dress without assistance

b. □ 1 - Client requires minimal assistance to dress

c. □ 2 - Client require moderate assistance to dress

d. □ 3 - Client requires maximum assistance to dress

e. □ 4 - Client is completely dependent on and requires total assistance from others to be dressed

f. □ 1 - Client requires physician ordered application of braces, splints, or anti-embolic stockings daily

g. □ 2 - Client requires physician ordered application of braces, splints, or anti-embolic stockings greater than once per day

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Skilled Task: Dressing


Factors that Make Task Skilled (see CO Benefit for Unskilled)

• Hair Care: Client is unable to complete task independently. The client requires shampoo/conditioner that is prescribed by a qualified physician and dispensed by a pharmacy and/or when the client has open Wound(s) or stoma(s) on the head. Task may be completed during skilled bath/shower. Does not include styling.

• Mouth Care: Care for clients who are unconscious, have difficulty swallowing or are at risk for choking and aspiration is considered skilled care. Mouth care is also skilled when a client has decreased oral sensitivity or hypersensitivity or when the client is on medications that increase the risk of dental problems or bleeding, injury or medical disease of the mouth. CNA may provide oral suctioning

• Nail Care: Clients with have a medical condition that involves peripheral circulatory problems or loss of sensation, at risk for bleeding and/or are at a high risk for injury secondary to the nail care may only be completed by a CNA who has been deemed competent in nail care for this population.

• Shaving: Clients with a medical condition that might involve peripheral circulatory problems or loss of sensation or when the client has an illness or takes medications that are associated with a high risk for bleeding or when the client has broken skin (at/near shaving site) or has a chronic active skin condition.

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Skilled Care: Grooming


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Skilled Care: Grooming

12. Grooming: Current ability to complete grooming tasks independently or safely. This includes hair care, mouth care, nail care, shaving, and oral suctioning. Current ability is not age appropriate.

a. □ 0 - Client is able to perform grooming tasks independently

b. □ 1 - Client requires minimal assistance to complete grooming tasks

c. □ 2 - Client requires moderate assistance to complete grooming tasks

d. □ 3 - Client requires maximum assistance to complete grooming tasks

e. □ 4 - Client is completely dependent on and requires total assistance from others for all grooming tasks


• Factors that Make Task Skilled: The client is unable to communicate verbally, non-verbally or through other means and/or is not able to perform this task independently due to fragility of illness, injury or disability, temporary lack of mobility due to surgery or other exacerbation of illness, injury or disability. Positioning may include adjusting the client’s alignment or posture in a bed, wheelchair, other furniture, assistive devices and/or Durable Medical Equipment that has been ordered by a qualified physician. This excludes positioning that is completed in conjunction with other activities of daily living.

• Factors that Make Task Unskilled: An unskilled provider may assist a client with positioning when the client is able to identify to that provider, verbally, non-verbally or through other means, when the positions needs to be changed and only when skilled skin care, as previously described, is required in conjunction with the positions. Positioning may include alignment in a bed, wheelchair, or other furniture. 30

Skilled Task: Positioning


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Skilled Task: Positioning

13. Positioning. Current ability is not age appropriate.

a. □ 0 - Client is able to shift weight and reposition without assistance

b. □ 1 – Client requires minimal assistance to reposition

c. □ 2 - Client requires moderate assistance to reposition

d. □ 3 - Client requires maximum assistance to reposition

e. □ 4 - Client is completely dependent on and requires total assistance from others for repositioning


• Factors that Make Task Skilled: Services must be provided by a CNA when the exercise or range of motion exercise is prescribed by a qualified physician. Skilled services include ROM and when the CNA has demonstrated competency, the CNA may also perform passive ROM exercises.

• Factors that Make Task Unskilled: An unskilled provider may assist a client with exercise. However, this does not include assistance with a plan of exercise prescribed by a qualified physician. An unskilled provider may remind the client to perform ordered exercise program. Assistance with exercise that can be performed by an unskilled provider is limited to the encouragement of normal body movement, as tolerated, on the part of the client and encouragement with a prescribed exercise program. An unskilled provider shall not perform passive ROM.

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Skilled Task: Exercise/ROM


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Skilled Task: Exercise/ROM

14. Exercise/Range of Motion: Client requires assistance with an OT, PT or MD ordered exercise plan including exercise, passive or active ROM, use of standers, gait trainers, or other similar equipment meant to improve development, muscle tone, or stretching.

a. □ 0 - Client is able to exercise or is sufficiently active without assistance or the client requires a reminder to perform and ordered exercise program

b. □ 1 Daily program consists of less than 1 hour per day

c. □ 2 Daily program consist of 1 – 2 hours per day

d. □ 3 Daily program consists of 2 –3 hours per day

e. □ 4 Daily program consists of > 3 hours per day


• Factors that Make Task Skilled: Transfers are considered skilled when a client is unable to communicate verbally, non-verbally or through other means and/or is not able to perform this task independently due to fragility of illness, injury or disability, temporary lack of mobility due to surgery and/or other exacerbation of illness, injury or disability. It is also considered a skilled task when the client lacks the strength and stability to stand and/or bear weight reliably, is not deemed independent in the use of assistive devices and/or Durable Medical Equipment that has been ordered by a qualified physician. Transfers are also considered skilled when the client requires a mechanical lift for safe transfers. In order to transfer clients via a mechanical lift, the CNA must be deemed competent in the particular mechanical lift used by the client.

• See Colorado Benefit Coverage Standard for factors that make task unskilled

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Skilled Task: Transfers


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Skilled Task: Transfers

15. Transferring: Current ability to move safely from bed to chair. Current ability is not age appropriate.

a. □ 0 – Client ability to transfer is age appropriate (Infants are dependent) or client is able to transfer independently

b. □ 1 – Client is able to transfer with minimal assistance

c. □ 2 – Client is able to transfer with moderate assistance

d. □ 3 – Client is able to transfer with maximum assistance

e. □ 4 - Client requires total assistance with the use of either a two adults and/or a mechanical lift


• Factors that Make Task Skilled: Syringe feeding and tube feeding may be performed by a CNA who has been deemed competent to administer feedings via tube or syringe (Home Health agencies may also choose to delegate this task to the CNA). Oral feeding is skilled only when the client is unable to communicate verbally, non-verbally or through other means, the client is unable to be positioned upright, the client is on a modified texture diet or when the client has a physiological or neurogenic chewing and/or swallowing problem, when there is the presence of a structural issue (such as cleft palate) or other documented swallowing issues. A client with a history of aspirating food or on mechanical ventilations may create a skilled need for feeding assistance. CNA may provide oral suctioning.

• Factors that Make Task Unskilled: An unskilled provider can assist clients with feeding when the client can independently chew and swallow without difficulty and be positioned upright. Client is able to eat or be fed with adaptive utensils. 36

Skilled Task: Feeding


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16. Oral Feeding or Eating. Current ability is not age appropriate.

a. □ 0 – Client is able to independently chew and swallow without difficulties

b. □ 1 – Client requires minimal assistance during meals

c. □ 2 – Client requires moderate assistance during meals

d. □ 3 – Client requires maximum assistance during meals

e. □ 4 – Client requires total or complete assistance during meals


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17. Enteral G-tube/J-tube feedings delegated to CNA’s specifically trained to administer tube feedings. (Mark up to two boxes):

a. □ 0 - No enteral feeds or task is not delegated to CNA

b. □ 1 - Enteral feeds can be completed in less one hour daily

c. □ 2 - Enteral feeds can be completed in 1-2 hours daily

d. □ 3 - Enteral feeds can be completed in 2-3 hours daily

e. □ 4 - Enteral feeds can be completed in 3-4 hours daily

f. □ 1 GT/JT residuals are recorded prior to each feeding per physician’s order


• Factors that Make Task Skilled: Diets that require nurse oversight to administer correctly and meals that must have a modified consistency (thickened liquids, etc) are considered skilled CNA tasks. There must be a documented decline in condition and/or on-going need documented in the client’s record.

• Factors that Make Task Unskilled: Meal preparation is an unskilled task except as defined above. Diets that do not require nurse oversight include (but are not limited to) diabetic diet, low salt diet, low/high carbohydrate diet, low/high protein diet, gluten free diet, “heart smart “diet, low/high fat diet, low/high cholesterol diet, low/high calorie, vegetarian, low/high fiber diet, low/high nutrient diet (e.g. calcium, vitamin K, potassium) or allergen modified diet.

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Skilled Task: Meal Preparation


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Skilled Task: Meal Preparation

18. CNA has RN delegation to provide modified consistency meals.

a. □ 0 No

b. □ 1 Yes


• Factors that Make Task Skilled: None; unless the CNA meets the DORA approved CNA-MED Authority which is always a skilled task. CNA may ask client if he or she has taken his/her medications. CNA may replace oxygen tubing and may set oxygen to ordered flow rate. (See Respiratory care)

• Factors that Make Task Unskilled: An unskilled provider may assist a client with medication only when the medications have been pre-selected by the client, his/her Family Member/Caregiver, a nurse, or a pharmacist, and are stored in containers other than the prescription bottles, such as prefilled medication minders. Medication minder containers shall be clearly marked as to day and time of dosage and reminding includes: inquiries as to whether medications were taken; verbal prompting to take medications; handing the appropriately marked medication minder container to the client; and, opening the appropriately marked medication minder container for the client if the client is physically unable to open the container. These limitations apply to all prescription and all over-the-counter medications.

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Skilled Task: Medication Reminders


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Skilled Task: Medication Reminders

19. CNA is a DORA approved CNA with MED Authority

a. □ 0 No. CNA does not assist with medication reminders

b. □ 1 No. CNA does assist with medication reminders

c. □ 2 Yes. Client requires a CNA with MED Authority to administer medications


Respiratory Treatments

□ 0 – No oxygen or monitors. Please skip to question 22.

20. Chest Percussive Therapy (Mark one): Task delegated to CNA

a. □ 0 - No chest percussive therapy or task is not delegated to CNA

b. □ 1 – CPT can be completed in less one hour

c. □ 2 – CPT can be completed in 1-2 hours daily

d. □ 3 – CPT can be completed in 2-3 hours daily

e. □ 4 - CPT can be completed in > 3 hours daily

21. Oxygen Therapy (Mark one): Client needs assistance to replace oxygen tubing and set oxygen at ordered flow rate by a CNA with MED Authority.

a. □ 0 No

b. □ 1– Yes

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Skilled Task: Respiratory Care


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Skilled Task: Vital Signs

• Factors that Make Task Skilled: Vital signs may be taken only as ordered by the client’s nurse and/or the Plan of Care and shall be reported to the nurse in a timely manner. The CNA shall not provide any intervention without the nurse’s direction and may only perform interventions that are within the CNA practice act and that, when necessary, the CNA has demonstrated competency in.

• Factors that Make Task Unskilled: N/A


22. Vital signs, nurse ordered: (Mark up to two boxes):

a. □ 0 Vital Signs not included in care plan

b. □ 1 Care plan includes temperature, pulse, and respiratory rate

c. □ 2 Care plan includes blood glucose and/or pulse oximetry performed by a CNA with MED Authority

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Skilled Task: Vital Signs


Recommendation Incorporated

Client Weight Yes – addressed in modifiers

Flaccid Paralysis/Severe Progressive Conditions/ Quadriplegic/Amputees

Yes – encompassed throughout tool

Menses Yes – addressed in CNA tasks

Pain Yes – addressed in modifiers

Delegation of tasks to CNA Yes – addressed in appropriate tasks

Self-abuse/Client Safety Influencing care/PICA

Yes – encompassed throughout tool

Frequency of Stools Yes – addressed in CNA tasks

New Scoring System Yes – under development

Comprehension Yes – addressed in modifiers

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Consideration Evaluated by Workgroup


Recommendation Incorporated

Overnight Needs No – HH care does no provide round the clock care

Non-School Days/School Days No – tool is general assessment for HH

Parent Environment No – tool is general assessment for HH

Age of Caregiver No – tool is general assessment for HH

Multi-Level Home No – tool is general assessment for HH

Specific Diagnosis Related Questions (i.e. Autism/Down Syndrome)

No – tool is general assessment for HH

Client IQ No – tool is general assessment for HH

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Consideration Evaluated by Workgroup


The following section assesses individual client Functionality and other

characteristics that may directly impact delivery of care. A choice of a Moderate or

Severe Risk will require supporting documentation such as a completed 485

and/or clinic notes from a licensed professional; this may include primary care

providers, teachers, and/or therapists. 48

Section II: Complexity of Care/Modifiers


Minimum Effect: client’s ability to function is impacted < 25% of the time or on a monthly basis

Moderate Effect: client’s ability to function is impacted 50-74% of the time or on a weekly basis

Severe Effect: client’s ability to function is impacted >75% of the time or on a daily basis

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Definitions of Functional Capacity


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Integumentary Status

1. What is the client’s risk of developing pressure ulcers? Client’s Braden Score: _________________

a. □ 0 No Risk (Total score 19-23) or Braden score not obtained

b. □ 1 Mild Risk (Total score 15-18)

c. □ 2 Moderate Risk (Total score 13-14)

d. □ 3 High Risk (Total score 10-12)

e. □ 4 Severe Risk (Total score < 9)


2. Neuromuscular Status: Factors that impact the ability of the client to perform tasks on demand; this may include muscle weakness, paralysis, involuntary movements, amputated limbs, contractures, spasticity, and/or other motor conditions.

a. □ 0 – Neuromuscular factors do not affect client’s ability to function

b. □ 1 – Minimum effect on client’s ability to function

c. □ 2 – Moderate effect on client’s ability to function

d. □ 3 – Severe effect on client’s to ability function

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MUSCULOSKELETAL/NEUROLOGIC STATUS


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Individual Characteristics

3. Levels of Cooperation: A lack of the client’s ability to cooperate with daily activities. This may include identifying risks, acting in safe manner, and/or the display of aggression towards self or others.

a. □ 0 – Level of cooperation does not affect the client’s ability to function



d. □ 3 – Severe effect on client’s ability to function


4. Airway Status: Requirement for interventions to maintain airway patency.

a. □ 0 – Stable airway




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Respiratory Status


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Sensory Status 5. Vision: The impact of the client’s visual status on their ability to

perform tasks on demand.

a. □ 0 – The client’s visual status does not affect ability to function




6. Ability to Hear: The impact of the client’s auditory status to perform tasks on demand.

a. □ 0 – The client’s auditory status does not affect ability to function





7. Receptive Communication. The ability of the client to understand the communication of others in their own language

a. □ 0 – Client’s understanding of verbal or non-verbal communication does not impact the client’s ability to function




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Communication (cont)


8. Expressive Communication: The ability of the client to express thoughts, feelings, and needs through their own means of communication

a. □ 0 – Client’s ability to express thoughts, feelings, and needs does not impact the client’s ability to function




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Communication


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Seizures

9. Client has documented seizures directly impacting care.

a. □ 0 – No. Client either does not have seizures or client’s seizures do not impact care





10. Client has a documented chronic condition causing physical pain:

a. □ 0 – No. Client either does not have chronic pain or the client’s pain does not impact care

b. □ 1 – Minimum effect on client ability to function

c. □ 2 – Moderate effect on client ability to function

d. □ 3 – Severe effect on client ability to function

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Pain and Comfort


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Weight

11. Client’s most current weight in pounds ______________

a. □ 0 – Client weighs less than 50 pounds

b. □ 1 – Client weighs 51-99 pounds

c. □ 2 – Client weighs 100-149 pounds

d. □ 3 – Client weighs >150 pounds


Nursing Tasks

1. Administration of Intravenous Therapy:

a. □ 0 - None of the following

b. □ 2 - Intravenous or infusion therapy (excludes TPN)

c. □ 3 - Parenteral nutrition (TPN or lipids)

2. Intravascular Catheter Present on Client (Mark one):

a. □ 0 - None

b. □ 3 – Regular intravenous

c. □ 4 - PICC

d. □ 4 – Central

3. Intravenous Medications (Mark all that apply):

a. □ 0 – None

b. □ 3 – Scheduled IV Medications (Other than IV Pain Medications)

c. □ 3 – PRN IV Pain Medications


Nursing Tasks 4. Flushing Intravascular Catheter (Mark one):

a. □ 0 - None

b. □ 2 – Daily

c. □ 3 - More than once a day

5. Peritoneal dialysis done at home (Mark one):

a. □ 0 - No

b. □ 5 - Yes

6. Catheter Status (Mark one):

a. □ 0 - Client has no urinary catheter

b. □ 4 - Client requires a urinary catheter (external, indwelling, intermittent, suprapubic)


Nursing Tasks 7. Enteral GT/JT feedings are not delegated to CNA or caregiver (Mark up to two

boxes):

a. □ 0 - No enteral feeds

b. □ 1 - Enteral feeds QID or less

c. □ 2 - Enteral feeds 4-6 x per day

d. □ 3 - Enteral feeds 7 or more times per day

e. □ 3 - Enteral feeds continuously with or without short breaks

f. □ 1 - Enteral feeds at night only (continuous at night)

g. □ 1 - Enteral feeds via funnel or syringe

h. □ 2 - Enteral feeds via pump over 30 min or less

i. □ 3 - Enteral feeds via pump runs longer than 30 min per feed


Nursing Tasks 8. Airway Status (Mark one):

a. □ 0 - Client has no tracheostomy

b. □ 4 - Tracheostomy

9. Airway/Tracheostomy Care (Mark one): a. □ 0 - No Suctioning Required b. □ 1 - Occasional (1-6 times a day) Suctioning required c. □ 2 - Intermittent (6-10 times a day) Suctioning required d. □ 3 - Frequent or Hourly Suctioning required

10. Nebulizers (Mark one): a. □ 0 - Client does not use nebulizers b. □ 1 - PRN or BID nebulizers, CPT, or cough assist c. □ 2 - Regular nebulizer/inhaler treatments (more than BID)


Nursing Tasks 11. BiPAP/CPAP (Mark one):

a. □ 0 - Client does not use BiPAP/CPAP

b. □ 3 - Intermittent BiPAP/CPAP

c. □ 5 - Continuous BiPAP/CPAP

12. Ventilator (Mark one): a. □ 0 - Client does not use ventilator b. □ 5 - Ventilator intermittent or only while sleeping c. □ 7 - Continuous Ventilator

13. Wounds/Dressings (Mark one): a. □ 1 - Has wounds requiring daily dressing changes b. □ 2 - Has wounds requiring BID or TID dressing changes c. □ 3 - Has wounds requiring QID or more dressing changes per day d. □ 3 - Has a wound, stoma, or ostomy that requires a dressing change that

takes longer than 30 minutes to complete due to complexity of wound or pain.


Stakeholder Feedback period

– Provide feedback to [email protected]

– Stakeholder Feedback must be received by close of business September 4th, 2013

Validation and Testing

Training & Implementation of new PAT

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What’s Next?

mailto:[email protected]

Colorado Department of Healthcare Policy and Financing

Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources

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Questions?

Colorado Department of Healthcare Policy and Financing

Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources

THANK YOU!

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pediatric assessment tool revision project€¢hcpf internal case review step 4: tasks vs. modifiers...

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