Point of Care data collection: information at your fingertips
What is Point of Care?
A point-of-care (POC) system does not replace existing clinical systems, but it does improve the completeness and accuracy of resident data residing in existing clinical systems. Through the utilization of hand-held devices, wall-mounted touch screens or other portable units, caregivers obtain and document resident observations at the point of care.
Some POC systems offer visual prompts that serve as reminders by highlighting observations required throughout the shift. POC eliminates lost paper forms, illegible entries, "copy-cat" charting and time spent by MDS coordinators searching for missing assessments.
The value of POC technology, however, is real-time access to information that is otherwise inaccessible in a paper environment. Ultimately, it's the access to timely, accurate information about each resident that affords caregivers an opportunity to improve quality of care.
Advantages of POC
Technology will never substitute for superior bedside care provided by compassionate and competent caregivers. Technology can, however, provide remarkable tools designed to empower caregivers to carry out their functions in an optimal manner. POC, when utilized properly, assists caregivers to constantly offer the highest quality of care possible. The advantages and benefits that come from POC technology apply to residents, staff and facilities.
1. Quality of care
One reason the Centers for Medicare & Medicaid Services (CMS) mandated Minimum Data Set (MDS) reporting for nursing homes has to do with the importance of accurate, timely and consistent resident assessment data. Routine assessments are critical to the quality of care received by frail and elderly residents. After all, resident assessments are the foundation upon which a resident's individual care plan is formulated. POC technology was designed to maximize both quantity and accuracy of data captured, while improving access to vital resident status information. Undeniably, access to better data leads to improved treatment plans, and improved treatment plans lead to higher quality of care.
In the whirlwind of caring for multiple highly dependent residents at one time, caregivers struggle to make documentation a priority. Without a doubt, during each shift nursing assistants take pause at the bedside of every resident to assess mobility, diet, weight, skin condition, mood and other indicators of well-being.
Too frequently, however, the actual documentation of these observations is copied from the prior shift, left blank or simply incomplete-observations that, if consistently documented, would allow nursing staff to more readily identify adverse trends and make necessary changes to treatment plans. Because POC technology simplifies the documentation process, compliance is increased, and nursing staff gain an accurate picture of resident status shift by shift.
2. Staff communication
Communication between nursing assistants and licensed nurses is a universal problem in nursing homes. For example, it's not uncommon for aides, preoccupied with meeting immediate demands, to overlook reporting a potential skin problem to a licensed nurse. In fact, it's not uncommon for minor problems to go unreported for several days as shifts change and staff turnover occurs. POC constructs an electronic bridge between nursing assistants, licensed nurses, ancillary staff and administration insuring critical communication. Through dashboard displays, licensed nursing staff can access real-time resident status and prioritize how they will allocate their time.
Some POC systems are equipped with automatic alert systems. Alerts are electronically generated to notify staff in the event of a negative trend or change in a resident's status. For example, if a resident's food intake is steadily decreasing, an alert will be generated, which allows for an intervention before the situation turns to dehydration or malnutrition. Alerts can be based on standard criteria or specifically designed for an individual resident's unique circumstances or tolerance levels.
In a paper-driven environment, licensed nurses would be required to pour over numerous charts and mounds of paper in order to track a resident's subtle, yet important, trends. Consequently, the window for preventive care is often missed, leaving the resident in need of more intensive treatments.
3. Increased reimbursement, reduced risk
While a facility's success is dependent upon proper reimbursement, proper reimbursement is (more than ever before) dependent upon a facility's ability to accurately document each resident's condition. Residents with higher acuity naturally use more resources, require more staff time and, therefore, entitle a facility to higher reimbursement.
With ADL (activities of daily living) scores and mood/behavior observations accounting for much of the reimbursement formula, consistently documented observations are essential for continued financial viability. POC captures the data necessary so that each resident's condition is coded accurately and commensurate reimbursement is obtained. Furthermore, a facility using POC technology can confidently, easily and rapidly support assessment data in the event of surveys, audits or inspections.
Effective risk management is another significant component of a facility's long-term success. As litigation continues to escalate in the long-term care sector, solid documentation is an essential aspect of any risk-management strategy. In fact, virtually all litigation cases involve an intense review of documentation regarding daily assessments and resident care. In most cases, undocumented care will imply lack of care to judges and juries leading to the presumption of negligence. With POC technology, facilities can demonstrate all manner of care provided: who, what, where and when.
While most nursing homes are eager to explore the opportunities technology offers (improved quality of care, increased reimbursement and reduced risk), budgetary constraints often present an enormous obstacle. Consequently, most facilities adopt only those technologies required by state and federal agencies. However, early adopters of POC report a rapid return on investment. In fact, most recoup the full cost during the first six months of implementation.
Cedars, a 110-bed skilled nursing facility in the Midwest, implemented POC in response to chronic incomplete ADL assessments, copycat charting and the need for a clearer picture of resident status. The system increased documentation compliance to 98%, improved overall resident care while increasing the CMI (case mix index), which paid for the system in the first year. At Silver Bluff, a facility in the South, the catalyst for change was inaccurate ADL scores and compliance issues. However, the benefits far exceeded expectations.
"We have been able to track and react much faster to problems with bowel movements, meal and fluid intakes, weights as well as other care issues" says Silver Bluff Assistant Director of Nursing Shannon Hayes. As a side benefit, CMI scores rose from 0.954 to 1.2296 and the system paid for itself.
Just do it
Complete, accurate, timely and relevant data regarding each resident's status placed at the fingertips of both caregivers and managers: This is the foundation from which resident care and facility success can advance. In sharp contrast, studies have demonstrated that long-term care facilities dependent upon paper data collection systems have an average accuracy rate of only 70%. Consequently, 30% of the critical information required to make important decisions about resident care is missing. Perhaps this explains one cause of escalating litigation. Regardless, the case for automating data collection is clear. The only question remaining is—when?
Larry Triplett is president of the technology company Resource Systems and developer of the CareTracker documentation system.