Team approach improves staff documentation skills

Georgia facility focuses on functional measurements

Preparing and training staff for the rehab prospective payment system (PPS) over the past year has been a challenge for Glancy Rehabilitation Center in Duluth, GA, but the rehab hospital has met its goals.

The rehab staff’s documentation has improved significantly in the past year, and everyone has become skilled in the new charting style and strategies of determining patients’ functional measurements, says Janet Patrick, RN, PPS coordinator for Glancy Rehabilitation Center - Inpatient Rehab Program, which is part of Gwinnett Hospital System.

"We’ve had to change the style of documentation, and that’s one of the areas I looked at prior to our switching to PPS," Patrick says.

Also, staff have always had a team approach to rehab, but under PPS they’ve had to improve on this and involve more disciplines in documentation of patients’ scores, such as having nurses assess some functional improvement measures, Patrick adds.

Here are some of the strategies the rehab facility has used to make the transition to PPS run smoothly:

Address department communication and team involvement.

A committee involving nursing, management, case management, medical records, billing, and the various therapy disciplines began meeting in 2001 before PPS was implemented.

"They would get together to plan ahead and see how the communication lines would go and try to make adjustments to how the different departments would interact," Patrick says.

In January 2002, Patrick became the PPS coordinator, and she and the committee developed a process for how she would interact with the different departments as she assisted the staff in making the transition to PPS.

Patrick daily contacted the medical records department to discuss coding, and she worked on making certain the PPS forms were properly completed.

Check scores for precision and accuracy.

Patrick audits every chart, pulling information from the documentation and looking for missing items or incomplete data.

"If there’s information I’m not certain is realistic, then I’ll go to that therapist or nurse and just confirm it," she says.

For example, if a person scored a patient as independent on the functional improvement measure (FIM) for lower body dressing, Patrick may remind staff that if the patient is wearing Ted hose stockings, the score needs to be adjusted, because Medicare considers that the patient could not put on the hose without assistance.

"I have a FIM book with guidelines in every department and also some scenarios that people might go through when treating a patient," Patrick says.

She will use the book to show staff why they may need to adjust a score to include a patient’s limitation or a nuance that previously wasn’t considered.

"There are simple things that tend to affect the score that we may not have been thinking about from the beginning, and now everyone is thinking about these and looking at it from a different light," Patrick says.

Encourage staff to change their rehab mindset to include PPS concerns.

Patrick interacts with staff on an individual basis to help them focus on how the information they collect affects reimbursement.

"We focus on what’s required of a facility and how it’s a requirement of their job to provide accurate information," Patrick says.

"In the very beginning, it was difficult, because we went through different processes along the way," she notes. "I had a worksheet on the chart, and I showed people what I was looking for."

The staff would fill in the chart, and then Patrick would look at it and make certain that it reflected what was required. The rehab unit was divided into five zones, and each zone was responsible for achieving 100% complete and accurate documentation in these PPS exercises.

When staff in a particular zone showed that they were filling in all documentation correctly, the facility held an ice cream party in recognition of their success.

"Each zone made sure their team members filled out the information correctly on the worksheet," Patrick recalls.

This provided peer support that encouraged individual staff to succeed, and it created a healthy competition, Patrick says.

It took a little while to change employees’ mindsets about the documentation, but now everyone is doing very well and realizes that documentation is at the forefront of their work, Patrick adds.

Provide ongoing education.

Each new employee watches educational tapes about completing the PPS documentation.

Also, if employees have a question about a particular documentation item or if Patrick finds a new point that must be emphasized, these are brought to everyone’s attention.

"I ask key people in each discipline if they’ve found something new to make sure their whole discipline is aware of it, and so there’s a lot of interaction within the discipline itself," Patrick says.

Need More Information?
  • Janet Patrick, RN, PPS Coordinator, Glancy Rehabilitation Center - Inpatient Rehab Program, 3215 McClure Bridge Road, Duluth, GA 30096. Telephone: (678) 584-6714.