Is weight loss a skilled nsg need?

[MickRN07]

I have been doing MDS & PPS for years, just switched companies recently. When a patient is d/c'd from therapies there is an option of doing an OMRA if indicated. My question: Is significant weight loss a skilled need? Weekly weights with weekly wt meetings and interventions are in place. RD is involved. There seems to be a debate within my company about this. I would appreciate any advice. :argue:

Thanks

[Talino]

unintentional weight loss in elderly patients is associated with increased morbidity and mortality. however, it's what you do to address the weight loss that determines whether the services rise up to a skilled level.

three of the most critical nursing activities to support medicare coverage that meets the criteria for a "daily basis" requirement:

• overall management and evaluation of an individual's care plan.
  
• observation and assessment of the patient's changing condition.
  
• patient education services
  

in that case, besides weekly weights and meetings ...

• is there a physician assessment to address the concern. did he order a lab workup when needed or xrays to identify the cause; a psych referral to address depression?
  
• can other medical conditions be compromised by the poor intake? do meds have to be adjusted, more lab tests be required, more frequent observation for adverse reactions?
  
• was a change in diet ordered to improve meal consumption? did the dietitian recommend a supplement suitable for the clients need; provide small frequent feedings instead of 3 full meals? is daily intake recorded?
  
• is there a decline in adl function due to weakness that requires modification of adl support? did nursing provide more meticulous skin care to avert breakdown?
  
• did the social worker visit more frequently to give constant support and encouragement?
  
• are the current care plan interventions modified and updated according to the client's responses?
  
• ... and blah, blah, blah
  

to good clinicians, those approaches are customary. documentation, however, is crucial.

[VeryberryRN]

unintentional weight loss in elderly patients is associated with increased morbidity and mortality. however, it's what you do to address the weight loss that determines whether the services rise up to a skilled level.

three of the most critical nursing activities to support medicare coverage that meets the criteria for a "daily basis" requirement:

• overall management and evaluation of an individual's care plan.
  
• observation and assessment of the patient's changing condition.
  
• patient education services

in that case, besides weekly weights and meetings ...

• is there a physician assessment to address the concern. did he order a lab workup when needed or xrays to identify the cause; a psych referral to address depression?
  
• can other medical conditions be compromised by the poor intake? do meds have to be adjusted, more lab tests be required, more frequent observation for adverse reactions?
  
• was a change in diet ordered to improve meal consumption? did the dietitian recommend a supplement suitable for the clients need; provide small frequent feedings instead of 3 full meals? is daily intake recorded?
  
• is there a decline in adl function due to weakness that requires modification of adl support? did nursing provide more meticulous skin care to avert breakdown?
  
• did the social worker visit more frequently to give constant support and encouragement?
  
• are the current care plan interventions modified and updated according to the client's responses?
  
• ... and blah, blah, blah

to good clinicians, those approaches are customary. documentation, however, is crucial.

you are 100% correct, all of these things are needed. however, it is almost impossible to get staff to document all of the above unless you have perfect staff. having said that, this would be a very difficult area to do an omra on. remember, it is done 8 days after therapy is ended, so those 8 days after therapy's end the documenttion has to be perfect!