Pain Assessment and Depression Screening Webinar Presented by Chris Angelini May 17, 2016
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Housekeeping • Please Type Questions in the Q&A Section in the Right Panel of Your Screen • We will answer questions at the end of the presentation.
Pain Assessment and Depression Screening Design Goal • Infian’s goal in this project design was to add TIME tools related to documenting a patient’s pain assessment and/or clinical depression screening that could be integrated into your current clinical processes – For example, the clinical depression screening can be incorporated into the Social Worker’s quarterly/annual assessment – The pain assessment can be integrated into the Nurse’s monthly assessment • Infian didn’t want to force you to establish totally new processes and timelines for this regulatory requirement
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Pain Assessment and Depression Screening Standardized Tools Selected • Infian has selected 2 standardized forms. One for Pain Assessment and One for Clinical Depression Screening – The Pain Assessment screen was designed to document the results of a standardized pain scale • Some of these include: – Wong-Baker FACES Pain Rating Scale – Numeric Rating Scale – Verbal Pain Intensity Scale – The Depression Screening Entry Screen was designed to utilize the PHQ2 depression screening tool
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Pain Assessment and Depression Screening Setup Training Objectives • Configure new and existing Progress Note Templates associated with either the patient’s pain assessment or depression screening using the applicable data elements in TIME. • Configure new and existing Physician Rounding Views to include the patient assessment and/or depression screening screen parts in TIME. • Configure and generate pain assessment and/or depression screening alerts in TIME • Determine clinical processes that will integrate pain assessment and depression screening tools in TIME .
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Pain Assessment and Depression Screening End User Objectives • Identify 2 mechanisms to navigate to the pain assessment and/or a clinical depression screening entry screens within TIME. • Document a patient’s pain assessment and/or depression screening in TIME. • Document a pain assessment and/or depression care plan follow up using Progress Notes in TIME. • Generate Pain Assessment or Depression Screening reports on all of the patient’s applicable QIP statuses in TIME • Transmit both pain assessment and depression screening information to CROWNWeb via the TIME/CROWNWeb interface.
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Pain Assessment and Depression Screening Overview
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As of January 01, 2016 CMS’ Quality Incentive Program (QIP) includes measures for the patient’s pain assessment and clinical depression screening provided by dialysis centers. Beginning with Service Pack 25, the TIME system allows users to document and report a patient’s pain assessment and clinical depression screenings. Additionally, TIME will allow users to document: • Follow up care plans for patients with positive screening results • Configure alerts to remind users of patients needing assessments and screenings • Generate reports of patient’s current QIP rating (based on values reportable to CROWNWeb) • Submit the QIP information to CROWNWeb via the TIME CROWNWeb interface
Pain Assessment General Info • 2 mechanisms for documenting a pain assessment in TIME – Progress Notes • Progress Note template with the Pain data element • Pain question from the assessment screen(s) on the flowsheet which is linked to template with Pain data element – NOTE: Applicable for client databases currently configured with the pain assessment question on the assessment screen(s) on the flowsheet – Physician Rounding App
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Progress Note Template Setup Required for Pain Assessment
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Progress Note Template Setup Required for Pain Assessment
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Flowsheet - Pain Assessment Link • The Pre and/or Post Assessment screen(s) on the Hemodialysis Flowsheet and/or the Assessment screen of the Peritoneal Flowsheet must be configured to include a question pertaining to pain assessment • The Hemodialysis Settings and Peritoneal Dialysis Settings screens will allow you to link a template containing the Pain Assessment Entry data element to the applicable Pain Assessment question • Path: Hemodialysis Dialysis Settings/Peritoneal Dialysis Settings – Main Menu/ Code Tables/ Medical Records Codes/ Clinical Systems Maintenance • Hemodialysis Settings’ Pre Assessment and/or Post Assessment tab(s) • Peritoneal Dialysis Settings’ Assessments tab
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Flowsheet Set Up related to Pain Assessment
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Flowsheet Set Up related to Pain Assessment
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Physician Rounding App Setup Required for Pain Assessment
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Physician Rounding App Setup Required for Pain Assessment
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Navigating the Pain Assessment Screen in TIME • There are 3 ways to navigate the Pain Assessment Screen in TIME: – Add a progress note using a template with the ‘Pain Assessment Entry’ data element – For clients who have flowsheet assessment screen(s) configured with the Pain Assessment question: • Answer ‘N – Reviewed with Problems’ – Right clicking on the Pain Assessment screen part within a View on the Physician Rounding App
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Navigating the Pain Assessment Screen in TIME
Demonstration
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Completing the Pain Assessment Screen in TIME • You can enter the following information on the Pain Assessment screen: • • •
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Current pain status Details regarding the current pain status The date of the pain assessment • NOTE: the date of the pain assessment will be editable when launching the Pain Assessment screen from the Physician Rounding App • NOTE: the date field on the Pain Assessment screen will be the date of the progress note The patient’s current pain level • Zero = a negative response • 1-10 = a positive pain response If the patient is unable to provide the assessment information If the pain assessment was not documented
Pain Assessment Screen Launched from a Progress Note
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Pain Assessment Screen Launched from the Physician Rounding App
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Completing the Pain Assessment Screen
Demonstration
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Pain Assessment Follow-up
• Pain Assessment follow-up is documented via the Progress Notes screen • The Category of PAF – Pain Assessment Follow-up is used by default • If your organization uses ‘PAF’ for another purpose or uses another code to identify pain assessment care plan follow up, you will need to contact Infian support to configure
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Pain Assessment Follow-up
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Depression Screening and Follow Up Documentation
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Clinical Depression Screening General Info • TIME by default is using the PHQ2 depression screening tool • There are 2 mechanisms for documenting a clinical depression screening result in TIME: • Progress Notes using Progress Note Templates • Physician Rounding App
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Progress Note Template Setup Required for Depression Screening
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Progress Note Template Setup Required for Depression Screening
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Physician Rounding App Setup Required for Depression Screening
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Physician Rounding App Setup Required for Depression Screening
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Navigating the Depression Screening Entry Screen
• There are 2 ways to navigate the Depression Screening Screen in TIME: – Add a progress note using a template with the ‘Depression Screening’ data element grid – Right clicking on the Depression Screening screen part within a View on the Physician Rounding App
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Navigating the Depression Screening Entry Screen
Demonstration
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Completing the Depression Screening Entry Screen • You will document the patient’s responses to the 2 questions from the PHQ2 form • TIME will calculate an overall depression score • You will have the option to document the patient’s perception of the impact the possible depression has on their daily life • You can also document: • If the patient was unable to respond • If the patient was unwilling to respond • Text comments related to the depression screening
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Depression Screening Entry Screen Launched from a Progress Note
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Depression Screening Entry Screen Launched from the Physician Rounding App
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Completing the Depression Screening Entry Screen
Demonstration
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Depression Screening Follow-up • Clinical Depression Screening follow-up is documented via the Progress Notes screen • The Category of DSF – Depression Screening Follow-up is used by default • If your organization already uses an Identifying Category Code of ‘DSF’ or uses another code to identify depression screening follow-up, you will need to contact Infian support to configure
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Depression Screening Follow-up
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Clinical Adherence Oversight
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Clinical Adherence Oversight • How do you know every patient’s Pain Assessments and Clinical Depression Screenings have been completed? – Follow up Reports – Alerts
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Reporting Pain Assessment and Depression Screening QIP Status • The QIP Reporting Measures report has been added to TIME – Path: Main Menu/ Medical Records/ Clinical Reports/ QIP Reporting Measures • It allows you to generate reports on all of the patient’s QIP statuses • You can filter by: – Facility – Pain Assessment or Depression Screening – Date Range – Which of the 6 QIP status values to report
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Reporting Pain Assessment and Depression Screening QIP Status
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Reporting Pain Assessment and Depression Screening QIP Status • The report works best when run for a single facility since QIP is reported to CROWNWeb on a facility by facility basis • The report only works for either Pain Assessment or Clinical Depression – You can’t run the report for both at the same time • The report will generate data for the date range entered, but it works best if run for dates that compliment the QIP measure requirements – January thru June or July through December for Pain Assessment – January thru December for Depression Screening
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QIP Pain / Depression Alerts • The QIP Pain / Depression Alerts screen has been added to TIME – Path: Main Menu/ Code Tables/ Medical Records Codes/ Alert Codes/ QIP Pain / Depression Alerts • The alerts are turned off by default • The Pain and Clinical Depression Tabs each work the same way • Use the ‘All Facilities’ entry to set the overall parameters for the alerts • The following are only available when ‘All Facilities’ is selected – Alert Priority – Action When – Assign To
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QIP Pain / Depression Alerts • Missing Data – Days prior to end of reporting period • The setting will generate a notification if no assessment has been performed within X days of the end of the reporting period – June 30/December 31 for Pain Assessment – December 31 for Depression Screening • Assessments/Screening Due – Days Prior to Anniversary • The Setting will generate a notification if there is an assessment needing to be performed within X days of the anniversary
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QIP Pain Assessment Alerts
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Clinical Depression Alerts
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Submitting Pain Assessment and Clinical Depression Information to CROWNWeb
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Submitting Pain Assessment and Clinical Depression Information to CROWNWeb • Run the Pain Assessment and Depression Screening transmission AFTER submitting the demographics and clinical transmissions and performing clean up on the applicable data • Submit the Pain Assessment and Depression Screening information to CROWNWeb separately • Pain Assessment information (at a minimum) should be run during the June and December reporting periods • Depression Screening (at a minimum) should be run during the December reporting period
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Pain Assessment and Depression Screening Exercises
• Exercises – Configure applicable Progress Note Templates using Pain Assessment Entry and Depression Screening data elements – Configure applicable Views using the Pain Assessment and Depression Screening screen parts – Navigatge the pain assessment and clinical depression screening screens via Progress Notes and the Physician Rounding App – Document a patient’s Pain Assessment – Document a patient’s Depression Screening – Document a pain assessment and a depression screening follow-up using progress notes – Generate Pain Assessment and Depression Screening Reports for all applicable QIP statuses
