The long-stay Quality Measure (QM) for the Prevalence of Behavior Symptoms Affecting Others is the percentage of long-stay residents who have behavior symptoms affecting others during the target period.
The numerator for the long stay measure is all residents with a selected target assessment where any of the following conditions are true:
- Presence of physical behavioral symptoms directed toward others (E0200A = 1,2, 3)
- Presence of verbal behavioral symptoms directed toward others (E0200B = 1, 2,3)
- Presence of other behavioral symptoms directed toward others (E0200C = 1, 2, 3)
- Rejection of care (E0800 = 1, 2, 3)
- Wandering (E0900 = 1, 2, 3)
The denominator is all residents with a selected target assessment, without exclusions.
Assessments are excluded if any of the following are true:
- Target Assessment is a discharge assessment (A0310F = 10, 11)
- If either a (-) or a (^) is entered for MDS items
- E0200A
- E0200B
- E0200C
- E0800
- E0900
There are no covariates for this measure.
There are multiple areas reviewed by State Surveyors regarding behaviors. These include the following Critical Element Pathways:
- Behavioral and Emotional Status
- Dementia Care
- Medication Regimen Review
- Physical Restraints
- Psychotropic Medications
- Unnecessary Medications
This measure can be addressed in multiple ways by the Interdisciplinary Team. Discuss with resident, family members, and caregivers resident preferences, hobbies, likes, dislikes, and daily routines to minimize potential behaviors. This may include various activities via the Activity Department.
As appropriate, refer residents to occupational, physical, or speech therapy for individual and group interventions to address mobility, ADLs, communication, and pain management including sensitivity strategies to limit behaviors.
Utilize QAPI to address facility and resident level opportunities for improvement. Ensure active diagnoses are accurate based on physician assessment and involve the medical director in reviewing patient records, medications, and possible treatment needs. During pre-admission, determine if the resident has known behavioral issues or is on antipsychotic, antianxiety, or hypnotic medications and if so, why.
The overall goal for improvement with this quality measure is to limit behavioral issues to maximize function and improve overall quality of life.