Marian Home
Fort Dodge, Iowa
 
Marian Home is located in a rural area of Iowa about 75 miles north west of Des Moines in the town of Fort Dodge. The facility houses a 97-bed skilled unit including about 47 percent Medicaid residents with the remainder being listed as either Private or Medicare.

Prior to being introduced to Resource Systems’ CareTracker System, Marian Home Assistant Administrator Tracy Gailey and her staff were fighting a losing battle with the traditional paper forms used for documentation.
A priority at Marian was identifying efficient, effective and accurate ways to personalize the assessment of each and every resident in their care. This was the challenge facing the administrative team.

Very early in the process it was learned that the Certified Nursing Assistants (CNA’s) were at the front of the line in performing the documentation for the Activities of Daily Living (ADL) report that is a key part of section G on the MDS form. At first blush this seemed liked a logical sequence of events. However, after further investigation, it was learned that the CNA’s were working from a single sheet of paper that contained a check list type grid. At the end of the shift the CNA on duty would, with few exceptions, simply check the same areas on the grid as the person on the earlier shift.

Following that revelation, the responsibility of completing the ADL report was returned to the nurses who were given the assignment of completing a 7-day or 14-day observation sheet. Quickly, it became obvious that a flaw existed in this approach as well. The nurses were not the people involved in the direct day-to-day care of the residents. Information was requested from the CNA’s which included showering, intake/output (food intake and bowel/bladder activity), etc. The result was that the nurses were charting second hand information. Accuracy of information, a major priority at Marion, was at best compromised.

In a turn of good fortune, the Director of Nursing (DON) and the Assistant Director of Nursing (ADON) found a solution to this major challenge at the Iowa Health Care Show. They met Resource System representative Jay Spargrove who introduced to them the CareTracker System.

The DON and ADON returned to Fort Dodge armed with the CareTracker information and shared it with the decision makers at Marian. A meeting was soon arranged that included the Resource representative, the administrative nurses and the DON and ADON. Convinced that the concept should be taken to the next level, presentations were arranged that included the facility administrator and the Board of Directors. Approval to implement the system soon followed.

The next step involved a two-day visit to Marian by Resource System Trainer Leslie Goins. The first day of her visit included a “train the trainer” session in which detailed information about Marian House was shared. Then in a step-by-step exercise relating to the inner workings of the CareTracker System, the training process began with the administrative nurses and the DON’s learning how to operate the kiosks who in turn trained the CNA’s and nursing staff. In groups of five, time was spent at the kiosks working through several scenarios relating to the MDS form with the session ending after completing all sections.

When asked about the staff’s initial reaction to the CareTracker System, Gailey stated that, “before they ever put their hand on it they were very excited because it was a computer and it was something that was going to increase our RUGS, reimbursement, etc.” She said, “When they first started working on the system, it was hard for them to fit it into their schedules but they stuck with it. We told them it would take time like anything new. Now they are fine with it.” An added benefit was the sense of importance the new system gave the CNA’s after realizing they are the eyes of the residents. Gailey said, “The CNA’s are the most important part of the care team and they know what is going on.”

With the implementation of CareTracker at Marian, the bar has been raised considerably on the accuracy of the ADL’s along with the depression, behavior and restorative program tracking. “That is awesome,” Gailey said, “because it actually takes in the information for you that you need for the MDS – how many minutes, the tolerance levels, how far a resident ambulated, or how long it took to do an activity.” In addition, CareTracker is used to monitor bowel movements and the incontinent brief count so the bookkeeper has access to that information at reporting time.

In the near future, the staff at Marian expects to use CareTracker for nursing documentation of skin breakdown. With the implementation of that feature, caregivers will be able to document immediately an area they see that is prone to breakdown.

Major advantages of the CareTracker System at Marian House are at least two fold, according to Gailey. After six months into the program, a study of RUGs groups of 20 people indicated that 13 of the 20 were placed in the next RUG group, resulting in a rise in reimbursement. “These are people who are steady,” she said, “that were on an even keel, that hadn’t changed so that shows that the accuracy of CareTracker helped us identify a significant increase. We didn’t have any that went the other way.”

The second major advantage is that Marian House administrators believe that they are able to provide better resident care because of CareTracker. Gailey stated, “before the system was in use the MDS coordinator would have conversations with staff on different shifts to determine the amount of care and condition of the residents. CareTracker now provides that information accurately and it frees the time of the MDS coordinator as well.”

Finally, Gailey pointed out that another positive result of the system is the reports. “We use some of the reports to actually give the aides a heads-up on how they are doing,” she said. “Many of them wanted feedback on how they were doing – if they were doing it right. So we pull the reports and give them tips on how to improve when needed or we give positive reinforcement if they are doing fine.”