An Activities-Based Response to the New Survey Protocols.

The Quality Indicators pose new challenges for activities professionals and departments

Quality Indicators and the W-H-P Group are new terms that all long-term care team members need to understand. What do these terms mean to the Activity Department? First, they are an opportunity to provide a better quality of life and care for your residents. Second, they are an opportunity for the Activity Department to be an even more viable part of the facility's team.

There are 24 Quality Indicators that are now part of the survey process. Quality Indicators are simply measurements of good or problematic areas of care. Quality Indicators are calculated based on the data entered into the Comprehensive Assessment, or MDS 2.0.

Quality Indicator 23 is "prevalence of little or no activity." It is calculated using the following formula:

Number of residents on the most recent MDS 2.0 with little or no activity

divided by

Total number of residents on most recent MDS 2.0 minus the number of comatose residents

It is important to accurately code Section N of the MDS 2.0, and equally important to have the supporting documentation for the data entered. This supporting documentation can be recorded in the Activity Assessments, Daily Participation Records, Activity Progress Notes and the Plan of Care. The Daily Participation Records have taken on added importance to document not only the activities attended, but also the level of participation.

It will be important for the Activity Department to encourage appropriate and meaningful activity interventions for residents identified as involved in activities little or none of the time, and to document those interventions.

The W-H-P Group targets those residents with a concern regarding weight loss, hydration problems and/or pressure sores. At first glance these might appear to be nursing and dietary areas. Nevertheless, appropriate interventions must be implemented and documented by the Activity Department, with special emphasis on those residents at risk or with an actual problem area.

Food-related activities, such as cooking and baking, must be part of the regular activity programming. Snacks should be provided at a variety of activity groups. Fluids, especially water, should be provided throughout the daily activity programming. The Activity, Dietary and Nursing Departments can coordinate the nutrition and hydration program to make it a fun and exciting event for the residents. Using a weekly theme, facilities can provide snacks and beverages that coordinate with the theme. The Activity Department can incorporate the theme into its weekly programming. As for pressure sores, the Activity Department should conduct regular in-room activities, which can be anything to get the residents moving, if only in bed.

With any change comes the uncertainty of how to proceed. Activity professionals who want to succeed and make a difference with their residents will rise to the challenge by embracing these new protocols.

Mary Beth Kelley is vice-president of Health Consultants Plus, a full-service healthcare consulting firm in Clarksburg, West Virginia. She is a certified activities professional and has served as activities director in long-term care facilities.