Table of Contents
Introduction 1
Job Description for Restorative Program Director 2
Policy and Procedure for Restorative Program 3
Definitions and Criteria 5
Resident Care Regulations 8
Data Collection 10
Quality Indicators and Quality Measures 11
QI / QM Reports 12
MDS Entries Indicating Possible Restorative Potential 13
Coding Section O0500 of the MDS 16
MDS RUG-IV Categories 19
Restorative Nursing Referral 23
Nursing Assistant Flow Sheet 24
Summary Notes 25
Restorative Program Log 26
ADLs
Factors to Review for ADLs 27
ADL Problem Evaluation 29
CAT Module ADLs 30
Ambulation / Falls
Evaluation for Restorative Ambulation 31
Test for Balance 34
Coding Section G0300 of the MDS 35
Balance / Gait Assessment – Long Form 36
Balance / Gait Assessment – Short Form 37
Fall Prevention and Restorative Nursing 38
Factors to Review for Fall Risk 39
CAT Module for Falls 42
Fall Risk Assessment Form 43
Fall Risk Care Plan 44
Cane Care Plan 46
Crutches Care Plan 48
Gait Belt Care Plan 50
Walker Care Plan 52
Transfers
Policy and Procedure for Transfers and Lifts 54
Evaluation for Transfers 58
Transfers Care Plan 61
Bed Mobility
Evaluation for Bed Mobility 63
Turning Repositioning Care Plan 64
Range of Motion
Policy and Procedure for Range of Motion 65
Range of Motion Exercises 68
Coding Item G0400 of the MDS 71
Measuring Range of Motion 72
Evaluation for Range of Motion 75
Range of Motion Care Plan 76
Locomotion
Evaluation for Wheelchair Use 78
Locomotion Care Plan 79
Brace / Splint
Evaluation for Brace / Splint 81
Brace / Splint Care Plan 82
Amputation / Prosthesis
Evaluation for Amputation / Prosthesis Care 83
Amputation Prosthesis Care Plan 84
Dressing / Personal Hygiene
Evaluation for Dressing / Personal Hygiene 86
Dressing Care Plan 88
Personal Hygiene Care Plan 89
Eating / Swallowing
Factors to Review for Nutritional Status 90
CAT Module for Nutritional Status 93
Evaluation for Restorative Dining 94
Restorative Dining Care Plan 96
Chewing Problem Care Plan 97
Swallowing Problem Care Plan 98
Incontinence
Urinary Incontinence 100
Coding MDS Section H 105
CAT Module for Urinary Incontinence 109
Evaluation for Incontinence 110
Policy and Procedure for Toileting Programs 112
Voiding Record 115
Bowel Incontinence Care Plan 117
Functional Incontinence Care Plan 118
Stress Incontinence Care Plan 119
Urge Incontinence Care Plan 120
Toileting Care Plan 121
Factors to Review for Urinary Catheters 122
Audit for Urinary Catheter Use 130
Catheter Care Plan 131
Communication
Factors to Review for Communication 133
CAT Module for Communication 135
Evaluation for Communication 136
Speech Impaired Care Plan 138
Receptive Communication Problem Care Plan 139
Hearing Aid Use Care Plan 140
Medication Self-Administration
Evaluation for Medication Self-Administration 142
Medication Self-Administration Care Plan 144
Nasal Spray Care Plan 145
Inhaler Care Plan 146
Blood Glucose Monitoring Care Plan 147
Insulin Care Plan 149
Ostomy Care
Evaluation for Ostomy Care 150
Ostomy Care Plan 151
References i
CD-ROM is in back of the book