– Intravenous or intramuscular injections and intravenous feeding.
– Enteral feeding that comprises at least 26 percent of daily calorie requirements and provides at least 501 milliliters of fluid per day.
– Naso-pharyngeal and tracheotomy aspiration.
– Treatment of decubitus ulcers, of a severity rated at Stage 3 or worse, or a widespread skin disorder
– Care of a colostomy during the early post-operative period in the presence of associated complications.
What’s more, skilled care may be provided to improve a patient’s current condition, to maintain the patient’s current condition, or to prevent or slow further deterioration of the patient’s condition.
The Plan of Care: The Achilles heel of swing bed programs
Once you’ve established that a swing bed admission is merited, the next hurdle is justifying and documenting the need for skilled care in the patient’s
medical record, including in the multi-disciplinary plan of care. “The plan of care must be developed by a multi-disciplinary team and must be specific
to the reason the patient was admitted,” St. Charles says. “Additionally, Medicare says that the plan must be measurable and time-limited. In other words,
the plan has to say what needs to be done, by when and how is it going to be measured. “The most common mistake Swing Bed programs make is that
they don’t identify short-term and long-term goals and then they don’t make them measurable and time-limited,” St. Charles says. Examples of measurable,
time-limited goals: “Patient will receive 14 days of antibiotic therapy” or “Patient will walk 100 feet with a front-wheel walker within one week.” “Physical therapy
is usually pretty good about those goals, while nursing often struggles,” St. Charles says. “Nursing is used to writing nursing care plans, but not goals that are measurable and time-oriented.
Missing the mark on length of stay
A final area of confusion for swing bed programs is when to discharge patients. St. Charles says she sees many swing bed patients that are discharged before
they are really ready, and then are readmitted either to acute care or back to swing bed. “A lot of facilities will discharge a patient as soon as a patient meets their therapy goals,” she says. But that’s really an outpatient construct that doesn’t always apply.” “If a patient needs a few more days to make sure they can sustain
their progress and have a safe discharge plan, additional days would be appropriate as long as the patient still needs a skilled level of care,” she adds. “The key
is to document WHY the patient needs the additional time in the swing bed and how it relates to the overall plan of care, including safe discharge”