Based on stakeholder feedback (Thank you!) DODD made revisions to the documents I shared with you a couple of weeks ago. They would like to get this out soon. Please review and get any additional comment to me by Monday.

Anita

From: janet.winterstein@dodd.ohio.gov <janet.winterstein@dodd.ohio.gov>
Sent: Thursday, December 6, 2018 2:36 PM
To: Anita Allen <AAllen@opra.org>
Cc: Linda.Donchess@dodd.ohio.gov
Subject: FW: Feedback on Revised Assessments

Hi Anita,

As indicated in e-mails below, we addressed the concerns in your e-mail (and those of other stakeholders as well). Attached are the final drafts with all the changes. 

We would like to publish this ASAP.

Is there anything else needed by you and yours to support going forward with this?

Thanks,

Janet Winterstein, RN

Health Improvement Policy Specialist

Division of Residential Resources

Ohio Department of Developmental Disabilities

Phone 440-714-5372 | janet.winterstein@dodd.ohio.gov

http://www.dodd.ohio.gov DODD Helpline 800-617-6733

Medication Administration Certifications and Classes can be found on DODD.ohio.gov > Health & Welfare menu> Medication Administration page > Medication Administration Certification link. OR on the FREE DODD mobile app for Android and iPhones available in your phone’s app store

The information contained in this transmission may contain privileged and confidential information, including information protected by federal and state privacy laws. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message.

From: Anita Allen <AAllen@opra.org>
Sent: Thursday, November 29, 2018 10:51 AM
To: DMR-MA Database <MA.Database@dodd.ohio.gov>
Cc: Donchess, Linda <Linda.Donchess@dodd.ohio.gov>; Winterstein, Janet <janet.winterstein@dodd.ohio.gov>
Subject: RE: Feedback on Revised Assessments

Thank you!

From: MA.Database@dodd.ohio.gov <MA.Database@dodd.ohio.gov>
Sent: Wednesday, November 28, 2018 4:21 PM
To: Anita Allen <AAllen@opra.org>
Cc: Linda.Donchess@dodd.ohio.gov; MA.Database@dodd.ohio.gov; janet.winterstein@dodd.ohio.gov
Subject: RE: Feedback on Revised Assessments

Hi Anita,

We reviewed all the various stakeholder input on the SAA forms and instructions. It was very helpful to hear how the words were being interpreted (or struggled with) and we have made changes to the documents accordingly.

Also please see my comments in response to feedback that is embedded in your original message below in BLUE.

We appreciate so much that people took the time to review and to provide input on this,

Janet Winterstein, RN

Health Improvement Policy Specialist

Division of Residential Resources

Ohio Department of Developmental Disabilities

Phone 440-714-5372 | janet.winterstein@dodd.ohio.gov

http://www.dodd.ohio.gov DODD Helpline 800-617-6733

Medication Administration Certifications and Classes can be found on DODD.ohio.gov > Health & Welfare menu> Medication Administration page > Medication Administration Certification link. OR on the FREE DODD mobile app for Android and iPhones available in your phone’s app store

The information contained in this transmission may contain privileged and confidential information, including information protected by federal and state privacy laws. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message.

From: Anita Allen <AAllen@opra.org>
Sent: Monday, November 26, 2018 12:54 PM
To: DMR-MA Database <MA.Database@dodd.ohio.gov>
Subject: Feedback on Revised Assessments

Comments from OPRA members:

Page 1 – 3^rd paragraph… other reasons that indicate someone needs to be assessed: Person (self-administering) has made medication errors (may want to assign some number of errors within a time frame) in their self-medication (can include failure to take, taking too much, etc.) And, related to the above, medical attention might have been needed due to the mistakes. These may all be valid reasons – the guidance supports all of these – it just does not call-out each possibility (that would be overwhelming in an already long document).

Page 1- last paragraph …with a review for potential status change done annually Can it state within 365 days from last assessment? We do not want to lock in a day count specification that could be burdensome for providers.  We have gotten good buy-in from OPSR to understand annual as a term relevant to the ISP – not the calendar. We want providers to have the flexibility to prepare for ISPs without being penalized for dates that need flex sometimes.

• Page 2- 4^th bullet point… Children under the age of 18 do not have the inherent right to self administer….. So can they administer if capable under age 18? Thank you. We added clarification that they can.
• Page 2- Where to complete the assessment… Can individuals self-administer at day  program and home if capable? Yes. Does this mean that for individuals enrolled in both a day program and a home setting with the same provider will have to be independently assessed for capability on self-administration? Does that seem like over-kill? We added guidance about using a single form for multiple settings. So yes, a single provider can put all settings on one assessment if appropriate.
• On the assessments can they add lines for reviews that have to occur within 365 days of the last? On the bottom of page 2 are signature lines for the annual reviews
• Page 3, paragraph 2 …..Just a comment - are there really that many IDD folks who self-administer their G/J tubes? 
• Researching the average number of medications, we find that the average is 6 separate medications, often taken twice daily.  This change would require a self-assessment be done for each separate med and (as above), at each setting and wherever they are performing health-related activities.  This seems like a considerable amount of work. We adjusted some words to try to clear up any misperception that a form must be done for each medication.  That was not intended to be the impression given.

I think they have put together a nice masterpiece of documentation for nurses to complete. Not only have they added site specific language (i.e., settings), The setting requirement has always been a part of the self-med assessment instructions.  It is respectful of the rights of people to use their skills in context of the location. they have also added an assessment for each health-related activity. Although nurses may be able to “translate” the questions about oral medication to be applicable to tasks the non-nurses have struggled and have asked for some time now to have alternate forms. Although I understand the concept of person-centered planning and that medication administration is a basic right, I think there comes a point when over-regulation and over-documentation has to be considered.

So now, for example, if we take one of our diabetic individuals (insulin prn), our agency nurses will have to complete a Self-Administration Assessment in every setting that the individual participates (home, day program, work, community) and complete a Self-Administration Assessment for Oral/Topical Medications, Glucometer, Application of Compression Hose, Blood pressure/Pulse, and Insulin/Metabolic Glycemic Disorder Medications. Four settings (4) X Five Self-Administration Assessments (5) = 20 Self-Administration Assessments for this one individual. We adjusted some wording to try to avoid the misunderstanding here that there is a separate form for each medication and a separate form for each setting. That is not accurate.

Different assessment forms for general/oral;  glucometer; insulin;  g/j; have always been separate assessment forms. The new ones added are for inhaled and for tasks, so that the questions make sense for the activity being  assessed.

There were also 2 comments in support of the revisions.

OPRA asks that DODD be mindful of the additional amount of work required in these proposed revisions and that they consider ways in which to insure that the assessment process is as efficient as possible. We would be happy to have a couple of our members work with you on this. We think it could be completed rather quickly.

We have had significant stakeholder input during the development of these revisions. We did want to send the product out to you and yours before it was published and the comments you sent were very helpful. Having a variety of inputs along the way has helped us to see any patterns of misleading or poorly worded material and I believe we are very close to a final product.  If you think there is need for a conference call to communicate with your group further on this I would be happy to do that. Hopefully very soon as we would like to wrap this up ASAP. My near term availability is Monday 12/3,  Thursday12/6, Monday 12/10 and early morning or late afternoon on 12/12.

Thank you for the opportunity to comment.

Anita Allen

Vice President

Ohio Provider Resource Association

1152 Goodale Blvd

Columbus  OH    43212

614-224-6772 x110

614-655-0170 direct

614-224-3340 fax

The Trusted Voice for Providers Serving Ohioans with Disabilities for over 40 Years.