Transcription of Skilled Nursing Facility Care Coordination Toolkit
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Skilled Nursing Facility Care Coordination Toolkit
Collaborating with partners, providers, patients, families,and caregivers to improve and lower healthcare Nursing Facility care Coordination ToolkitAn overview of care Coordination best practices to avert hospital readmissionsDownload available at: Page | 1 Table of Contents Executive Summary Readmission Prevention .. Skilled Nursing Facility (SNF) Resident Rehospitalization Tip Sheet Top 10 Things to Know About SNF Readmissions Measure SNF Readmission Exclusion Criteria Accessing Official Rehospitalization Data Tip Sheet Readmission Pre/Post Assessment Readmission PIP Sample Readmission Strategy Tree Sample Reducing Adverse Drug Events .. Warfarin: Why you Need it, How it s Monitored, Interactions to Recognize Reducing Diabetic Agents Adverse Drug Events Diabetes Education: Use Teach-Back to Help Patients Successfully Manage Their Insulin Opioids: Centers for Disease Control and Prevention (CDC)Prescribing Guidelines for Clinicians Readmission Tools.
3. The SNFRM tracks readmissions within 30-days after discharge from a prior hospitalization, not discharge from the SNF. The readmission window starts on the day of or up to 24 hours after discharge from a prior hospitalization. 4. A prior hospitalization for the SNFRM’s calculation is defined as an admission to an
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