What to assess and ask during a Skilled Nursing Facility (SNF) visit?

From the Guidelines

During a Skilled Nursing Facility (SNF) visit, it is crucial to assess the patient's overall condition, functional status, and care plan progress while asking about any new symptoms, medication effects, and quality of life concerns, with a particular focus on discussions about goals of care and preferences for end-of-life care as recommended by the American Heart Association and the Heart Failure Society of America 1. When evaluating a patient in an SNF setting, several key areas should be addressed to ensure comprehensive care.

• Begin by reviewing the medical record for recent changes, lab results, and medication adjustments to understand the patient's current health status and any potential issues that need to be addressed.
• Perform a focused physical examination based on the patient's conditions, paying special attention to vital signs, cognitive status, skin integrity (especially pressure areas), respiratory and cardiac function, and mobility.
• Assess functional status using standardized tools like the Barthel Index or Katz ADL Scale to track progress in activities of daily living, as this information is vital for planning appropriate care and interventions.
• Review medication regimens thoroughly, checking for polypharmacy issues, potential interactions, and appropriate dosing for elderly patients with possible renal or hepatic impairment, considering the recommendations for heart failure management in SNFs 1.
• Discuss pain management effectiveness using a numerical scale (0-10) or PAINAD scale for non-verbal patients, and ask about bowel and bladder function, sleep quality, appetite, mood, and social engagement to assess the patient's quality of life and identify any areas that require additional support.
• Evaluate therapy progress (physical, occupational, speech) by reviewing documentation and speaking with therapists to ensure that the patient is receiving the necessary therapies to achieve their care goals.
• Discuss goals of care and advance directives periodically, especially after significant health changes, as this is a critical component of comprehensive care in the SNF setting, according to the recommendations from the American Heart Association and the Heart Failure Society of America 1.
• Communicate findings with the interdisciplinary team including nurses, therapists, social workers, and dietitians to ensure comprehensive care and promote continuity of care and appropriate interventions.

From the Research

Assessment and Questions for a Skilled Nursing Facility (SNF) Visit

When visiting a patient in a Skilled Nursing Facility (SNF), it is essential to assess their overall condition and ask relevant questions to ensure they receive proper care. The following points highlight key areas to focus on:

• Patient's Awareness and Satisfaction:
  • Ask the patient about their awareness of the physician in charge of their care 2.
  • Inquire about their satisfaction with the frequency of interaction with the physician 2.
  • Assess their perception of receiving individualized care from the physician 2.
• Cognitive Status:
  • Evaluate the patient's cognitive status, as patients with a hospital discharge diagnosis of dementia may be classified as cognitively intact or mildly impaired on SNF admission 3.
  • Consider the patient's cognitive impairment when assessing their expectations and experiences with physician care 2.
• Cost and Insurance Coverage:
  • Discuss the patient's understanding of the costs of care and insurance coverage for SNF services 4.
  • Assess how perceived costs influence post-acute care choices made by clinicians, patients, and caregivers 4.
• Continuity of Care:
  • Verify that daily morning weights are ordered for heart failure patients 5.
  • Check if parameters are in place to contact the primary care provider in case of weight gain or other concerns 5.
  • Ensure that a 2-gram sodium restricted diet is ordered and appropriate diuretic is reconciled 5.
  • Confirm that follow-up provider visits are scheduled within 3 to 5 days following discharge 5.
• Communication and Education:
  • Facilitate frequent communication between physicians, patients, and caregivers to improve satisfaction with care 2.
  • Provide just-in-time education to SNF staff to clarify discharge orders and improve continuity of care 5.