In this issue:

• Documentation of nursing work to resolve patient social issues and documentation of extensive teaching count in the LYNX Facility Charging Algorithm!
• Release of Service Pack (SP) 7

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Documentation of nursing work to resolve patient social issues and documentation of extensive teaching count in the LYNX Facility Charging Algorithm!

The underlying goal of the LYNX Algorithm is to capture resources used so the calculated visit level accurately reflects the services provided thus ensuring proper reimbursement. ED nurses may document nurse’s notes in the areas of intervening in social issues and extensive education that LYNX coders and these notes count as a Nursing Note to add points in the charging Algorithm.

• An example of a social issue that may appear in a nurse’s note is a nurse making calls to assess a home and/or safe caregiver situation and making arrangements for a safe discharge.
• Examples of extensive teaching might be diabetic teaching or significant crutch walking teaching, demos, etc.

Nurse’s notes on these issues that are a restatement of what a social worker or ancillary staff called to the ED coordinated would NOT be counted as a nurse’s note. Consult social services/ancillary staff points would be added in this case.

Nursing Assessments are performed for every ED patient and it is important to always document these. When considering whether an assessment counts in the LYNX Algorithm, the decision is based on the number and quality of nursing notes. Nursing notes should be timed and are considered only when they provide patient clinical information. This patient clinical information might include notes related to the patient’s clinical condition or pertinent social issues, education that is more extensive than standard discharge instructions (which are included in the base weight) or critical care notes.

Not all nursing notes count toward the Nursing Assessment calculation in the LYNX Algorithm. Notes such as “to x-ray” or “patient discharged” are not considered when determining ED visit level (however, they are included in the base weight). Multiple entries for vital signs would not count as Nursing Assessments. However, if a patient requires frequent vital signs and the nurse documents the correlation of abnormal (or normal) vital signs with clinical symptoms, response to interventions, etc. the note may be counted. The same would apply if postural vital signs were taken.

Other examples of documentation that may or may not count toward the Nursing Assessment calculation:

• 02 sats and pulse oximetry readings are usually considered as a 5th Vital Sign and not counted by themselves as a Nursing Note (NN). If the nurse’s note read:
• “pt. placed on 02 2LPM per NC for continued c/o dyspnea. O2 93% on 2L.”
• This would not count as a NN. Statements such as “continued c/o dyspnea,” are patient statements and alone would not constitute a NN. If an additional data element of assessment, such as “rales bilaterally,” was present, this could be counted as an assessment. NN include documentation of clinical patient data assessed by the nurse.
• “My pain is worse” is a statement by the patient, not the nurse and would not be counted as a NN in the LYNX Algorithm. An assessment is a nursing evaluation or observation and not a patient statement, observation, etc. If the nurse further noted that “pain is 8/10 and pt. is diaphoretic” this also could be counted as a nursing assessment.
• NN related to procedures are not counted. For example, nurses notes documented for or about a separately billable procedure “at the time of the procedure” will not be counted as nurse’s notes in the LYNX Algorithm.

Release of Service Pack (SP) 7

LYNX is pleased to announce the release of Service Pack (SP) 7. This software upgrade includes a number of enhancements for E/Map, E/Code, E/Point and M/View. A few of the software enhancements include heightened security, additional functionality and other benefits. Your client manager will be contacting your organization in the near future to coordinate the upgrade.