DEBBIE HOMMEL'S AD TIPS
Dedicated to helping Activity Professionals with the daily operation of their department.
by Debbie Hommel, BA, CRA, ACC, Executive Director of DH Special Services.
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DEAR DEBBIE:
About Debbie

Debbie Hommel, BA, CRA, ACC,
is the Executive Director of DH
Special Services. She is a
Certified Activity Consultant on
State and National level, with
over twenty-seven years of
experience in providing direct
care and consultation to long
term care, medical day care,
assisted living, and ICF/MR
facilities throughout New Jersey,
New York, Maryland, and
Pennsylvania. She is an
experienced trainer and
workshop presenter, conducting
a variety of seminars throughout
the Tri-State area for the Activity
Professional, Administrator, and
allied healthcare professional.
Debbie Hommel is an active
member of Activity Professional
Associations on State and
National levels. She is ACC
certified through the NCCAP.
She is a founding member of
the New Jersey Activity
Professionals' Association,
serving terms as Vice President
and President. She received the
Weidner Lifetime Achievement
Award in 1994 and the
Monmouth & Ocean County
Activity Professionals Life
Achievement Award in 1999.
DEBBIE HOMMEL
ACTIVITY DIRECTOR TODAY
Providing Internet Resources
for Activity Professionals
in Long Term Care Settings
admin@theactivitydirectorsoffice.com

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The Activity Director's Office
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ACTIVITY DIRECTOR TODAY
Episodic Entries for the Activity Professional
By Debbie Hommel, ACC, CTRS

In last month’s article, routine progress notes were discussed.  In addition to regular entries
documenting progress toward care plan interventions, the activity professional may need to
enter episodic entries.   Episodic entries are also known as focused charting, clinical notes or
incident charting, depending your facility policy and protocol.  In all cases, such notes are
entered in response to something that occurs in between the time frames for routine progress
note charting.  In nursing homes, episodic charting substantiates changes to section N of the
MDS, for quarterly reviews and necessary changes to the care plan.  To arrive at the care plan
meeting, with significant changes to the MDS noted without any substantiating documentation
is not good practice.   Additionally, episodic charting shows progress (positive or negative)
toward defined problems (behavior, response levels, and health issues) as they occur
throughout the quarter.  

One big question is when should I document an episodic note?  The following is a
listing of suggested incidences to consider for episodic notes:
  •  -Demonstration of unusual or out of the ordinary behavior, difficult or negative
    behavior which may not be part of the typical nature of resident.  On the other side of
    the coin, a ceasing of a particular behavior which is the "norm" for resident should also
    be noted.  Any change in behavior that is noticeable should be documented.  Chances
    are the nurse is documenting such changes.  However, in terms of behavior
    management, the more documentation that is noted, the better and the activity
    professional can offer significant information regarding the success or lack of success of
    non-pharmacological interventions and responses.
  •  -Significant responses to a targeted intervention should be noted, as relevant.  A
    resident who doesn't respond to sensory approaches or suddenly responds to a cue is
    significant.  A resident remains awake through a program when generally they generally
    sleep is significant.   Being able to complete a task, when they were never able to
    complete a task or focus n a task is significant.
  •  -Negative responses to targeted interventions should be noted.  When the activity
    professionals’ efforts to engage the resident in the written interventions are met with
    consistent refusal, and obvious negative responses, there should be some
    documentation.  When the resident usually attends or pursues activities and suddenly
    stops or becomes reluctant, that should be noted.  To wait until the quarterly note is
    due, to document refusals or difficult responses is not good practice.
  •  -When providing some sort of device or approach previously requested or noted in the
    care plan, it should be noted that it was provided and the initial response.  Specific
    cases may include noting that a cassette player was requested from the family and was
    provided; a special craft project was found for the resident and provided; specific 1-1
    activities were requested or defined and provided;  and any specific interventions for a
    behavior.
  •  -Any aggressive act or encounter in an activity or during a 1-1 visit should also be
    noted.   

Another question that comes up is – What should I include in the note?
  •  -Define the incident or episode; describe what actions, responses and behaviors
    occurred.
  •  -Include when and where the incident, episode or behavior occurred.
  •  -Include what you found on the scene, if you were first to arrive to the incident.
  •  -Describe what care was provided to the resident, upon arrival to the scene and after
    the incident occurred.
  •  -Include any resident comments, statements and responses to incident, intervention or
    episode.
  •  -Note who was notified of incident.
  •  -Include any preventive steps to be introduced or changes to the plan of care, to
    prevent incident from occurring again.

Some final helpful hints regarding documentation, in general…
  •  -Use behavioral language.  Describe the resident's actual actions, responses,
    reactions, facial expressions, body language, posture, and general movement as
    opposed to labeling response.
  •  -Ensure consistency of information.  This is not to say your entries must agree with all
    others, however if your perception and description is different from other professionals,
    be sure to explain what you mean and how this impacts upon the consistency of
    observations.  Documenting from a behavioral perspective supports your observations.
  •  -Use meaningful versus vague phrases.  Stick with behavioral and observable
    language.  Vague phrases include "seems" or "appears".  If the resident is crying, you
    would note they were crying rather than note “resident seems sad”.    Instead of saying
    “resident seems to enjoy group activities”, it is more effective to note “resident shows
    signs of enjoyment at morning social through smiling, interacting with peers and
    verbalizing actively during discussion time”.
  •  -Be accurate.  Don't document anything you are unsure of and did not directly observe
    or encounter.   If documenting what another professional reported to you, note that it
    was reported by that individual.
  •  -Follow medical record guidelines.  Remember grammar, spelling, legibility, and
    corrections.  
  •  -Follow facility policy regarding each entry.  Note department, focus, time, date, full
    name, job title or certification.  
  •  -Consider follow up notes as pertinent.

The activity professional is an important member of the treatment team.  Documentation, and
our role in the process, plays a significant part of fulfilling our responsibility.
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