Teaching and Training Activities

30.2.3.3 - Teaching and Training Activities (Rev. 179, Issued: 01-14-14, Effective: 01-07-14, Implementation: 01-07-14) A3-3132.1.C.3, SNF-214.1.C.3 Teaching and training activities, which require skilled nursing or skilled rehabilitation personnel to teach a patient how to manage their treatment regimen, would constitute skilled services. Some examples are: • Teaching self-administration of injectable medications or a complex range of medications; • Teaching a newly diagnosed diabetic to administer insulin injections, to prepare and follow a diabetic diet, and to observe foot-care precautions; • Teaching self-administration of medical gases to a patient; • Gait training and teaching of prosthesis care for a patient who has had a recent leg amputation; • Teaching patients how to care for a recent colostomy or ileostomy; • Teaching patients how to perform self-catheterization and self-administration of gastrostomy feedings; • Teaching patients how to care for and maintain central venous lines, such as Hickman catheters; • Teaching patients the use and care of braces, splints and orthotics, and any associated skin care; and • Teaching patients the proper care of any specialized dressings or skin treatments. The documentation must thoroughly describe all efforts that have been made to educate the patient/caregiver, and their responses to the training. The medical record should also describe the reason for the failure of any educational attempts, if applicable. EXAMPLE: A newly diagnosed diabetic patient is seen in order to learn to self-administer insulin injections, to prepare and follow a diabetic diet, and to observe foot-care precautions. Even though the patient voices understanding of the nutritional principles of his diabetic diet, he expresses dissatisfaction with his food choices and refuses to comply with the education he is receiving. This refusal continues, notwithstanding efforts to counsel the patient on the potentially adverse consequences of the refusal and to suggest alternative dietary choices that could help to avoid or alleviate those consequences. The patient’s response to the recommended treatment plan as well as to all educational attempts is documented in the medical record.