Used when the resident’s overall condition and the complexity of the unskilled services require a registered nurse to ensure the unskilled care achieves its purpose and to promote safety and recovery. Management & evaluation is itself a skilled service.
Model daily note — management & evaluation
Resident with HF, diabetes, a healing sacral wound, and a fall history, on eight medications with two parameter-based orders. Skilled management & evaluation of the multi-problem plan: reconciled the regimen after a dose change, correlated a 2-lb weight rise with the diuretic order and the sodium restriction, verified the wound and turning schedule are being carried out, and confirmed the fall interventions are in place. Licensed judgment required to integrate the interacting problems and keep the unskilled care (diet, repositioning, ADL) achieving its purpose safely; the complexity requires daily RN oversight at SNF level. Ties to the care-plan problems for HF, skin, and falls; supports Section N and M.
