[greenbean21]

How far behind do you normally run as far as completing assessments, etc.?

[cotjockey]

I'm generally not behind...my assessments are usually completed, in the computer, and submitted within three or four days of the ARD. I am behind (but still in compliance) this week becasue I spent all last week at a conference and have only worked one day this week. (Went to a funeral last Friday and a bunch of people there were sick with respiratory stuff...now a bunch more have it). I've only submitted one assessment late since I started and that was only a day late...still bothered me but my corporate supervisor told me to blow it off because things just happen sometimes.

I work in a small facility and we are lucky enough to have a week every now and then where there are no asessments due...with the way our schedule is set up, that means no care plans the following week. The off weeks give us time to play catch up if we need to.

[poohmdsnurse]

I am usually running behind all the time, as I have so much more on my plate than just MDS. Boy what I what do to have them done, in the computer and submitted 3-4 days after the ARD.

[Rexie68]

Behind?? All the time. Let's see....i have one right now who's ARD was 06/04...not too bad......lots with ARDs in the past week.....probably about 15....but I'll stay in compliance....done by day 14 and submitted within 30 days (except new admits submitted within one week of completion). It's just how we live....always running behind. I have 139 residents, 15-25 of which are skilled at any given time, and now the HMO's want 5, 14, 30, 60 and 90 day RUG levels.......so.....*sigh* But hey, we have the *easy* job, if you ask the floor nurses.....


PS...today is my 40th birthday...and it's Friday the 13th...how appropriate!

[edhcinc]

Hi--right now, "running behind" seems to have little to no actual impact on patient care or care planning, since most/all of the MDS information is pulled from information/documentation somewhere else in the medical record. Clinical staff does not depend on the MDS to provide new or vital assessment information--most never see or read it. Although "in the beginning" we were told, and believed, that the MDS was a "source" document, we rapidly learned otherwise--DAVe and CERT reviews taught us that MDS items need "backup". We found that there were only 2 times when "timely completion" mattered (to anyone other than the MDS coordinator)-when assessment completion and submission was needed for billing or to positively impact a QI/QM.

But times they are a changin'...as we know, several sections of the MDS 3.0 are DIRECT PATIENT/RESIDENT INTERVIEWS. Depending on the particular section, 85% to 92% of non-comatose residents were able to understand and give clinically relevant responses. The responses ARE the MDS required assessments for pain, mood, and activity preferences. And the assessment may require an immediate intervention or medical consultation. We cannot be behind, because others WILL depend on the seeing the MDS in the medical record the same day it should be completed.

Even though we will not start using the MDS 3.0 until October 2009, we need to start looking at how we can "re-tool" NOW. We can't be behind in THIS!! Persons who complete the MDS need terminals for data entry. Nurses who "lock" the completed MDS need an easily accessible printer. Look at present assessment tools, and consider whether to delete or modify. What will the MDS 3.0 coordinator's job description look like? ...and on it goes...

[Rexie68]

Even with 3.0, I still doubt that the floor nurses are really going to care much about what our data shows. It will just mean that we have to contact the doctor for interventions, etc. And as far as being behind....I can't see how it will stop. Even if I have to do a direct resident interview, it's not going to mean I can stop having 20-30 MDS/week and subsequent care plans to do. I also don't believe the very high numbers that CMS thinks can answer the questions....during a teleconference, we asked the average age of the residents interviewed. They wouldn't answer....twice their response was "residents ages 18-late 90's were involved." This tells me nothing. All of our inpatients are aged 65+, many with severe dementia, who may or may not respond to their own name, let alone be able to answer the 3.0 questions. Plus, even those who can answer the ?'s......I have to be able to get the resident alone and available for responses. So, meals, morning care, mass, activities and therapy all have to be contended with. I, for one, am cynical.

[cotjockey]

I really wonder how some of the residents at my facility are going to answer some of the questions. We have a HUGE dementia population and a lot of them can't even tell you their name, let a lone answer some of the questions on the MDS. Oh well...I'm still looking forward to seeing 3.0 come out...it will take some getting used to, but I hear a lot of positive things.

Are they still going to have the balance test? I really hate the one we use currently and have trouble with the third position myself!

[edhcinc]

The current draft MDS 3.0 includes OBSERVING the resident doing 5 functional activities and indicate ability to balance self...MUCH EASIER AND RELEVANT!!
See below...
The current test is difficult except for a tai chi expert, and I'm not one, either!


After observing the resident, code the following

walking and transition items for most dependent over the last 5 days:
a. Moving from seated to standing position
b. Walking(with assistive device if used)
c. Turning around and facing the opposite direction while walking
d. Moving on and off toilet
e. Surface-to-surface transfer (transfer between bed and chair or
wheelchair)

Coding:
0. Steady at all times

1. Not steady, but able to stabilize without human assistance

2. Not steady, only able to stabilize with human assistance

8. Activity did not occur

It looks like we will need to talk with staff, use direct observation, or use therapy notes to ascertain most dependent episode.

[Rexie68]

[quote=edhcinc;The current test is difficult except for a tai chi expert, and I'm not one, either![/quote]

I've begun doing the balance tests myself for our residents, as the floor staff seem to think that if a resident can stand, even with a walker and assist of two, well gosh, they're a 0/0. Despite myself demonstrating the various positions myself (and not getting a 0 for the standing balance!) and leaving laminated copies of how to administer the test.....they just didn't get it...or didn't care...and then I was left with the option of marking the MDS with what I knew was incorrect information, or marking the correct information but not having that test on paper to back me up. By the time I realized the test was coded incorrectly, it was after the ARD......

So, the 3.0 version looks more realistic, in that area, anyway. Who knows, by 2009 I may be in another field, since I'll (finally) have my RN by then and our administrator doesn't want 2 RNs in the RNAC office. (we have 139 Medicare certified beds; about half are medical assistance). For some reason, that saddens me....'cause even though I whine, i actually like doing MDS' and care plans....I must be ill!!!

[edhcinc]

Hi--one of the things we can do NOW is to become very familiar with the interview tools, and start using them!

In RAND's research, residents with/without dementia were interviewed. If we are cynical or skeptical of their findings, then we should try it out ourselves! We must become comfortable with what is necessary--environment, approach, style, "aids"--whatever will lead to the most successful interview with different residents.

Use the BIMS in conjunction with your current mental status exam. Use the PHQ9 in conjunction with the Geriatric Depression Scale. Conduct the pain interview and see if the results "match" the medical record/prn MAR (or whatever you use to evaluate your resident's pain status).

Sometimes we are surprised how an individual will respond to an individualized approach..
GOOD LUCK TO US ALL!!