How do you decide on an ARD?

[flashpoint]

I know when the resident has therapy, you base it on that, but what about when therapy isn't involved? We usually set for the first Monday in their assessment period, but sometimes it doesn't work out well.

What about changing the date after the assessments are complete, but not submitted? We had a resident this week that had her assessment completed last week, but over the weekend developed a really nasty cold. If I change her ARD to today, I can capture three doctor visits, about six new orders, IV meds, injections, abnormal labs. My MDS team is furious that they have to do their assessments over, but my DON would shoot me if I didn't capture everything.

I feel kind of guilty for causing more work, but it makes sense...and she didn't have changes that would allow me to do a significant change in status.

[Talino]

RN4Life, nratchet, edhcinc ... Excellent pointers!

You three nailed the most ideal procedure:

1. Always attempt to communicate w/ the therapists and develop rapport.

2. Provide therapists w/ workable ARDs.

3. When all else fails, involve the Administrator.

[CapeCodMermaid, RN]

4. When the administrator is MDS challenged, ask the DNS for help.:bowingpur

[Poppyfield]

I know all about feeling guilty when changing ARD dates. But I always keep in mind, Higher case mix score is job security. Every MDS nurse working in a case mix state has been it your position. It just has to be done, no matter who gripes or complains. Remind everybody it's more work for you too! And, I'm a bit onery, so I just sling crap right back at them. :argue: They get the picture and hush up pretty quick!

[Rexie68]

no one really complains about the date changes at my facility, but they do complain about the extra mds' we end up doing. i get excited about bringing up the cmi, but not everyone does. but when they whine a lot, i just tell them to hush, 'cause i do sections bcdghijlmopqrsw, along with the raps, and their sections are a whole lot smaller!! plus, if they're too busy, on vacation, ill, etc....i do their sections. isn't this job fun? *smile* who knows what mds 3.0 will bring......

[edhcinc]

no one really complains about the date changes at my facility, but they do complain about the extra mds' we end up doing. i get excited about bringing up the cmi, but not everyone does. but when they whine a lot, i just tell them to hush, 'cause i do sections bcdghijlmopqrsw, along with the raps, and their sections are a whole lot smaller!! plus, if they're too busy, on vacation, ill, etc....i do their sections. isn't this job fun? *smile* who knows what mds 3.0 will bring......

well, it looks like we all will actually have time for fun with the mds 3.0--truly. much more straightforward, no required "expert" interpretation needed--and the opportunity to get our heads out of the medical record and actually interview and assess the resident! this mds will truly be a "source document", as the interview items would never be found in the medical record.

looks like interesting times ahead!