The MDS coordinator is the one who makes sure that the MDS is completed. Anyone can do the work if they have the knowledge & assessment skills. The skills include working the Raps. Some facilities divide the Raps up between the different disciplines, but that can be very difficult to do as the problems are interdisciplinary & the care plans
are as well. I divide the MDS between the disciplines, They provide the information to me by the ARD date. I do the MDS & Rap summaries identifing the problems, the causes, the risks, & needed referrals,. I write a short course of action & write the care plans. If I don't feel I understand why something is marked on the MDS, I go to that person & find out. They will usually write a short note or write it on the care plan. The other disciplines have given me goals & approaches for each problem area. at the care plan meeting we pare down the plan of care to be realistic. we keep it short simple & easy so everyone understands what is expected. What ever I have included in the Rap summary goes on the care plan as well. In regards to quarterly assessments. Divide the sections up, each discipline makes a note in their section of the chart. I the write a Quarterly progress note addressing each goal of the care plan, i.e. Geri will continue to maintain the ability to walk daily thru the next 3 months, The progress notes would be Geri is walking to & from all destinations every day with the assist of staff. Occasionally will c/o pain that is resolved readily with current prn pain meds (see MAR). I also include any new goals/potential such as has stated she wants to be able to toilet herself, but is not able to manipulate her clothing. Will start a restorative toileting program & restorative dressing program to increase self performance. I then add it to the care plan as Geri will improve ability to toilet self daily thru the next 3 months. Have OT screen for a program, & assign the restorative CNA to work with her. if she does not participate, we discontinue the goal, but we did try to improve. If she improves, we advance the goal. Our restorative CNA trains the Staff CNA's the restorative tech"s. You may be surprised at what the CNA's are really capable of doing. I have one that could potty train a horse with brain damage. DAmn I'm long winded aren't I?