MDS as admission assessment

skl0923,

Our LTC facility USED a MDS based form for admits. It was basically an MDS with a place to draw wounds on a body and on carbon paper. This form was terrible to try to get completed. The staff nurse had a hard time grasping the assessments and the proper coding. It was easy for the MDS coordinator to complete the 5 day PPS, but did not always reflect the true picture as some nurses would "guess" at the assessment. When I took my current possision that form was toast!

We now use a simple check form with space to explain abnormal findings, etc. has all the same info in a easy to understand and is quick to fill out. The upper level assessments are separated from the initial assessment for the managment to complete (not that staff nurses can't do an upper level assessment, but they have less time).

With the never ending stream of paperwork nurses are given by regulatory changes and to meet compliance with assessment and care requirments simple and quick is the only way to go and retain nurses pushed to the limit of human ability to complete the mass of duties a nurse has every shift.

Also, if the charting does not match the MDS, is the MDS coordinator reading the charting before coding???? or is there a lack of charting to substanciate the MDS?

peter

MDS is an excellent assessment tool to develop care planning needs after the resident has stayed in a facility for at least 5 days. On newly admitted residents, you need to have a good idea of what the resident needs are within 48 hours of admission. The MDS asks for the resident’s status in the last 7 days (minimum). Some of the information required may not be available on the day of admission, or after a week, even longer. Hence using an MDS on admission is ineffective. You frequently would end up with an incomplete assessment. It would be a good idea however to pattern an admission assessment according to some of the MDS questionnaires (bcoz whether u like it or not u subsequently still need to complete MDS's) with a primary focus on the traditional “head to toe” assessment.

As for data entry of the MDS into the computer, a clerk would suffice (that is, if you use booklets or hard copy) or a discipline can complete the MDS sections directly into the computer. The MDS Coordinator should be focused on training, scheduling, maximizing reimbursements, coordinating care plans, and facilitating prompt completion.

Unfortunately, MDS is there to stay in LTCFs. But MDS has many benefits tho. Not only will it be used for care planning, but also for reimbursement purposes, QA, and finally getting all disciplines to see the resident as a whole (remember the old days when nurses were only focused on a nursing care plan or a nursing point of view, and dietitians on the resident's diet, etc ?).

As with any changes, the transition period is always the most upsetting part. So right now, it’s okay to whine about it. A year from now, you probably won’t be able to discern the difference, including the paycheck which remains the same.

I agree that using the MDS form as an admission tool is difficult, and a waste of valuable staffing time. Our facility has a shortened MDS form that we use, focusing on areas like "foot problems", "assist with ADLs", "ability to make needs known", "ability to understand others". Just because you code something on the admission assessment, does not necessarily mean that the MDS coordinator with agree with that coding for the 5-day or 14-day assessment. In some cases, the change is not only expected, it is welcomed! (especially if you have a resident receiving therapy or the like). You didn't say how large a facility you have, or what your staffing is like. At our facility, our supervisors fill out the assessment form, leaving the MAR for the hall nurse to do. This cuts down the demand on one particular nurse by sharing the wealth! MDS is such a large part of the survey process. Because so many deficiencies are tied to the MDS, there is a great focus on accuracy. Remember though, that if you are using the MDS form as an admission assessment (cruel as that may be), the MDS form IS ONLY an admission assessment. It is not being transmitted. It is not being billed. If you are using the Full MDS, perhaps you could suggesting a taper to the quarterly MDS, which is significantly shorter. Good Luck!

Hi, Peter:

I work in a LTC facility on nights. We went from a low census to overflowing with Medicare admits which has made for very long hours. I have been trying to find a form that will speed up my assessments and charting while being sure to hit all the areas needed to support the MDS. My search has been extremely frustrating and I am dreading heading back to work without something. On reading your entry, I thought "That's exactly it!" Is it possible to get a copy of the form your facility is using? I would only use it as an organizational tool-not as part of the record. If not, I would appreciate any ideas of how or where to start putting together such a tool. Thanks for your help!

I just got a job as an MDS coordinator, I am an LPN and I am looking for salaries I should accept... help me

If you go out to Amazon and enter "MDS" and search books you'll get pages of guides to its use.

Salaries vary greatly depending on your census and how much you are responsible for. I have 2 examples for you. I work with an LPN in my office and she makes 22/hr, now she has been employed as an MDS Coordinator for 4-5 years, she is also responsible for the completion of MDS and careplans for 70 residents which are mostly MA. I also know another LPN who is the MDS Coordinator for a small facility of about 65 residents, she responsible for all aspects such as the MDS and careplan schedule, completion of the MDS, admission/discharge tracking, case mix & maximizing reimbursement, input and submission & she makes $25 per hour. I hope this helps.

I have a question on Quarterly MDS's. In section I if you have a resident who has Alzh Dementia wouldn't you want to capture that ICD 9 code instead of a new dx code of PVD? I would think that the Alzh Dementia required more care planning than did the PVD. Maybe I'm not understanding the Qrty MDS.

Hi.
Diagnoses recorded in section I 1 (like Alzheimers dementia) on a comprehensive MDS do not get changed in the database until the next comprehensive MDS. There is no requirement that dx in I 1 be coded at I3, unless the coding adds more specificity.

Each diagnosis does not require an individually numbered care plan. Symptoms/concerns/abnormalities/strengths/goals/conditions/diagnoses can be combined into a few summary RESIDENT "problems"--most important to the resident/family.

I 3 ICD 9 codes can clarify specific MDS items--eg, ulcer stage and location, or relationship of symptoms/complications to a certain diagnosis. Since it is important to note whether or not an ulcer was present on admission, a suspected DTI (which cannot be captured in section M) can be coded here.

BUT...Diagnoses recorded at I 3 a and b on a comprehensive assessment DO change if you put in a new diagnosis on a quarterly assessment. (c thru e stay in the database).

Am not sure why you are asking about a diagnosis in relationship to "more" or "less" care-planning and a quarterly assessment. A NEW diagnosis SHOULD be added at I 3 on a quarterly, so that the assessment accurately reflects the resident co-morbidities and complexity. During the quarterly CP review, a new diagnosis, or any other issues, should be addressed.

Good luck!!