MDS QUESTIONS

According to the RAI p3-123 last paragraph... "Item H2d must be checked whenever a fecal impaction was present during the 14-Day assessment period, regardless of how the determination was made (e.g., digital rectal examination, x-ray, CAT scan or other method)."

If you're unconvinced whether it is a true fecal impaction, you must obtain a complete hosp. record, particularly an X-ray or a physician's statement pointing to a digital rectal exam. Unless it can be proven the ER finding is inaccurate or inconclusive, the diagnosis in that hosp. summary stands.

Using an ARD past the 14th will be the best option. Just make sure the Sig. Change status determination was not made on the day of hosp. return. Otherwise you will be compelled to set the ARD on or before day 14 w/ R2B/VB2 also no later than day 14. See Assm't Management tips for SCSA, bottom chart p2-12.

Hi.

As Talino said, perhaps you can set the ARD so that you will not "capture" the fecal impaction. Or perhaps you can spend hours as you relentlessly try to prove that a fecal impaction is not an MDS bowel problem...(a UTI is Usually Treated Incognito)
But it's hard to win in the Avoid Regulatory Detection game. The resident will show up as a new in-house fracture and a SCSA--with a 99.9% "opportunity" for review during your next survey. Could one make the case that the facility failed to recognize a significant change in condition which CAUSED actual harm--a bowel "problem" and fall/fracture?

FOCUS---Care about the CARE--or BEWARE (with a prayer...)

TODAY(not when/if the SCSA and RAPs are completed) the professional care team must assure that this resident has a PLAN, and RECEIVES, the APPROPRIATE CARE to:

• monitor/ameliorate these 2 "events",
• prevent/control future occurrences (maintain or improve function), and
• prevent (or recognize and manage) adverse consequences from these 2 "events."

Am sure that the Unit Manager, DN, QI nurse, and Administrator already know about this "hit". When an adverse event (harm) occurs, it is reported. The facility must be "pro-active", not "survey reactive". To quote Forrest Gump, "S __ IT HAPPENS" (in this case, NOT.) Most assuredly, your facility "knows the drill"--look at this resident's care and see if a process was missing, not followed (ignored or unknown), or ineffective. Tell the ombudsman, local agency, and anyone else who must/will listen--a problem is/was identified and "solved." A facility POC now will usually prevent a "G" citation.
Surveyors don't like the Avoid Regulatory Detection or Manage Definitions Successfully games...(or Facility Recognized Adverse Uncorrected Developments.)


Good luck!!