The QI report from CMS is NOT MY FAULT!
Yet another management team has decided to screw with the MDS process, and when my partner and I try to explain that QI's for the next three months are going to look REALLY BAD, we get the deer in the headlights looking back at us. For years, untrained nurses have been completing quarterlies and annuals in this 200+ bed facility, and they now decide trained professionals need to do them. Excellent choice, but they have to understand that we are going to CODE THE FACTS! We are appalled at what we are finding in the long term care MDS's of the past. The floor nurses have done all the basic mistakes you would expect:
#1) Doing the MDS from "knowing the patient." Like coding the unusable side of Ms. S's body as having no limit to range of motion. Yes, I know it's "normal" for her, but that is not what they are asking, so....QI will flag for the way we are coding this.
#2) Coding all the meds that are ordered, not just the ones given in the look back period (plus the monthly ones, I know) Hasn't used prn tylenol in two years, but it's on the standing orders, so let's just count it.
#3) No behaviors. Honey, I know that Ms. B bangs her cup on the table when you put her in the dining room, and she has for every meal for six years. IT'S A BEHAVIOR, EVEN IF
YOU ARE USED TO IT.
#4) Even if the bed rail is a mobility device, you have to code it as such. (Bed rails used for mobility) IF SOMETHING IS A RESTRAINT, assess for it and care plan it!
#5) The surgical wound was over a year ago, news flash-It's healed. Stop coding it.
And we're only two weeks into the new process.
SO: Have any of you ever had to deal with management killing the messenger here? I have been through this before, so I know what to expect at QI, but can I somehow use this as a teaching opportunity for the people in management? I don't make the news I just report it.
Thanks, ST
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