Raps

[toicole]

I was recently dinged for the RAPS, I didn't indicate where to find the information until I got to the narratives, basically I have to shorten some stuff so it can all fit. But here lies the problem for me, I was trained to do them wrong. I am having a problem grasping this. I was even given a orientation by our consultant. The problem I am having is, in the RAP SUMMARY you say where to locate the information, in the NARRATIVE you are explaining the triggers and whether or not to care plan, but do you also list dates. Example: Behavior is triggered, you indicate SEE RAP NARRATIVE 11-13-08, in the Narratives do you discuss the behaviors and reference any nurses notes. It would make sense to put the dates in the Summary, but 2 or more dates won't fit. I have been doing it this way for awhile so it seems strange to change. Please any advice. Thanks

[noc4senuf]

For years I have always said "see nursing rap summary", or "see dietary rap summary", etc. I have never stated specific pages or sections. This is also what i have taught my medicare and mds nurses.

[edhcinc]

In the "Location and Date of RAP Assessment Documentation" I would enter "See RAP Summary ____ (date)". In the RAP summary, I would then either WRITE a complete summary, or reference other parts of the chart in which the information is summarized or discussed. For certain RAPS, such as nutritional or feeding tubes, there is usually room to directly enter the date/info in the column--"Dietitian's monthly note 6-6-07".

The RAI Manual, on page 4-24, gives this one example of referencing particular dated notes:

Delirium: RAP Summary Example 2

Mr. S triggered for delirium. RAP was used as a guideline for assessment by team. (See nursing notes: 8/24/02, 8/28/02, MD note 8/25). Possible causal factors: UTI, Medication, Dehydration, Relocation have been identified and treatment plans are indicated. Refer to Delirium care plan.

There are other examples given for a RAP summary which reference a particular document, with no date. Here is one on page 4-15

PROBLEM: IMPAIRED PHYSICAL MOBILITY

Mrs. X has impaired mobility... We will continue current care plan of walking, titrating weights per protocol (see strength training progress form) and individual progress note.

The main purpose of the RAPs is to

• obtain an interdisciplinary overview of the trigger,
  
• decide if it is, or isn't a problem for this resident (based on current documentation or documentation of a thought process which "puts it all together"), and
  
• define the problem, and
  
• develop an interdisciplinary approach (with the resident) to this defined problem using evidence-based protocols/guidelines.

If your medical record documentation and care plan shows this "thinking", am not sure how you can be cited for completing a form "incorrectly", as even the RAI manual is not clear how this "form" should be completed.

Concentration and efforts spent to complete the "form" correctly is one reason professionals give to explain how RAPs impede effective interdisciplinary assessment and planning.

Good luck!