RAPS--should CMS keep, change, or delete?

You all made valid points!

The RAP is a very good learning tool that can guide a discipline to develop a more individualized care plan. However, to a more experienced or seasoned discipline who is responsible in completing portions of the MDS, the process becomes redundant. Completing Section V is overkill! It only serves one purpose - convenience for an auditor or a surveyor, as one pointed out. It gives them one quick reference on what to zero in with regard to resident care.

A well trained discipline should be able to identify the items that would normally trigger a RAP and incorporate them in their initial evaluation, plan of care, and review their goals/interventions in a progress note, even before they actually complete the MDS.

Should a tool be necessary for auditing purposes, use the Trigger Legend instead (see Appendix C-3) which simply identifies what items triggered what RAP. The trigger legend will be calculated after the MDS is completed and entered into the the computer. Then it will be the auditor’s responsibility to pore over the legend and peruse the medical records on how the staff addressed the triggers.

The disciplines will not need to respond to a Section V or write a separate RAP summary note. The triggered items will likely be located and addressed in a care plan, a physician’s eval or progress notes, behavior tracking, the MAR/TAR, a CNA assignment sheet, a dietitians nutrition assm’t, an Activity’s recreation plan, a social worker’s resident interaction notes, etc.

To sum it up – keep the RAP (Appendix C) as reference and use it as a training tool for the less experienced discipline. Eliminate Section V.

Remove them, they are a reitteration of data already exhisting and do not lead me or the team to any further defination of the resident or the residents care needs, I find them an exercise in redundencey, I believe a better thing would be to expand on the triggered areas in the Care Plan, no one reads the raps in the several places I have worked, but everyone reads the care plan