Side duties of MDS/PPS coordinators - page 2

by allezel 7,445 Views | 21 Comments

Does your facility have side jobs for you guys? Such as rounding,MAR audits and following up with every single problem you find? (irks me how if i find a med error - i just cant bring it to that halls supervisors attention -- i... Read More


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    I guess I do.
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    I really think that delegation of duties and who actually does what varies from building to building, company to company.

    Where I work, I do 90% of the MDS and usually all the CAAs. Everyone is always busy. Staffing is always less than ideal. In all my years of MDS, just this past year I started going entirely case mix. With everything going on with the changes, it wasn't that hard to give up PPS. Doing case mix has made me see things in a different light though. Our charts have stickers for MCR (we use them for mgd care as well). The floor nurses are in tune to look for those and usually chart fairly well. Other areas like the rehab depart, SW notes etc are good sources for me when doing PPS. For case mix we make out lists ahead of schedule as to what date which resident is having an assessment done, but honestly with the Mcr/Mcd reimbursment changes it's all anyone can do to do the minimum. We had layoffs, pay cuts, layoffs again and again. (I was actually part of the last tier of layoffs.) Then of course something comes up and an assessment has to be added and another postponed.

    For case mix, I had to do quarterly nursing assessments on each of the residents I was working on which consisted of Brayden scale, fall risk, transfers, bowel and bladder, pain, all psychotropics for consent for present dose, aims if needed, smoking if needed as well and restraints, but we didn't have any in the building. I gleaned the chart for changes etc, interviewed the resident and usually because of time constraints, if anyone's part wasn't done, i would do it. More times than not I was doing it. I didn't mind if it was something that I came across anyway or could find easily, but I hated having to interview the resident for mood. After all my interviews and data input (or before) I had to write a lengthy nurses note that covered each of the items that there was no documentation for, such as behaviors, seat cushions and pressure reducing mattresses, the results of the restorative nursing, any changes in adls or any temporary condition that might cause a temporary change and not a significant one.

    Very often, unfortunately, I would come across something that was missed. Perhaps something as simple as MD needing to be notified of recent blood sugars and current insulin or oral hypoglycemic doses. It might be something I saw during my interview that needed further assessing and follow up or even sometimes hospitalization. Labs were not put in the chart regularly,or were kept in a different place until filed and all x-rays, MRIs, CT Scans, I called the hospital for a copy to put on the chart. The same with hospital discharges or notes from an ER visit or dialysis notes. It could even be an order written that no one took off. I took it upon myself to pitch in with these things because I am the patient advocate. I am supposed to be his champion. The nurses love the patients and follow up as best they can, but we seem to be more interested in filling in a square, signing off on some lame "inservice sheet" that someone just made up because of something that happened or going to more and more meetings to see that we are doing our job and catching things. And most facilities I've worked at the residents have so many medications. They are coming in sicker with poor prognoses and nutritional intake just waiting to become pressure ulcer candidates. Or they may be bariatric patients with personality disorders and demanding demeanors. whew! Well.... I guess we all know we are in a mess and in this together.

    I enjoy working. I'll do almost anything as long as it's ethical and in my scope of practice and I feel it's in the best interest of the resident. But like everyone else, my time is limited. I have deadlines. Who do I perfer to get mad at me? Why do I have to ask this question? If I'm salaried and work way way over 40 hrs, I put off my own appts., MD, dentist. If I'm on the clock, I can't get overtime. We need clones. I read where one of the CEOs (won't mention any names) in his quarterly report to the board and stock holders "we're cutting back all we can and nurses won't work for pauper pay you know" No, but now we get the privledge of doing the work of two people.

    By the way Cape Cod Mermaid, what is your position now? Are you DON? Katoline
    andy3k likes this.
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    Katoline,Yes. I'm the DON.
    katoline likes this.
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    CapeCodMermaid - could you please let me know how many residents are in your facility, and how many MDS coordinators?

    I had an experience at the last facility I worked at. When one of the MDS Coordinators (I will call her Sue) was in the office she made sure there were 3 coordinators and one data entry person (full time) for 150 residents. Well, the data entry person quit, Sue became DON so I got her MDS job, and then one of the other coordinators quit, leaving just two of us with no data entry person. We begged for any help we could get, but Sue said we should be able to get it all done. Finally I had enough and left. Well, Sue was relieved of her DON duties and went back to doing MDS's. After the first week she said that two people couldn't possibly do that job and so talked Administration into hiring a 3rd coordinator. Now they also have a part time person, giving them 3 1/2 people. Go figure.
    Bella'sMyBaby likes this.
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    I am curious as to how big your building is. How many MDS nurses do you have? What's your skilled vs. long term census?In my building (avg 12 skilled pts, 65 LTC pts), I complete all the MDSs including gathering info and doing data entry. I case manage the Long Term pts. I help in the dining room 1 day/week, and as a nurse manager, I am on call 1 weekend in 3. The term "other duties as assigned" is used pretty loosely in my building. I can get an extra assignment at any time. I answer to the DON, and am considered Nursing.
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    Our building is 59 beds. We only average around 7 on Medicare A caseload. I have one MDS nurse, but she does not complete the MDS/Care plans in their entirety. Social Services, Restorative, Wound Nurse, Activities, and Dietary have their own section and CAA's they complete. The MDS nurse reports to me(DON). She is hardly overworked and cant wait for the clock to strike 4 so she can leave. She is on-call one weekend a month and she does help with meal service. Yes, I was the RNAC for years prior- I can adequately judge the work load. I am also certified with AANAC so I understand the 3.0 side of things with the extra assessments. I believe it varies building to building and who are completing the assessments. I understand places out there have the RNAC complete the entire assessments including the care plans entirely.
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    After leaving Eastern North Carolina for the Great State of Texas (it's a whole nother country - i was going to get that license plate, next time when i can order online and not wait two hours in a line) i have started my position as MDS Coordinator of a beautiful nearly new (2 ys) luxurious facility only five miles from where I am staying.

    This is the fourth facility i have worked at, it is for profit, two of the other three were as well. There are 125 beds all full. 75 certified medicaid. where i had worked previously all the beds were duelly coded. We have approx. 40 medicare/managed care residents the rest are medicaid, private, hospice. We admitted 42 medicare residents this month, that doesn't include the few private pay that are not PPS. We discharged about the same. I believe the average PPS length of stay is 25-30 days. Thats a whole lot of five day admission assessments. Not to mention keeping up with the medicare book, schedules, certs and doing diagnosis codes on the admissions. There is daily stand up, weekly mcr meeting, an IDT meeting which is basically a delivery of care meeting of all the admissions since the previous meeting which is counted as a care plan meeting of sorts. They usually last 30 min. a piece. Last week we were scheduled from 10 am after morning meeting until 3:30 pm without a lunch break. Very informative, help with the assessment and for care planning not to mention being able to get things off on the right foot or correct an issue before the resident has been there very long.

    We have no data entry person. I haven't had a data entry person at any of the facilities i've worked at. the charts here are electronic. it sounds great at first, that you could find the information you want without having to travel the building or worry about waiting for a chart. but electronic charting is only as good as the information entered. there is never a complete ADL sheet to pull, ever. usually the are filled out less than half. i now have access to another program so i can get the therapy evals without having to ask therapy. i guess i like a paper chart that i can put my hands on and say "there it is" "there is the answer to my question". this way, not so much. there may or may not be a nurses note. usually they are just like checking a box on a form, but no added information. it's very difficult to tell if a person has had a fall. sometimes there will be a note, but not always. someone with the admission assessment may say there is a stage I or skin tear, then it can't be found later on the treatment cart or skin sheets. of course no order. usually the weights aren't to be found. often there isn't a diet order. if the dietician comes in before my ARD, i'm lucky and can read what she might have suggested. the dietary manger doesn't even have access to the program, so i've inherited sections K & L. the social worker here does B & C, which is new to me, along with D and Q and activities does her section F.

    Coming from NC and having Myer and Stauffer CPA llc. for CMS mcr and mcd audit yearly, along with taking the yearly training. I have it drilled into me that you MUST have documenation to back all your answers. I could write or enter a note I suppose, but i'd need to do it on every subject. Even that wouldn't support the entire look back or even three occurances.

    We have weekly dining room duty, daily MAR, TAR and skin sheet checks and maneger on duty weekends maybe once every 6 to 8 wks. I was given a stack of MARs to check for the end of month and i wasn't able to fit that in. I was also to look over each and every possible admission, state my concerns and come up with dx codes whether they were to be admitted or not, this can be six to eight a day. i no longer do that. i just come up with the codes. I've been here now just 3 full weeks and have worked two out of three weekends to try to catch things up. I was given a few "days" of training that lasted maybe five or six hours, usually less, and instructed on the computer program, i was just exposed really. the computer freezes up regularly and when i ask for help, i've been told help will be there. i'm still waiting.
    Bella'sMyBaby likes this.
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    My coworker does my discharges, other than that she stays to herself and has nothing to do with "this side over here". it seems that others are disappointed in my ability to handle the workload or manage my time. i wasn't even shown how assessments are completed here, how to do the caas or even how to get in to the care plans. i guess with my experience i was expected to just come in and run with things. well i have to the best of my ability, but if i wanted help, to make someone feel welcome and a part of the team, i don't think i would have done things this way.

    i have noticed that there are three in admissions, two in social services, an SDC nurse, ADON and DON. they had a wound nurse, but are looking for another. there is a receptionist and as far as i can tell the nursing staff is on each of the two ends with 62 residents, two nurses, two med techs, a nurse manager beside the CNAs. looks like it's well staffed everywhere but our department. so that's how it is over here. someone did end up coming in to do assessments at the end of the month. we'll see how things go next month. katoline
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    Well, went in Monday, computers down again. Good time to catch up the Medicare book with admissions since Friday (5). I have heard that other facilities, at least Kindred where I worked before had a case manager who really Coordinated the tasks to be done. There is a lot to oversee. When the computers came back up just before lunch, I get an email saying all the assessments for month end close weren't done, I need to do three short assessments, a 5 day readmit and a new 5 day comprehensive assessment before the day is done.

    I couldn't believe it. It was cc to the administrator and she forwarded to me and asked me to let her know how things were. Month end was supposed to be over, that's why the big rush on Fri. Unfortunately, I emailed back that I felt there was a communication problem. I was told on Friday all the assessments would be completed, to just relax and start fresh. (I had offered to come in again on a weekend - I'm salaried, so no overtime for them. I just asked to take Mon off if I came in) I was told this by three people, the Admin., the DON and my coworker. Why go thru everyone else to tell me something and give a lame excuse such as email down, well how did the corporate person get up with the other three people?

    I completed the short assessments, then the 5 day readmit. It was almost 5 pm when I started on the comprehensive. After putting in the required information I realized the activities director did not do her section. this was maybe 6 or 6:30. nothing i can do. After interviewing the resident, who has a terminal illness, she was exhausted. There was no way I would wake her to ask activity questions. In this MDS computer program, you can get to the Caas without closing the assessment, so I completed them. I emailed everyone with cc to everyone what I had done and went home exhausted myself. It was almost 8 pm. I go in before everyone and leave after everyone. I'm working the same shift as the 12 hr nurses. After just three weeks, I'm thinking maybe this isn't the position I thought it would be. Makes me sad, but I've got to do a reality check. Oh, and I've never worked in a facilty where the floor nurses input any data on the MDS. In fact, the MDS depts. did the quarterly nurses risk assessments. And rarely does anyone else put anything on a careplan. I'm just given notes, emails or spoken to in the hall that such and such needs to go on the care plan.
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    I am our facility's MDS coordinator and I have 1 LPN helping me and along with scheduling, completing, and transmitting assessment, we initial and update ALL care plans in the building. Any nurse can update the care plans but they don't. Also responsible for updating the 672/802 by hand because our computer system does not save the changes we make to it. We were told by our regional MDS person that we were no longer responsible for this but we still do it every week. We also do room rounds and have to pick up the slack of our CNAs if the rooms are a disaster. When we are short staffed or if a nurse calls out they ask me to work another 8 hours that day. Some days I don't mind because I still feel as an RN with only 1 year experience that it is important to keep my skills.


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