After 2 months..what do you think of the MDS 3.0?

glm777, BSN, RN · Dec 9, 2010

I still think the 3.0 is cumbersome. I think it definitely could have been simplified. The number of skip patterns make it difficult for some of our staff members to follow. Also, the amount of room it takes in the chart is ridiculous. I still feel like only about 50% of the form actually assists us in providing appropriate care for our residents - the other 50% is simply data gathering for the government. I don't like the CAAs and I especially don't like what triggers them. If reading is not important to a resident - why does that trigger a CAA? Some folks just don't like to read. It seems to me that the government has set it's own criteria about what should and should not be important to a resident and any deviation needs further investigation! I could see if the resident enjoyed reading and could not d/t vision or limited access to books but if he doesn't like to read - what is the issue???? I love to read - my husband hates it! And things like triggering an incontinence CAA because a CONTINENT resdient needs help to the toilet is ludicrous! More writing to explain a "problem" that isn't a problem!

Oh well, sorry that turned into a rave but I'm still not a fan - at all.

Nascar nurse, ASN, RN · Dec 10, 2010

And things like triggering an incontinence CAA because a CONTINENT resdient needs help to the toilet is ludicrous! More writing to explain a "problem" that isn't a problem! Oh well, sorry that turned into a rave but I'm still not a fan - at all.

Rant away! I agree of some of the CAA triggers are just stupid...the continent resident that needs physical assist with toileting should be completely covered by the ADL CAA.

Bella'sMyBaby · Dec 10, 2010

The D/C Assessments are a Nightmare. We can't keep up.

We are so far behind, don't even know which MDS to start with.

We are having problems with the floor nurses not completing the Pain Assessments within the ARD.

We could easily work 7 days a week & not be caught up.

And daily "Spoon Feeding" the other disciplines to make sure they entered their sections & CAAS completely..... :banghead:

glm777, BSN, RN · Dec 10, 2010

"The D/C Assessments are a Nightmare. We can't keep up."

LOL! Don't get me started on the D/C assessments!!!

Again, what is the point other than data gathering for the federal government? Free labor for the government is what it is all about in my opinion! I think at this point we should be able to collect federal benefits!

99% of our residents are d/c'ed home with services. These services go into the home on day 1 and do their own eval. They don't need my info from my facility to help them provide care - it would be like getting a resident from another facility and not doing an assessment of my own because the facility they came from sent us their assessment! Who would accept that? So our d/c assessment is not in any way helpful to the resident after d/c.

I've been at my facility for over 10 years and can count on one hand the number of times we have EVER sent in an assessment late. Now - I think 50% of our d/c assessments are submitted late! We can't keep up either. It's either we do the d/c assessments or we do the MDS for residents that are still in the facility - we can't keep up with both.

I wish the folks who dreamed this craziness up would have an open forum so we nurses who actually DO the work could voice our opinions. I'm loading up on tomatoes just in case!

katoline · Dec 27, 2010

thanks guys! i often feel i am the only one so lost and far behind. we also were never behind, now when late we get less payment? right? i often feel i'm going to lose my job.

our residents go in and out, in and out of the hospital. yes, i believe the state is keeping records to dock such facilities more money in the future. the only change i see is keeping residents who need to be in the hospital in the facility against our better judgement. and when the case-mix go out, stay three days, become mcr you have so little time to do a discharge, reentry and 5day pps/sig change. usually i don't even know these residents.

my co-worker is supposed to be part-time, but has been working full-time since Oct. If i'm late with her full-time, how am i ever going to catch up if/when she goes back part-time?

i feel overwrought, had the flu, didn't go to the Christmas Party because i really wasn't feeling well and needed to catch up. I also worked Christmas Eve to catch up as well. We got an admission and i was expected to help. And no, the others aren't getting their parts in on time. I know i'm behind, but if i put the assessments in on admission, why is everyone else? and to get others to do their CAAs is like pulling teeth.

over the holidays i decided that i have to come up with better plan. give team members 5 days to get their parts in (or less?) then one or two to do the CAA. should we put the discharges on the back burner because we don't get reimbursed for them? need some leadership direction here. sps

miccay · Jan 1, 2011

I agree with all the above comments. When I first heard about 3.0 coming out, I was excited and thought they would really improve and simply the MDS. I was so disappointed when I saw it. I think most of it is a waste of time. I don't understand what they were thinking when they created it. They sure weren't thinking environmently friendly with making it so many pages. We also can not keep up with the discharge assessments at my facility. And the questions are so redundant. Some of our residents refuse to keep answering the same questions when multiple assessments are due. I hope they make some revisions in the near future, but I am not holding my breath. I have already been disappointed once with the new MDS.

rukiddingme · Jan 1, 2011

Things are moving along better now than it was in October - since we're used to the software, and they've fixed some of the glitches.

We're printing out the MDS' using both sides of the paper -- and sometimes we even put 2 pages on each side (so 4 pages are shrunk and fit onto just one sheet of paper, 2 on each side) The text is small, but we have found no regulations stating we can't do this, and when someone from public health came in a week ago, she said she knew of no rules about it either.

susanthomas1954 · Jan 1, 2011

We don't print anything. It's all in the computer. I liked the concept of the 3.0, but if soc. svc. can't get their interviews done, then the "resident's voice" is moot, or should I say "mute." Doing discharge MDS's is a crock, and going back to change DC return anticipated to not anticipated after you read the daily obits just aint gonna happen.

Changing to 3.0 has not made any of my patients able to afford dental care, also. I'd like it if it worked, but it doesn't and I'm losin it. Two full time people cannot handle a two hundred bed building. It's that simple. We're short in social services, and they hire a marketing person first. Whatever.

katoline · Jan 2, 2011

Susan, you're a hoot. Everything you said are my sentiments exactly!

If the state survey team stated to me that THEY didn't like the new 3.0, who came up with it anyway? The surveyors said they really couldn't tell from the questions asked whether or not the person had memory loss, dementia or psych issues unless it was documented and we all know how much supporting documentation we find. People with dementia usually fluctuate in their daily mental status anyway.

And do we spend time trying to appease someone who wants to go home, but can't and now we've cruelly put it back in their thoughts so they can cry or attempt to elope after all the time we've spent getting them accustomed to the facility, the staff and some kind of routine. And yes, i know we are patient advocates and should accommodate as best we can, but face it, if these long term residents really had an alternative, would they be here? I'd like to think i'm an idealist, but the only resident's that are going to get really individualized specific care are the ones in private facilities where CMS doesn't have to survey because they don't depend on state/federal funds...not that i want to be out of a job or anything.

NurseMomDori · Jan 3, 2011

We print the MDS four pages to one sheet and most of us can still read it. Noone does except survey team anyway! Also, use the dash now that it is an option. Pain interview on DC to hosp--dash all except meds given in last 5 days. Also, most of the info is the same as the last MDS and your software should be able to populate the prev info into the new MDS automatically. Since I do most of the sections, I give the others (ACT, SOC SER, DIETARY) 24 hours after a DCRA to hosp to finish their sections--from notification if it happens over the weekend. Also on changing the DCRA to DCRNA, that is where section X comes in and you can modify without having to change anything else. Noone else even has to do anything, and you sign again for changing X on the date you modify, then submit. Way easier than doing a new MDS when you send a resident to the hospital and he dies there a week later.

katoline · Jan 4, 2011

Dori, how smart you ARE! Love your suggestions. I wish the software at this facility did populate from the previous MDS, one of my gripes-having to go out, find the dates of the flu/pneu shots, etc. Go back in. Redundant. We don't have the capability to print doublesided or shrink the MDS, so we just print out section Z, the previous page with the Rug score and section O with the rehab minutes. I write the type of MDS, ARD date and if an OBRA a note as to why the resident is continuing on Mcr, weight loss, wound care, in house IVs etc. We'll see how it flies next state reveiw. I don't think they really care, as long as they are done.

We had mucho change over in this dept. before my coworker and myself who both started in Oct. State came in, was looking for missing assessments and came down to our dept., where we pulled them up on the computer. The surveyor said she was just interested in seeing that it was completed and answers to a section she was interested in.