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

[Nascar nurse]

Now that we've all had a chance to get used to the 3.0 what do ya'll think? I hate the bulk of the whole thing and our corporation's software program is sooooo slow it's painful most days, but.. surprisingly I think I like the 3.0.

For the most part, our interviews are going fairly well. We've had several residents that I didn't think would even be able to participate with interviews do surprisingly well at at least making an attempt to follow along and answer questions (even if their answers were off the wall).

For the most part the questions themselves are more relevant and we've lost some of the "dumb" questions...I mean who really cares if someone took 14 vs 15 meds in a 7 day period.

What do you all think?

[NurseMomDori]

Sharon,

I made a sheet with all of the residents' names for the nurse who gave the flu shots this year. She dated when she gave the shots. I gave a copy to our billing dept so they could bill them all, and I kept a copy so I have a quick glance for the dates. Our software has an "order text search" feature, and I use this to check all residents with specific orders, ie. psychotropic meds, wanderguards, flu shot dates, etc. to make sure I have these items care planned or medically reviewed periodically. I also keep my sheets in my files so I can quickly reference the last MDS or problems we dealt with at the last family conference. We do interdisc. progress notes and cover pain, new meds or problems, ADL, rehab/PT, B&B, mobility, act, nutritional risk, etc. It presents a quarterly summary and our surveyors seem to love it.

[rukiddingme]

I'm still hoping that the 3.0 will get reviewed by the powers that be, and they will get rid of the discharge assessment for people that get sent out suddenly (to the hosptial) Printing the MDS with both sides and multiple pages helps.

[JTworoger]

Wow.. I'm so glad I'm not the only person that thinks 3.0 is a mess. On top of MDS, I also cover the Medical Records department in my nursing home.. talk about a full load on my shoulders. Plus I do all the sections myself, I find it is easier to just do them myself then to split the sections between the departments. On the CAAs, I was told when I went to my training that we do not have to go into each and every CAA that triggers, we just have to look at the CAAs that trigger and summerize all the information into one of the CAAs. As long as you have where the information is that is all that matters. State does not see the CAA documentation anyway and all the surveyors want to know is if we are doing them or not.

[GRACERN47]

The whole 3.0 thing is crazy ! The full assessment is fine but all the rest like the discharges is a waste of time. The surveyors better not pick apart what all of us are trying to keep up with because I would challenge them to try it for one day. I am so glad there are so many that hate it ! Why did they make so much extra work??? I am lucky , my company has allowed me to bring on a part timer which gives us 3 full time and 1 part , all RNs so we can divide everything up and not worry about having someone else sign. We are a 173 bed facility so I feel very lucky. I feel for those of you who work with one or two. Anyone have any ideas how we can get the powers that be to rethink this mess???

[Bella'sMyBaby]

The whole 3.0 thing is crazy ! The full assessment is fine but all the rest like the discharges is a waste of time. The surveyors better not pick apart what all of us are trying to keep up with because I would challenge them to try it for one day. I am so glad there are so many that hate it ! Why did they make so much extra work??? I am lucky , my company has allowed me to bring on a part timer which gives us 3 full time and 1 part , all RNs so we can divide everything up and not worry about having someone else sign. We are a 173 bed facility so I feel very lucky. I feel for those of you who work with one or two. Anyone have any ideas how we can get the powers that be to rethink this mess???

Maybe we all should QUIT??? LOL

[katoline]

''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"

Oh Dori, as i said our company developed it's own software and is always "tweeking" it. We are now unable to dash anything. Can't leave anything blank, or you can't complete it. And as far as changing discharges to return not anticipated, by the time we get to doing them, we can just make them that way!

and yes, i think we all should quit

[susanthomas1954]

I think we should all protest and do something that is right for the patients and residents. If we all just quit, some robot humans will come in and do the MDS's as they are now, and no one's plan of care will mean anything still.

Is there a way for us to make OUR voices heard in a meaningful way?

I am an AANAC member, but you know how it feels to be the one saying the emperor is naked.......

ST

[GRACERN47]

If there is , Please let me know because I know my whole department will participate. There are 4 of us !

[katoline]

You know Susan, maybe there is something. Being an AANAC member, I'm sure you got the email asking how the site is doing, what we would like to see etc. I don't really go on their forums because I like it here, but maybe we should write back that we are all disappointed(?) saying it nicely, that we have to do 27 page discharges that we don't get reimbursement for, clogs up the system for those who go in and out, or just those residents that are long term, have an exaserbation of some kind and return in three days, making us have to do at least a discharge and reentry and most likely a 5day PPS if not a significant change is as short period of time. The discharges being put off, hold up the reentry assessments.

I guess what I am trying to say is have members be able to start polls. (or can we?) we did participate in a survey not long ago that I saw published in one of the long term care magazines. did it have to do with how long it took to do assessments, what other responsibilities we had? I can't remember now. Sometimes I tell other members of the team during morning meeting that I have no business asking residents questions I can't answer myself...what day of the week is it? bed, blue ...sock. everyone remembers blue for some reason. I often forget one myself when i talk about that section, then everyone laughs.

Can we start a Nurse Assessment Coordinators union? Or how about "let our voices be heard" to those in high places that impact our jobs.

[grannybhere]

can you tell me what your med A census runs on average? we have three of us in a 200 bed facility, two doing medicare and one doing med A. we are running ragged!!

[katoline]

welllll....the facility i'm at now has on average 62 filled beds, we run about 12 mcr. there is a full time and a half time person. where i worked before, 120 beds, around 25 mcr with two full time people.

i thought the smaller facility would be less stress, easier. they micromanage here, too many long daily mtgs, and too many redundant forms and having to presend assessments to an outside auditor is a plane waste. my previous facility software had built in checks.

the extra long discharges and extra OMRAs don't help the situation. how many med A/managed care do you run?

[dbsue1954]

I have found that it is becoming a little easier as i work with it..other than software issues, it has gone pretty smoothly. the d/c assessments are a waste of time. I use ALOT of not assessed/dash fills when doing them and so far have seen no negative outcomes. These assessments are not reimbursible so i feel if i do not have everything asked for, it is no great loss. the one problem we have encountered in our facility is the question which asks "have you thought about harming yourself/thoughts you would be better off dead" WHY DIDN"T THEY SEPARATE THESE TWO QUESTIONS????? Many of my residents answer yes theyf eel they would be better off dead ("I am ready to go"....I have had a good life.....I am tired>>>want to be with spouse, etc,etc,) but deny any thoughts of hastening their demise. however, if either section is answered "YES" you must answer a 1 which leads to the notification section. This has involved formulating a new policy/procedure, etc. related to suicide watches, etc. i just feel that who ever authored this question should have separated it into 2 parts.actually depite my prior opinion, it does seem to go faster and flows a little better, the change in font and only one column to a page results in needless tree death i think (we are still printing paper assessments for file) and we have had to purchase file cabinets instead of binders to hold these tons of paper assessments.