how do you all ahndle signing the MDS?

[glm777, BSN, RN]

Hi all. My floor nurses and other disciplines complete their own section of the MDS on an MDS form that I put in the chart weekly. I give them a 7 day time frame to complete it then I go to the chart, pull it and input it into the computer.

When they actually fill out the form, they sign the front sheet the day they do it. Some disciplines do it on the first day of the time frame - others wait until the last day so the dates are often different for each discipline.

Now, according to the RAI manual, the disciplines are supposed to sign the MDS ONCE IT HAS BEEN PRINTED. MY staff feels that this is not a true picture of when they completed the MDS. They feel that if they fill out the info, why are they signing that they completed it what could be 6 days after the fact? I see their point. Every other form we fill out has to be signed when we fill it out. Plus - what date should I be using for my R2B?

Should it be when the form was actually completed by every discipline or should it be the date that I input it into the computer? If it is the date I input it into the computer - what happens if a discipline is out that day? If I have them sign it the next day - the signature will be after the R2B!!

Can someone tell me:

1. What is the rationale behind the "date it the date you sign it" and

2. How do other facilities manage this?

Thanks for any input!

[Rexie68]

i'm not certain i understand the question, but i'll do my best. when a resident is due for an assessment, one of the disciplines (whoever starts first) puts the mds in the chart and completes their section after the ard. whatever date they do it is the date they sign. our floor nurses don't complete any of the mds. myself, for nursing (i'm the lpnac), social services, dietary, activities and therapy all complete their sections and sign it for the date they did it. after the "hard copy" mds is completed, our secretary puts it into the computer and prints it. we all then sign the printed form with the same dates that we put on the original "hard copy" mds. the printed form is put in the chart. we keep our hard copies in files in our office in case there's any questions and they go to medical records when the person is discharged or dies. r2b is the date that the last person completed the mds...that's the date our rnac signs, since that's the date the form is totally completed. i'd say the "date it the date you sign it" is what we're always taught to do....we put the date in that we actually do something....just like you wouldn't backdate a nurses note, you wouldn't backdate an mds......but re-signing a printed copy with the same date that you signed on the working copy isn't back-dating. hope this helps! good luck. (ps...i hope your floor nurses are well-versed in mds language. our staff don't fill out the mds because the rai manual definitions and common nursing definitions don't match.)

[edhcinc]

Hi--another way to "legally" sign the printed MDS, if a printed copy is signed a few days after all have actually completed it, is to sign like this--

I. B. Busy, Activity Director, 7/5/08 for 6/30/08

This indicates that a computer generated MDS was printed. Mr. Busy CAREFULLY REVIEWED the data entered information to assure its accuracy, then signed, no matter what the reason, the printed MDS on 7/5; he is indicating that he actually completed the MDS on 6/30/08,

However, am not sure why you are printing the electronically submitted MDS. If you have a PAPER MEDICAL RECORD, and only data-enter the MDS to meet electronic submission requirements, AND the electronically submitted MDS MATCHES the hard copy pen/ink prepared MDS, there is no requirement to do so. Having a pen/ink copy as "back-up" and placing it in the medical record at discharge is "overkill" and troublesome.

If a clerk data enters information because the professionals are "too busy", or the facility doesn't have enough terminals for staff to enter their own data, these are other issues to address. All staff must become comfortable with using computers and various software in the "near future." The interview information in the MDS 3.0 (beginning October 2009) should be available and "on the chart" almost immediately. Electronic Health records, as well as other demands, will require computer and software utilization.

One last point, which Roxie somewhat eluded to--you say that you give your co-workers 1 to 7 days to complete the MDS. This can be problematic, as memories quickly fade, and "laggers" can put MDS completion out of compliance. Staff, also, CANNOT complete the MDS until AFTER the ARD (unless the patient is discharged or dies on the ARD). Ensuring staff completion by day 2 or 3 after the MDS ARD may be "drastic", but it will assure better accuracy and less chance that MDS completion and submission are "late"--and less frustration for you!!

[Rexie68]

however, am not sure why you are printing the electronically submitted mds. if you have a paper medical record, and only data-enter the mds to meet electronic submission requirements, and the electronically submitted mds matches the hard copy pen/ink prepared mds, there is no requirement to do so. having a pen/ink copy as "back-up" and placing it in the medical record at discharge is "overkill" and troublesome. our consultants recommended this method. overkill, perhaps, but i have been able to justify a few things with umr by looking over the notes i've scribbled on the working copy. not troublesome, in my opinion.....if there shoud happen to be a discrepency between the two, it's easy to see where the breakdown occured....our data entry system keeps track of who put what in. besides, we're used to "overkill"....look at all the ltc regs!

if a clerk data enters information because the professionals are "too busy", or the facility doesn't have enough terminals for staff to enter their own data, these are other issues to address. all staff must become comfortable with using computers and various software in the "near future." the interview information in the mds 3.0 (beginning october 2009) should be available and "on the chart" almost immediately. electronic health records, as well as other demands, will require computer and software utilization. we find it more time efficient for non-professional staff to enter the data into the computer for us. this allows us spend less time trying to get access to a computer, log on and off, etc. she can input everything at once. we're all comfortable using a computer, as we communicate via email and write our care plans on a computer, and we're online just like everyone else. as far as 3.0 goes, i'm sure we'll have the interview information on a separate form on the chart "immediately," and everything from the "hard copy" will be entered into the computer as it is now. we'll find out for sure once 3.0 actually goes into affect and work out the specifics as we go along.

one last point, which roxie somewhat eluded to--you say that you give your co-workers 1 to 7 days to complete the mds. this can be problematic, as memories quickly fade, and "laggers" can put mds completion out of compliance. staff, also, cannot complete the mds until after the ard (unless the patient is discharged or dies on the ard). ensuring staff completion by day 2 or 3 after the mds ard may be "drastic", but it will assure better accuracy and less chance that mds completion and submission are "late"--and less frustration for you!!

2-3 days after the ard? gosh, that must be nice. i'm happy that we have 14 days to get them done (except for admission) because if we have 20-30 mds' with ard's in one week (less or more depending on our skilled population) there's no way they'll all get done within 2-3 days. we all have calendars with the ards written on them and cross them out after we've completed our section, so that no one has to rely on their memory! if i see that it's day 12 and someone hasn't finished one yet, i remind them and offer to help if needed. i think we only had one out of compliance last year, so it works for us.

[edhcinc]

In some ways you are right--if something works, why change it?

Right now, most/many staff believe that the MDS has no real clinical value. So completing it days after the information was gathered, and not having the information on the record, is of no concern. Unit staff "doesn't understand". But we must change this perception and have 14 months to work on it. All professional staff will spend less time on MDS 3.0 than 2.0--and gather somewhat different information. Paying a data-entry person may not be the best route. Each facility will need to look at their process/workflow. We certainly do NOT want to repeat our MDS 2.0 errors, or continue duplicative or unnecessary work.

This type of conversation will be continued, re-created, changed by opinions, debated, ignored, etc. But we all must realize that a change IS coming.

The way we gather, re-configure, and document MDS 2.0 info, in some ways, is a "mystery"--one done only "experts". MDS 3.0 is more straight-forward, timely, and clinically oriented. We may find that unit staff demands to be involved, and/or will want to know the findings immediately--especially if the findings impact actual care given or planned--and they will!

Good luck to us all!!

[KristenLPN]

Wondering why you are dating after the ard date? Assessment reference date...with a 30 day/14 day and a 7 day lookback period, is every department on the same time frame? For instance, ARD of 06/09/09 7 day starts on 06/03/09, 14 day starts 05/27/09, etc. How can you sign after the ard date of completion if it is supposed to be done BY ARD? Not understanding. There is to be a signed hard copy (same one that is transmitted) in the chart. The day signed is the day completed which is the ARD date. The only date that can be different is the R2B day, up to 14 days after ARD day, but no more than 92 days between ARD.

[Rexie68]

Hi! I'm not sure if we're talking about the same thing....the ARD is the last date of the assessment period. Staff then has 13 days after that to complete the MDS....with the exception that the admission MDS must be completed by day 14 of admission. If my pt were admitted on 06/01/09, her admission MDS must be completed by 06/14/09. We would make her 5 day her admission assessment with an ARD of 06/06/09 (or another date close to that). Her 14 day ARD may be 06/14/09, and staff has until 06/27/09 to complete it. Again, the ARD is the last day of the assessment period...not the date that the MDS must be completed by. Hope this helps.