Published Feb 8, 2002
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I have found the biggest time saver in completing your MDS's, raps and CP's is to put your foot down and just say "NO!" to doing everyone elses job and stick to your own duties.
I was getting pulled to work the floor, settle staffing "emergencies", give facility tours, and everything ELSE that nobody else had time for.
I also come in sometimes at 4AM or any other time when I can just be left alone to do my work.
I work in a 118 bed facility and pps is a part of it. We are not a case-mix state yet but get a higher reimbursement for hnf medicaid and I do a good part of setting up what needs to be documented etc. for hnf justification.
I like the job fine and can do it on time if they just LEAVE ME ALONE!
Thanks Russell, I am pulled in the same way at my facility. I had years of experience with Hospice, and since I am comfortable with dealing w/pain, death/dying, I am called on alot. I also know the MD's pretty well in this area, d/t my prior Home Health Nursing, being the liason/admission nurse, so many of the doc's will usually respond to my calls fairly well. But in addition to this, I supervise when the adon/don are gone, and take call q3rd week end in the facility. I am lucky that I have great boss's: adon/ and don. They are currently learning how to do MDS/raps and care plans. God love them. But my hardest hurdle is how to do my raps in a day. Usually in our facility, a 14 day MDS w/raps and care plan takes at least 6 hr to do w/o interruptions. I know there are facilities that the MDS cordinators can knock out several sets of raps/ care plans in a day...............I have been asking alot of questions on this site, hoping to obtain advise and guidence from the more experienced nurses.........I just looked at my time card for the last two weeks 108 hours. I know my facility is glad I am salaried. I do get comp time, but when do I take the time off. Thanks for your response...........Tex
P.S. Russell I work in a 122 bed facility. Our census is currently 100. Tex
I am a fairly new coordinator from Ohio, about 6 mo. or so since I began doing MDS's. Before that I wrote care plans for our 122 bed skilled facility. We specialize in rehab and all the beds are licensed for Medicare; we also accept ventilator patients and have had up to 5 pediatric vents at a time. Our census turnover is incredible, probably averaging 6 to 10 admissions per week. Last month we broke the record w/ 6 admissions in a day! We have 4 coordinators; 2 for PPS and 2 for Intermediate MDS's. We hand-write our RAPS (a pain in the ***), and our care plans are on computer. Each discipline is responsible for their own MDS sections and their care plan problems. I'm still getting the hang of it; we have the building divided and we each track and submit our own MDS's. We have a pretty good system going, but it has been a stressful transition for our whole facility.
GeorgieGirl........Instead of hand writing your raps, we did until a year ago, we just go to word perfect and type in the raps. example: Cognitive # & Communication #..: Triggered: (in this we list the triggers exactly like what is on your triggered sheet Then we go into why when where.....Hope this helps, this is saved on a disc, then we can go in a year from now or with any significant change and use what we have or modifiy it.....hope this helps Tex
catlady, BSN, RN
I never spend that kind of time doing RAPS. I don't have that kind of time. I am a unit manager, which is head nurse, day supervisor, chief cook and bottlewasher, in addition to MDS, PPS, and care planning.
I am always looking for ways to streamline my RAPS. I gave up using the Briggs hand-written forms, as well as the computer-generated trigger sheets, and just do a narrative that I type on the computer. I write which sections caused the triggers; I address areas of relevance, with parenthetical references to documentation in the chart, and I close with my care planning decision. But even if there are ten RAPs, it would never take me 4-6 hours to do them. The Medicares are actually easier because the nurses are required to chart every shift. The Medicaid residents rarely have good documentation in their charts--heck, they rarely have *any* documentation. I have been told that if the documentation is good enough, you don't have to write anything--you just send the surveyor to the documentation. Your RAP would reference the note, and state that you are proceeding to care plan. I have basically told TRD to go ahead and just do that for Activities. They were very confused about how to do RAPS (and I didn't understand their section much better), so they would code their residents in a way that they would never trigger. But they write detailed notes on everyone, and they care plan everyone. So a separate RAP summary is just silly. Now they will just code the resident appropriately, and when Activities triggers, reference their own note and be done with it. My counterpart (the other unit manager) and I have begun to take over the monthly summaries, and we write them in such a way that we can use them as our primary RAPS source documentation. I think this is good in two ways--the RAPS are complete, and the nursing documentation is solid, fer shur. :) I've never had RAPS go over two pages, total, and the state had no issues with my RAPS on our survey. I did inservice the nurses on charting for the MDS, and the documentation is now marginally improved. ;(
I have about 50 standardized care plans that I have made on my computer, with checkboxes for each intervention (pick and choose). I leave room to write in individualized comments. I have started redoing them with a tag that identifies which RAPS they address (some, like pain, don't fit--yet). It is rare that I can't address all the RAPS with my canned plans, updated for the particular resident. But it is always a challenge to come up with a care plan that is specific enough without being so specific that you'll get hanged if something on the care plan doesn't get done.
does anyone know of a computer program for care plans. I recently change facilities and know work for a smaller company who does not have anything computerized and feel like I am wasting time writing out care plans when I could be doing numerous other things. I would appreciate any help anyone can offer
AccuMed is a computer software package for MDS that includes RAPS and care plans. I'm sure it's pretty expensive. There are software programs out there--do a search and you'll find some, I'm sure.
I was bringing my laptop to work and creating my own templates in Microsoft Word, because there was nothing in my building. Everything was done by hand. Not even a decent care planning book; had to buy my own.
I also have been writing my own careplans.but after working for a large corporation this seems like a waste of time.They had everything computerized which was really nice because you could compile data on anything that was on the mds.
I would like to know what you think of compiling a quarterly summary that would cover everything from falls to weight loss/gain and ROM decline to follow the QI's. I think this would help cover area's that are not on the MDS and focus more are area's of decline. It could be a checklist type form that could be completed quarterly with all the assessments. or do you think I would be wasting my time??
From what I understand, quarterly summaries are how they do it in the building I'm *starting* on Monday. I like the idea, because it will give you supporting documentation for not only your MDS and care plans, but you can cite them in your RAPS. I wouldn't just focus on decline, but also look for areas of improvement, so you can say on your care plan that you're achieving some of your goals.
Now who did you have in mind to complete these quarterlies? You, or the nurses? The building I just left required monthly summaries, but the staff was so noncompliant (and the quality was just not there) that we unit managers ended up doing the monthly summaries just to give ourselves good documentation to use for RAPS.
I AM GONNA DO THE QUARTERLY REVEIW FOR THE RESIDENTS ON MY UNITS. I WILL DO THESE WITH ALL ANNUALS AND QUARTERLY MDS's. I CAME UP WITH A FORM THAT IS 3 PAGES IN LENGTH AND HAS A SMALL SUMMARY AT THE END OF EACH SECTION, SO THAT WHEN THE STATE SURVEYORS COME IN AND ASK QUESTIONS RE PSYCH MEDS,WEIGHT CHANGES I WILL HAVE A LITTLE SUMMARY WITH BACKGROUND INFO. TO PRESENT TO THEM. I WILL ALSO HAVE A AREA AT THE END OF IT THAT IF IT IS DEEMED NOT TO ATTEMPT REDUCTION OF MEDICATIONS I CAN DO A RISK/BENEFIT AND HAVE THE M.D SIGN IT ON ROUNDS. I SHOWED THE ROUGH DRAFT TO THE DON AND SHE LOVED IT. IT WILL HELP FOCUS MAINLY ON QUARTERLY MDS's FOR AREA's THAT CAN BE MISSED ON THE MDS.
Sinead, what kind of software are you doing your MDS on? A lot of times these have careplan software incorporated. If not, I have also used Word or Word Perfect as catlady did. Once you get the basic care plans in they can be easily modified for your needs.
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