Careplans and Quarterlies

Ruas61, BSN, RN · Sep 10, 2011

Careplans or the actual quarterly MDS? How big a facility and what numbers do you run for Medicare/Insurance residents.

montecarlo64, ASN, BSN, LPN · Sep 10, 2011

Are you talking about quarterly MDS assessments or quarterly assessments such as bowel and bladder, braden, dehydration, etc??

Bella'sMyBaby · Sep 11, 2011

The MDS Dept is not taking care of the patients, the staff nurses are...

The MDS Coordinator pumps out the paperwork for Reimbursement and the Government...

For the most part, the MDS Dept completes an MDS every 3 months...So how could they keep all careplans current?

My MDS Dept is drowning in work; we can't keep up the way it is...

We don't take breaks/lunches...we are Salary & work well over 40 hours weekly...we come in on weekends...MDS is a seperate job for good reason...

The nurses taking care of the patients should be doing their own quarterlies as well...they are the ones who need to know & intervene if there are problems (such as pain). :eek:

katoline · Sep 11, 2011

There could be an acute folder with simple careplans for use until the MDS nurse can fine tune. It could be part of a check off for change in condition.

I once had state come in and ask to see a chart, then want copies made of careplans. I thought we were doing well and asked the surveryor was there a problem, she couldn't really say, but when i looked at the nurses note, i understood. A resident was transferred and a rib was cracked. She was fragile, had osteoporosis, but it was still a sentinal event. That occurred not long before and for whatever reason, there was no new careplan for transfers. The hands on staff did a great job of changing cardex to mech lift transfers, educating staff with a form and signatures so all i had to do was add a careplan. We had an action plan in place already. Believe it or not, we were deficiency free that year. I've called MDs when I think there is a change or to notify them of consistantly low blood sugars, what insulin doses and accu checks are. I let the charge nurse know, so if there is a call back she's not in the dark. We really need to work together and respect each other. We're all tired and overworked and i don't think it's going to get better any time soon.

I've worked at the big K and the staff nurses did the risk assessments, at the big S, MDS does them. I don't know what CMS requires as far as those assessments go, but company to company they are done differently, so it's not an MDS 3.0 thing. Your company may have a policy, if it does, that is what CMS will expect.

CapeCodMermaid, RN · Sep 11, 2011

Care plans are supposed to be working documents not something to be updated every 3 months (yeah ok stop laughing).

The floor nurses should be instituting/changing/updating the care plans as the resident's condition changes. How is the MDS nurse going to know if someone gets an abx for a uti? Whoever takes the order should do the care plan. New pain med--same thing. Quarterly-the MDS nurse would know (I hope) if anything triggered a sig change, but really care plans are everyone's responsibility.

I, too, worked for the Big K. The floor nurses did the assessments (bladder,pain,falls) and the MDS nurse did the actual MDS.

pixie120 · Sep 11, 2011

Ok, I will admit I am not at all familar with MDS. I am a fairly new DON and need some MDS advice. The current MDS nurse wants the floor nurses to do careplans when they write new telephone orders that would warrent careplanning a new diagnosis or behavior. She is also wanting the nurses to do all the quarterlies for her. It is my understanding that MDS 3.0 requires the MDS nurse to do the quarterlies. My nurses are already overwhelmed with everything else they are responsible for. Any advice?

Census? MDS is very techical, "just anyone" cannot do it, it requires training and proficiency. Quarterlies are shorter but he careplan still has to be updated, as do all the assessments: restraint, fall, pain, braden.....etc. I do agree that with each T.O, that nurse add genericly that order to the existing careplan (don't train them to put mg or anything very specific on c/p...all meds as ordered by md, etc should suffice with date and initial...surveryoers love handwritten updates). They should get dx for every new med, and sw should get copy of or the pink T.O every morning to careplan the new behaviors, add to behavior sheets as back-up.

MDS coordinator is suppose to coordinate/oversight all of that, and do the careplans, print out and bring to care conferences, which technically MDS should attend, but rarely has time, and RCM's should attend, update careplans at CC. It is a good recoomendation for the floor nurses to get familiar with the chart (lol) and careplans as many try to stay as far from it as possible and that isn't a good thing. Can you send any of the RCM's or floor nurses TO MDS training? THat would bolster confidence and proficiency and can your MDS or your regional come and DO MDS charting training, so MDS's are supported by the charting which is more of a floor nurse responsibility. Hope this helps?

pixie120 · Sep 11, 2011

Care plans are supposed to be working documents not something to be updated every 3 months (yeah ok stop laughing).
The floor nurses should be instituting/changing/updating the care plans as the resident's condition changes. How is the MDS nurse going to know if someone gets an abx for a uti? Whoever takes the order should do the care plan. New pain med--same thing. Quarterly-the MDS nurse would know (I hope) if anything triggered a sig change, but really care plans are everyone's responsibility.
I, too, worked for the Big K. The floor nurses did the assessments (bladder,pain,falls) and the MDS nurse did the actual MDS.

THe MDS nurse should be hearing this in the am nursing meeting/PPS/MDS meeting when the telephone orders are all reviewed by the IDT/DNS/MDS/RCM's. ABO T.O's should go to infection control nurse who can also careplan, and there are companies that make T.O's with all the reminders to be checked off on the T>O prior tosaying it's done. DO you have RCM's/Charge nurses who oversee each unit?

CapeCodMermaid, RN · Sep 11, 2011

We don't have a traditional stand up meeting where I work now. If anyone needs information, they have to call the units, email the nurse manager, or get out of their office and go to the unit to get the information first hand. We don't have those pink slips any more, either. Any new order of importance is supposed to go in the 24 hour report book.

txdon · Sep 11, 2011

My facility cencus is 89 with 19 Qmix. Thanks for clarify careplans and quarterlys. At my facility we don't have unit managers to oversee this process. Each nurse is now responsible for careplanning t.o's and changes. They are assigned 8 residents who they are responsible for doing the quarterlys. One more question: The current MDS nurse is always harping on the poor quality of charting. What is truly need for the MDS nurse? We do daily head to toes and a small narrative regarding what transpired for the resident that day. Any suggestions on how to improve documentation?

itthybitthythpider · Sep 12, 2011

If they are being skilled for Part A, it needs to be very detailed. If they are working with therapy, nursing needs to document what they are doing and if they see any progress. For wounds, you need very detailed description of the wound itself. At one facility I worked at, we had a page in front of the nurses notes section that was specific to what we needed the nurses to chart on. In the facility I'm in now, they have a flow sheet for daily skilled charting and all residents get the same sheet.

In all my facilities, the nursing staff has been responsible for TOs, care plans of all short term (and quite a bit of long-term) issues, and documentation. The IDT then comes behind, reviews and tweaks the care plans.

When I was doing MDS, my DON was trying to say I needed to do all care plans, including DCing 72-hour ATB care plans and what not.... I kept trying to tell her that I couldn't be responsible for all the short term care plans. I was the only MDSC in a 114 bed building!

I would generate the quarterly nursing assessment schedule to coinside with the quarterly MDS assessment, and the nurses would do it. We broke it down so that each shift had a couple of pages so it wasn't such a burden on them. MDS entails a lot of data collecting and we really depend on nursing and CNA documentation, otherwise it could take use 3 times as long to run around and interview everyone, which also takes up the other staff's time.

When we are in a resident's assessment window, we are very focused on that resident and may see something nursing may have missed. We spend a lot of time fixing things, calling docs, following up on things, getting orders if we need to, etc, but the rest of the three months until their next quarterly rolls around, we aren't focusing on them. That's why we depend on the nurses.

pixie120 · Sep 12, 2011

My facility cencus is 89 with 19 Qmix. Thanks for clarify careplans and quarterlys. At my facility we don't have unit managers to oversee this process. Each nurse is now responsible for careplanning t.o's and changes. They are assigned 8 residents who they are responsible for doing the quarterlys. One more question: The current MDS nurse is always harping on the poor quality of charting. What is truly need for the MDS nurse? We do daily head to toes and a small narrative regarding what transpired for the resident that day. Any suggestions on how to improve documentation?

The MDS nurses are looking for this:

"Resident alert to self, STM. Inc B/B. Intact skin. Surgical incision healed. 2 person assist to shower chair. On person assist to bathroom. Usually continent with phsycial assist to bathroom. Always continent bowel. Denies pain after percocet, had pain 8 of 10 prior. B/P, Vitals, wt. N.O. Lasix 80 mg, placed on daily weights, Continues on abo for UTI, foley draining clear....dx is MS/neurogenic bladder.......NO s/x depression noted and no ASE for Antidepressant usage (new med). Lung CTA,BT x4, ate 50 % at lunch with set up and cue. No ase from recent NIF, 2nd NIF since admit last week. Tabs alarm in place.Working with therapies, progressing to FWW."

They want ADL, pain, b/b, fall hx.