Careplans and Quarterlies

Specialties MDS

Published

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?

Specializes in Geriatrics.

Your MDS nurse is looking for documentation to help her code that particular resident. The MDS and care plan should paint a picture of what is going on and it can only show that if the documentation is in the chart. She is looking for behaviors such as refusing care, combativeness, wandering, delusions, hallucinations. She is looking for shortness of breath - and if it occurs - when? At rest? on exertion? Lying flat? She needs to know about continence or incontinence. Hopefully all disciplines are writing in the chart any changes or updates such as dietary, treatment nurses, social services, activities and the interviews are being completed. It is so difficult and frustrating to complete an MDS when you know what is going on with a resident and there is no documentation.

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Specializes in Gerontology, Case Management, Pediatrics.

You might want to network with your state DON organziation. Ask the more experienced DONs how they manage this issue. The charge nurses should be working with the MDS coordinator on careplanning. From my years in LTC/skilled nursing, staff nurses did not have the time. It was one nurse for 30 residents on LTC on days and evenings and one nurse for 60 on nights. If your nurses only have 8 each..wow, that's good staffing. Ask your MDS coordinator what she means by "poor charting". Don't the nurses chart by exception? I agree that if a resident is started on an antibiotic for a UTI, the nurses on the floor should add that to the care plan. Don't the units have weekly care plan meetings to review new issues? When you meet with residents and family/caregivers to review plans of care, they can/should be updated then. We used to have the resident or family sign the care plan with us showing they agreed to the actions.

Best wishes to you!

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Specializes in gerontology.

I put out MDS 3.0 hardcopies to all the "neighborhoods" and also sent along a "suggestion" list of things to chart to for the MDS (pick and choose) for each shift to be charting during the reference period. All staff has access to the hardcopy and are expected to familiarize themselves with it.

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Specializes in LTC, Nursing Management, WCC.

Our charting is pretty straight forward thanks to our software. We select MC: and the admitting diagnosis... it then takes us through whatever assessment it is looking for. For example MC: Rehab for functional loss, or MC: Pneumonia, MC: Hip fracture, etc. Our nurses do the assessments but it is up to us to interpret the information and incorporate it into the MDS and CP process.

We have report every morning. We make copies of our 24 hour report and head off to the meeting. We do not have "MDS" nurses. We are nurse managers in charge of everything that gets thrown our way. I would not want floor nurses to do the MDS process. It is not as easy as pointing and clicking. The question on the MDS might sound simple until you check the RAI and get a 2 page explanation on what NOT to include in the one loaded sentence they asked. Furthermore, I do not want them to do care plan because in the end, I will be the one answering to the state. My nurses do not have time for such things. I need them to perform assessment on critical patients, run the unit, supervise the CNAs, ensure showers and cares are getting done, medications passed, orderd transcribed, MDs called, labs reviewed, family dynamics, admission and discharges, etc. They have enough on their plate. I'm sorry but if your MDS nurse is having such a problem, then I suggest she spend some time with the nurses and explain what she needs from them. I apologize again, because it sounds like she is pawning off her work onto others.

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Our charting is pretty straight forward thanks to our software. We select MC: and the admitting diagnosis... it then takes us through whatever assessment it is looking for. For example MC: Rehab for functional loss, or MC: Pneumonia, MC: Hip fracture, etc. Our nurses do the assessments but it is up to us to interpret the information and incorporate it into the MDS and CP process.

We have report every morning. We make copies of our 24 hour report and head off to the meeting. We do not have "MDS" nurses. We are nurse managers in charge of everything that gets thrown our way. I would not want floor nurses to do the MDS process. It is not as easy as pointing and clicking. The question on the MDS might sound simple until you check the RAI and get a 2 page explanation on what NOT to include in the one loaded sentence they asked. Furthermore, I do not want them to do care plan because in the end, I will be the one answering to the state. My nurses do not have time for such things. I need them to perform assessment on critical patients, run the unit, supervise the CNAs, ensure showers and cares are getting done, medications passed, orderd transcribed, MDs called, labs reviewed, family dynamics, admission and discharges, etc. They have enough on their plate. I'm sorry but if your MDS nurse is having such a problem, then I suggest she spend some time with the nurses and explain what she needs from them. I apologize again, because it sounds like she is pawning off her work onto others.

I understand the floor nurses are busy, when they get a new dx/treatment, all they have to do is turn to the careplan, handwrite somewhere a new C/P: UTI goal: Resolve UTI Interventions: ABO as ordered, montior for ASE of ABO, report s/sx new UTI once ABO done. Takes a minute. Good practice, good for all. Surveyors just exited our building, spent far more time with floor nurses than ANY of the nurse manager staff. IF your floor nurses were to say "Oh, I dont' do that, the MDS , RCM, SDC, DON does that.........." Really, and are they the primary care nurse? It doesn't fly. The more times they practice a short term c/p the faster they will get at it. Same with elopement, new fall, new injury, interventions are just whatever you are doing right then for the patient.

THe nurse managment team can come behind later and tweak the careplan. I have been for over 10 years as a nurse manager, careplanning events I never witnessed, wasn't in the building when it happened, and now have to investigate, re-interview etc and then careplan the event. It can be careplanned, investigated immediately, takes a few moments, the more you do, the more you know and the more it makes sense to you. (That's how I learned....).The witness statements need to be filled out right away, by the C.N.A, then the nurse careplans it, so...if the nurse adds a wanderguard, go careplan it short and sweet. The number of resident's that the nurses are now expected to care for has dramatically dropped, taking care of 15-18 residents, in LTC is very doable. Medicare 10-15 very doable. No time to sit around and cry,whine and point fingers...and if you do, PLEASE careplan that!! And in this state, the economy is affecting nurses as well, and we are finally seeing nurses understand that and be willing to step up to the plate and be part of the nursing team. Communication is everything. If the floor nurses can't do short term careplans, or if they say they don't know how or don't have time, get them some training and support them in this learning process. If they have their heads buried in that bloody MAR, for god's sake stage an intervention. MOst of those meds are completely benign, useless and if the floor nurses would speak to the families and MD, can whittle those meds off that bloody MAR, and then focus on the actual patient. Careplanning and updating the CNA careplan/Kardex if far more important than making sure 89 year old Wilma gets all 16 of her bloody vitamins, plus one important med.

WHen I was running a 40 bed dementia unit, we whittled those drugs down to the barest nubs of important cardiac, HTN meds (and some of those can go away as well, ask the pharmacist if you aren't convinced) and no less than 10 had NO meds, ZERO, (and they had a ton less behaviors as well) we made a boatload of Hospice referrals and we focused on pain meds and bowel meds, and then...activities. We took a 4 hour 8 am med pass and got it to less than 1-2 hours, so the floor nurse could supervise the cares given. We also did a ton of care conferences and met with families to increase/personalize the care given, care goals. Yes, it takes time, but it is so worth it!!

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