CNA coding and QMs

[glm777, BSN, RN]

I need some advice. Since our regional team has been working from home, they are checking every MDS done. They are frequently asking me to change coding for ADLs because it will affect the quality measures since they require more assist this quarter per the documentation. But How do I know that one particular CNA, new to floor, doesn’t ask for assist to move this resident in bed? I am a big woman-I might be able to turn someone by myself while a smaller CNA may need 2 people. Their response to my argument is that I need to personally watch that CNA turn and reposition the resident! I work 24 hours a week and our long term care census runs about 122. I also run care plan meetings for 3 floors and send out the invites and open every MDS and the eval’s that go with it. I don’t have time to watch every CNA who codes differently do her job! And the reason is always that it will trigger the QMs.  I’ve been doing this job 22 years. I know that if a CNA coded a quadriplegic as ambulatory independently, it’s wrong and I need to change it and write a note but I don’t know what support every CNA needs to care for his/her residents! I have refused to change some responses because I am not be sure they are miscoded-and have been reprimanded for it.  I’m not sure what to do but I’m certainly not changing a response simply so we don’t trigger on the QMs! They even hassled me because our QM for locomotion triggered-our residents are still restricted to their rooms due to COVID! Of course their locomotion got worse!! I would appreciate some input. I’m really ready to give up on MDS-a job I used to love.

[Talino]

It can't be a one-man role. DON and staff ED should definitely be involved. Let the regional team know that the matter is already brought up to the attention of the Nursing Admin and beyond your authority. Should they have issues, have a conference call with the entire team, including the Administrator. Good luck!

[Sherry Washington, CNA]

I am an CNA licensed in approximately 25 states and I have 10 years experience.  I have traveled all over and I have seen most everything.  One thing I know for sure is that there is always somebody who thinks you are doing your job incorrectly but it is ALWAYS somebody who has never done your job.  A CNA sees what others do not.  We help patients/residents up close and personal so we have inside knowledge which changes day to day with patient condition.  Nobody in any facility is ever independent.  This should be common knowledge but it isn't.  If a patient/resident gets their meals cooked for them, their laundry done, their meds given to them, etc.  they are NOT independent.  If they were ambulatory yesterday but not today, they are given a higher dependency rating today.  You CANNOT CHANGE WHAT SOMEONE ELSE CHARTS.  You can insert a note saying what you believe is actually the rating but you cannot change what someone else charts because you did not witness it personally. The only reason to even insert the note anyway is to get more money from Medicare because the patient has a higher dependency rating.  Talk to your staff and share with them the financial importance of proper charting.  Give them a written explanation of what each level of dependency should be charted as but NEVER  change what someone else has charted.  That is illegal, unethical and could cause you to lose your license.