Mds

Talino · Feb 6, 2002

For a start, you only do RAPs if the PPS assessment is ALSO a Significant Change in Condition, an Annual Assm't, or an Admission assm't. You only do PPS assm'ts if a resident is on Medicare. Distinguish between an OBRA and PPS requirements.

You type RAPs??? RAPs is simply reminding you of a trigger which can be a problem or not. Such a trigger may already be addressed somewhere in the medical records or in the care plan. Simply refer that triggered RAP to that record.

Your facility should have someone who will be responsible for transmitting the MDS after you have certified its completion. The RN position is a wasted skill for a clerical job - data entry.

The MDS Coordinator should be focused on training, scheduling, maximizing reimbursements, coordinating care plans, and facilitating prompt completion. Hence, should be a full-time dedicated position. Until you can settle in with your new responsibility, the Care Planning duties should be assumed by the ADON. It's time to have someone else do the supervision on the 3rd weekend.

I am responsible for 264 residents, an average of 50 are PPS. I also do the scheduling, care planning, coordinating rehab rx mins. to maximize reimbursements, and policing other disciplines for prompt completion. We have a clerk that does data entry and weekly transmission.

122 would be "a walk in the park".

"Work on a system and it will flow like a stream." Organize, organize, organize. Good luck!

tex · Feb 6, 2002

Thank you for your reply. I do understand the difference between medicare pps, annuals, significant changes in a residents status. When this occurs, the trigger sheets will be printed (working the raps), and a decision to care plan. I am in North Carolina (did get my RN in New York) but I was always told that a written or typed narrative with each e.g.: cognitive, adl's, urinary inc. I probably didn't explain myself clearly. In any case, it would be wonderful to have your experience. I do refer through my narrative, refer to MD progress notes, labs, therapy, nursing notes etc. I also work very closely with the therapy department making sure that q one can recieve the most etc. If you could e mail me a sample of how you do your raps or further suggestions I would appreciate it very much. You are correct this should be a walk in the park, thus far it isn't. Today we recieved 5 new admissions all pps/medicare. # of them have behavioral/mood/psyh problems. Thanks tex

CoachCathy · Feb 11, 2002

Hey tex, me again. We are a facility that is part of a "chain" throughout NC. We have a "short-cut" book that we can refer to. I understand that it is hard to start from scratch, knowing what the state is expecting to see. How does your system work? With our computers, we enter the MDS and it spits out the RAP summary sheet and the RAP sheet. We also have a form that our company uses. It is a nine-block form that kind of streamlines the process for us. Do you have anything like that? It helped to eliminate the narrative part, you only have to put data into the little blocks. Again, I am not the fastest at MDS - I usually do QA, but I do it when the regular MDS person is on vacation. I disagree that 100 or so would be a "walk in the park" to someone with your experience. Heck, I know people who have been doing MDS for ten or so years for 120 patients, and they still get stressed. With all the down-sizing that we are seeing in LTC (did you REALLY need that data entry person, or that extra MDS person?), the MDS coordinator becomes the nursing MDS department. let me know if I can help more --- keep smiling - makes 'em wonder what you're up to!

tex · Feb 12, 2002

I to am in North Carolina. my facility is privately owned. We too have a system that will spit not only the mds, the triggers & the whether to careplan under summary. we had the former system that would spit out the check list so to speak, that I refer to from a notebook to answer questions. It has been determined that this check list, has caused alot of sitations from the state. I understand the state doesn't like this check list. Am I wrong? It still is a long and tetius task. I am so afraid if I don't put down under urinary rap, what the labs are, or under cognitive in detail what they can recall exactly with a 5 min test etc.... Care plans are what we got sited for. And As much as I am trying to cut down on my typed narrative (working the raps) I still feel like I am typing a thesis. What is the name of your system? How long does it take for you to do a 14 rap on a pps resident. thanks tex

CoachCathy · Feb 12, 2002

Ya know, Tex, I really don't know the name of the program!!:imbar I'll check tomorrow when I go in and let cha know! hee-hee. I differ from the regular MDS nurse in that I actually like doing RAPs. I'd rather do a set of raps than a full MDS. To me, it's like putting together a puzzle. Once you get to the rap stage, your information seeking should be done, and all that you are doing is sorting through the information. When I go to work on the raps, I make sure that I have the MDS and the care plan in front of me. I generally like to use the phrasing that you see on the MDS, only because it seems that it what the surveyors are looking for. Take the urinary rap - At the top of the rap sheet, it lists "reasons triggered" and gives you incontinent 2+ times a week (occasionally incontinent), incontinent 2+ times a week (usually incontinent), incontinent 2+ times a week (frequently incontinent), use of pads/briefs. Does your program do this? I'll then go back to the MDS and write the wording that is used there "incomplete bladder control", "incontinent urine less than daily", etc. With the use of pads/briefs, I always put "disposable briefs used". (cuz they are!!). The next section on our rap sheet is the "contributing factors", e.g. DM, use of diuretics, dependence with ADLs, etc. Again, I go back to the mds to justify what triggers a yes. Here is also where the chart is necessary. You can put "Humulin 70/30 15U qam" next to DM, or the Lasix dosage next to diuretics. Once that is completed (again, I really don't use narratives, but will put dates of nursing notes, social notes, etc. on the rap to refer state when necessary. Why write the same thing twice? ) Then we go to our worksheet, which is a nine-block form. I don't remember if you said that you used this or not.... We don't care plan routine nursing care, so if a person is incontinent, and not a candidate for a toileting program. I write "will not proceed to care plan, protection and containment program is part of routine nursing care", and will leave it at that. I have been at this building for almost two years, I was at another building in the same corporation for four years before that. The building that I am in now was in real trouble - fast tracked with DFS - surveys every six months, sub-standard, etc., etc. We have only had one deficiency cited in the past year (knock wood), and that was a transcription error with no harm. Anyway - it's good to see that you are able to keep your sense of humor!! I am in Coastal NC, and have seen seven different survey teams in the past year (we actually had survey in our building three times from Thanksgiving through Christmas!! between annual and complaints) What part of the state are you in? take care-

CoachCathy · Feb 12, 2002

ooops! sorry tex - with all that I actually forgot to answer your question!! If I am not doing my regular work, I can do three to four sets of raps a day. (that is given that I am also not doing careplans, assessments, etc.) Some of the raps you can bundle together - like the interventions for urinary can sometimes go under pressure ulcers. take care ---

tex · Feb 12, 2002

thank you so much for your info,,,,,i am located on the coast up from wilmington, tex

CoachCathy · Feb 13, 2002

Golly, we must be neighbors or something - I am in Jacksonville!!! :) I have found the surveyors in our area to be thorough, but fair, in the area of MDS. As long as you can justify why you proceeded/not proceeded, they are okay. The major concerns (that we were able to discuss through) were things like significant changes (especially when noted at the time a quarterly is due), VB2 and R2B being within the dates, dates of the assessments in general. From what I have seen (again, we had nine surveys during 2001), they didn't nick pick too much. I don't see where a narrative note is required, just make reference to specific areas in the chart. take care -

tex · Feb 13, 2002

Yes, I am real close to you, about 45 min on the coast.......So clearly the state doesnt require 4 + hours of typed narratives, I understand why or why not to proceed, and I type in through my narrative refer to different areas, such as labs, md notes, nurse notes, therapy progress notes, but still explain in detail a story about each resident..........thank you tex

jayray · Feb 16, 2002

For a urinary rap instead of putting all the labs in I just put in See lab dated 2/10/02. You only need to touch on the problem areas. Refer reader back to lab, n.n., Dr. notes. I was taught raps should be short. Example... Resident has functional incontinence r/t dx of alzheimers. wears briefs, staff does brief changes and peri care q episode. No s/sx uti, see lab 1/20/02. Drinks independently see I/O records. ect..

MDI has soft ware that flags the raps that are triggered. MDS nurse does nursing raps and care plans. Dietary does food related mds section, social worker does there section ect.. the mds coordinator makes sure all sections are done.

The MDI software also has a section for care plans and you just click on the ones you need and they can be printed out. You can also add your own care plan requirements to them. You can do care plans in just minutes.

With the MDI system they also set up training programs to everyone can learn how to do them.

tex · Feb 16, 2002

thank you jayray.............tex