Help with RAP's...PLEASE!

[catmom1, BSN, RN]

I am a new MDS coordinator in a facility that has a huge number of rehab patients. (We call them residents, but they come and go so fast that they are more like acute care patients to me).

Anyway, we have so many admissions and discharges that it is an overwhelming task to complete a comprehensive assessment, including RAPs, on each one.

The detail of the RAI doesn't bother me and I am a stickler for paper-documented accuracy of what I enter into an assessment, but the RAPs are killing me.

Does anyone have suggestions on how to streamline the RAPs process so I don't feel so overwhelmed?

Thanks in advance for any help you can give.

Catmom :paw:

[Talino]

First we have to keep in mind completion of RAPs is only required when resident is still in the facility on the midnight census of the 14th day of admission.

A triggered RAP does not always suggest a care plan should be put in place but simply an alert to look into the trigger which may cause a problem or not. Triggers are not only identified upon completing the MDS. They were already present on the first few days of admission. If you pattern the discipline's initial assm't in response to a trigger, you will have a goal and care plan included in the assm't already even before the MDS is initiated.

Example:

Triggered RAP: Nutritional Status

Under Location of Information, enter "See nutrition assm't 2/2/07"

In the chart under Nutrition Assessment...

"2/2/07 - Problem chewing due to missing dentures. Able to tolerate chopped diet and consumes 80% or more of serving. Continue w/ chopped. Monitor consumption. Re-eval when dentures become available." -- signed Dietitian

Since CMS does not require a specific format, that alone is a care plan. And when presented to the interdisciplinary team, becomes a comprehensive care plan approach.

[catmom1, BSN, RN]

Good point, Talino. We do have more than a few "residents" who are not here through the 14th day. If I were to wait to complete the RAPs until they are in the facilty past midnight of the 14th day, how much time to I have to complete the RAPs? (I am thinking of OBRA requirements here)

By the way, I bet that deadline is in my RAI manual but I am at home and don't have it and I'll bet you know the answer off the top of your more experienced head.

Thanks again!

Catmom

[Talino]

If I were to wait to complete the RAPs until they are in the facilty past midnight of the 14th day, how much time to I have to complete the RAPs?

R2B and VB2 are due on the 14th day. Thus, if resident is still in the facility before the RN coordinator goes off, make sure R2B and VB2 are signed off. If resident was eventually dc'd before midnight of day 14, you can either complete the entire MDS (including VB4) and submit it or just keep the incomplete MDS on file and not submit. And if resident did remain in the facility on day 15, you're covered.

[RN 4 Life]

Just remember that if the resident is Medicare you must submit at least a 5 day assessment if they are in your facility past midnight the day of admission...Example: Admitted on 2/14/07 at 9:45pm and sent out to the hospital at 1am and admitted on 2/15/07 3 am = 5 day assessment must be done. No RAPS though!

[catmom1, BSN, RN]

Thanks for all the knowledgeable replies. My facility is paying for me to get certified by AANAC next week. I am looking forward to having some of these issues clarified.

What is clear to me is that I have more work to do than one person can keep up with, considering the huge number of medicare admissions at my facility.

Management had said they want to hire more help but for some reason they seem to be having trouble getting applicants willing and able to do MDS.

I like MDS, just not the overwhelming volume of work. :typing The overtime is nice but I need a life, too.

Catmom :paw:

[lpnbecky123]

In my facility I work the RAPS. NATURE OF CONDITION, CAUSAL FACTORS (usually the diagnosis(es)) OTHER FACTORS, RISKS/COMPLICATIONS, REFERRAL, CARE PLAN (yes or no), COURSE OF ACTION. I make sure that everything on the RAP is in the care plan, I LIMIT THE NUMBER OF CARE PLANS TO 6 OR 7, & combine where appropriate, i.e; 1; is Information-list the PCP, Code status, discharge plan, doctors visits, DDS, POD. FLU VAC & Pneumovac. The next is COGNITIVE FUNCTION/COMMUNICATION, ADL SELF PERFORMANCE/RISK FOR FALLS, CONTINENCE / RISK FOR SKIN PROBLEMS

, NUTRITION / HYDRATION, MOOD/BEHAVIOR PSYCH MED USE. Doing this tightens up the plan of care & makes it much easier to update. I guess some facilities have a large number of separate care plans, too much for me. The way I do it makes it much easier for the other disciplines to add approaches & make the care plans interdisciplinary. I have had 5 deficiency free surveys doing the care plans in this manner. Hope this helps.