How will I correct Prevalence of antipsychotic w/o psychosis - QI/QM?

[lionjr]

I'm having problems with this... I just replaced the old MDS with all these problems. How will I correct the Prevalance of Antipsychotic use without psychosis diagnosis etc. etc... If I am going to do the Quarterly Assessment and patient used antipsychotic meds for 7 days (7 days look back), patient was on that medications and diagnosis like for 3 years. Do I need to put the psychosis diagnosis in I3 so that it won't trigger? But I3 is only for diseases diagnosed in 90 days right? My DON told me that I need to correct everything, next assessment I should put the psychosis diagnosis if applicable regardless it was diagnosed long time ago because it wasnt coded right by old MDS and next assessment would be the right time to code it... is she right??

[SuesquatchRN, BSN, RN]

Any current diagnosis that drives care is included. If they were schizophrenic three years ago they are still schizophrenic and need the Seroquel as much as they did they.

[Bella'sMyBaby]

Make sure that the appropriate diagnosis is on the monthly re-writes that the Dr. signs. Code the dianosis with the appropriate ICD number & this should be sufficient.

[lionjr]

Thank you guys!

[SuesquatchRN, BSN, RN]

There's another thread on this around the geri forums and I can't find it. It was quite comprehensive and helped me a lot.

[CapeCodMermaid, RN]

There are TWO (at least) other posts about this. I saw one, couldn't find it so I started another. Obviously if so many of us are having problems, it must be the SYSTEM, not us. My administrator is stressing over this. I've asked my pharmacy consultant as well. As long as the chart tells the story with a correct diagnosis and behavior documentation we all should be fine. We could get tagged under Unnecessary Medications if we were giving ANY med without a diagnosis. If I can't find a diagnosis for every med the resident is taking, I either search the chart for one and add it to the list and the MAR or I leave a note for the doc to write one. Celexa, for one, can help behaviors in demented elders even if they don't have a diagnosis of depression...some antidepressants are used to treat PTSD (I have a high pop. of veterans) and sometimes antipsychotics are used as an adjunct to antidepressant therapy. As long as all the reasons are documented, it should be fine.

[susanthomas1954]

WAIT- look at the manual. Psych dx is only counted on a FULL MDS. You can do quarterlies til you're blue in the face, but the psych dx is only taken from an ANNUAL, ADMIT or SIG CHANGE assmt. Read the QI section, it specifically says "the last full assessment."

[CapeCodMermaid, RN]

I just finished annual DPH survey. The item on the QI/QM was not an issue at all. The surveyor actually said to me, "I have no doubt your residents need all those antipsychotics!" The charts told the story so we were okay.

[edhcinc]

Hi. Even though the medical record (and I3 on the full/comprehensive MDS) contains a diagnosis which clinically justifies an antipsychotic, there are only specific dx that "count" as appropriate for the QI/QM--they are listed in the QI/QM manual. (and the list is years old)

RE: MDS QIES and diagnoses.

The MDS system stores all diagnoses recorded at I 3 a thru e. If you change a diagnosis listed at I 3 a or b on a quarterly, that diagnosis is replaced by the new diagnosis--c thru e remain, and can only be changed if changed on the next full/comprehensive MDS.

Hope this explanation helps.

[SuesquatchRN, BSN, RN]

Any of the psychoses count - bipolar, schizophrenia.

I can't remember the number, but "dementia with behavioral disturbance" is an actual diagnosis and we have started using it and promoting it to #1 on the dx list. CMS accepts it so you don't have to get dinged for charting a buttload of behaviors.

I'm reminded of the old Far Side with the devil poking his pitchfork at a guy before two doors that say "Damned if you do" and "Damned if you don't."

[CapeCodMermaid, RN]

The list we have used:

Schizophrenia

Schizoaffective disorder

Delusional disorder

Psychotic mood disturbances

Brief reactive psychosis

Schizophreniform disorder

Atypical psychosis

Tourette's disorder

Huntington's disease

Organic mental syndrome with associated psychotic or harmful behaviors that are quantitatively and objectively documented in the medical record.

Don't forget to document any behaviors AND document that you are monitoring for any signs and symptoms of side effects.

[sls73]

Any of the psychoses count - bipolar, schizophrenia.

I can't remember the number, but "dementia with behavioral disturbance" is an actual diagnosis and we have started using it and promoting it to #1 on the dx list. CMS accepts it so you don't have to get dinged for charting a buttload of behaviors.

I believe it is 294.11 for dementia with behaviors. 294.10 is dementia without behaviors.