Help--Calling any MDS nurse

Nascar nurse, ASN, RN · Oct 12, 2006

Wow - where to start? Of course I do the MDS's - primarily I just do the PPS medicare assessments (@ 5day, 14day, 30D, 60D and 90d intervals), but right now my partner is out on sick leave which leaves me doing all 90 beds. I am responsible for writing all nursing RAPS, keeping the care plan current, understanding the entire PPS financial impact and keeping the RUG score as high as practical (and explaining why it's not when "big shots" think it outta be higher), constant inservicing of staff as to documentation requirements - end up doing 1:1 several times daily most days. I am responsible for the entire medicare puzzle ie: Who still quailfies, what are we skilling them for, again inservicing staff as to what they need to document, medicare meeting, deciding when to take someone off, communicating w/ resident/families/Dr's as necessary, looking over UB92. My partner takes care of the whole restorative nursing, ie: determining programs, careplanning, instructing restorative aides. We both go to way to many meetings. I could keep going, but would probably scare you to death. Good luck

fultzymom · Nov 28, 2006

Nascar nurse or anyone who knows,

I am taking over the Medicare nurse position at work. Here is the thing, they have just turned it over to me and I am trying to find my way. Do you have any where that I can get some good guidelines for how long I can keep a person skilled for what reason> Ex: a patient with newly diagnosed anemia? How long can you keep them skilled? Until it is resolved and proven by labs? Is there a period of observation time after it is resolved? Any thing you could offer that would serve as guidelines would be great! fultzymom

CapeCodMermaid, RN · Nov 29, 2006

Try to think logically. If someone has newly diagnosed anemia what really is the skill to care for that person? Vital signs? nope..the CNA's can do those...labs...only do those every few days...pretty hard to keep someone on Medicare simply because they have anemia. Do they have any co-morbidities? Anemia can lead to CHF, falls, and an overall decline in condition especially if it makes the person short of breath..are you doing lung sounds?Oxygen??? good luck with that one.

brendamyheart · Nov 29, 2006

Wow - where to start? Of course I do the MDS's - primarily I just do the PPS medicare assessments (@ 5day, 14day, 30D, 60D and 90d intervals), but right now my partner is out on sick leave which leaves me doing all 90 beds. I am responsible for writing all nursing RAPS, keeping the care plan current, understanding the entire PPS financial impact and keeping the RUG score as high as practical (and explaining why it's not when "big shots" think it outta be higher), constant inservicing of staff as to documentation requirements - end up doing 1:1 several times daily most days. I am responsible for the entire medicare puzzle ie: Who still quailfies, what are we skilling them for, again inservicing staff as to what they need to document, medicare meeting, deciding when to take someone off, communicating w/ resident/families/Dr's as necessary, looking over UB92. My partner takes care of the whole restorative nursing, ie: determining programs, careplanning, instructing restorative aides. We both go to way to many meetings. I could keep going, but would probably scare you to death. Good luck

I have been doing PPS/MCD easements for 11 years and you scared me to death. :uhoh3: However, she is right. There is way to much going on with doing MDS's then most realize. Take courses, and learn, learn and learn. When you think you got it, they change the rules!! :uhoh3: :uhoh3: :uhoh3: :uhoh3: :uhoh3: :uhoh3: :uhoh3:

fultzymom · Nov 29, 2006

I guess that I was just using that as an example. I know you can not skill them forever for that and not for long. Not a great example. I guess I should have asked how long for the different conditions can you keep someone skilled. I just wonder where I can find out some guidelines and where I can learn the rules and regs. It is hard to learn when you are just thrown it and told you are now in charge starting now. I have been to a couple of conferences and one of them was really good and the other had more to do with the actual billing of different services which I do not deal with. The billing department does.

mdscarentx · Nov 29, 2006

Your best bet is going to be to ask your DON or Adm if they can have someone within your company (sister facility maybe?) to come for at least a week to train you. But I feel as above - I have been doing MDS & TILEs for 12 years and wow have things changed! It will take actual exp to learn and time. But it helps if you have someone for resource - someone close to you.

Nascar nurse, ASN, RN · Nov 30, 2006

Sorry, I don't have any good references to give you. I just learned along the way, but actually it is really just good common sense and clinical decision skills, ie: evaluating what is wrong and anticipating what MIGHT go wrong and document that you are monitoring for these possibilities. Example: Hip fracture.. going to cover them on medicare and document related to pain management, monitoring of effected limb (edema, pulses, etc), monitoring surgical wound for signs of infection, use of coumadin/lovenox w/ related lab results, response to therapy. In a typical hip fracture resident - I would expect 4-8 weeks of therapy (which can vary a great deal from person to person depending on all their other issues and their prior level of functioning). By the time they are done w/ therapy, most of the nursing issues are also resolved. Often we will put them on restorative nursing for a week to ensure they do not decline after being off therapy. We are also doing any discharge teaching that needs done and making discharge arrangements.

Hope this helps a little.