MDS Coordinators/ RN or LPN Assessment Coordinators

Nascar nurse, ASN, RN · Apr 20, 2007

An RN is required only to sign R2b - stating the MDS is complete. That's it. This is not even a statement of accuracy, just that all the blanks got filled in. I did entire MDS's/RAP's/Careplans w/ mtgs for years as an LPN (RN now). An RN signed off as complete at R2b and this was never a problem during state survey. Even as an RN now, I find it silly that it takes this RN degree to accurately determine that all the blanks have been filled in!

CapeCodMermaid, RN · Apr 23, 2007

You find it silly that an RN has to sign to state all the blanks are filled in?

At one facility I worked at, the LPN's could do meds, treatments,IV's...BUT they weren't allowed to do a dental assessment and count teeth on admission!....hmmmm, you can put something in someone's vein that theoretically could kill them, but you can't count teeth. Lot's of things in this business don't make sense.

Nascar nurse, ASN, RN · Apr 23, 2007

At one facility I worked at, the LPN's could do meds, treatments,IV's...BUT they weren't allowed to do a dental assessment and count teeth on admission!....hmmmm, you can put something in someone's vein that theoretically could kill them, but you can't count teeth. Lot's of things in this business don't make sense.

Actually, I believe this is a JACHO regulation (and I can NEVER remember how to spell that out and bet I've got it wrong again {JACHO}!?)

But anyway, we can't allow LPN's to count teeth either for that reason. And yep, this is another example of stupidity in our business. And we question the cost of health care!

CapeCodMermaid, RN · Apr 23, 2007

I don't know about if it's a Joint Commission thing, but the LPNs are now allowed to do the entire admission...including counting teeth...1,2,3,4.....woowoo

nursy711 · Apr 24, 2007

I HAVE A QUESTION. PAGE 3-100 IN THE UPDATED MDS MANUAL, THE EXAMPLE (RES PERFORMED ALL THE TASKS OF PERSONAL HYGIENE EXCEPT SHAVING. THE BARBER VISITED HIM ON THE UNIT 3 TIMES A WEEK TO SHAVE HIS THICK BEARD) THEY HAVE IT CODED AS A 3 2. I WOULD HAVE FIGURED SINCE HE DOES ALL OF HIS OWN PERSONAL HYGIENE I WOULD HAVE CODED IT AS A 2 2. THE SAME SENARIO. A WOMAN DOES ALL OF HER OWN CARE AND DRSG AND ONLY NEEDS HELP BRUSHING HER LONG HAIR, AND ITS ALSO CODED AS A 3 3. AGAIN I WOULD HAVE CODED IT AS A 2 2. IN YOUR OPINION, WHAT WOULD YOU HAVE CODED THESE 2 PEOPLE?

THANKS ,

CHRISTINE:monkeydance:

Nascar nurse, ASN, RN · Apr 24, 2007

I HAVE A QUESTION. PAGE 3-100 IN THE UPDATED MDS MANUAL, THE EXAMPLE (RES PERFORMED ALL THE TASKS OF PERSONAL HYGIENE EXCEPT SHAVING. THE BARBER VISITED HIM ON THE UNIT 3 TIMES A WEEK TO SHAVE HIS THICK BEARD) THEY HAVE IT CODED AS A 3 2. I WOULD HAVE FIGURED SINCE HE DOES ALL OF HIS OWN PERSONAL HYGIENE I WOULD HAVE CODED IT AS A 2 2. THE SAME SENARIO. A WOMAN DOES ALL OF HER OWN CARE AND DRSG AND ONLY NEEDS HELP BRUSHING HER LONG HAIR, AND ITS ALSO CODED AS A 3 3. AGAIN I WOULD HAVE CODED IT AS A 2 2. IN YOUR OPINION, WHAT WOULD YOU HAVE CODED THESE 2 PEOPLE?
THANKS ,
CHRISTINE:monkeydance:

I would have coded both as a 3/2 (because that is the right way to do it AND it's the way the RAI - AKA MDS bible - states to do it!)

I teach this way:

Supervision (#1) = talk

Limited (#2) = touch only with an opened hand. (Like w/ the weeble-wobbley little ole lady walking down the hall - open hand just guiding them to keep their balance)

Extensive (#3) = closed hand &/or your muscles are involved (but resident also participates at least w/ something)

Therefore it would take a closed hand to hold and "power" the brush/razor. This makes it an extensive assist.

I find to many people that think limited = "little bit of help", extensive = "lot of help". This is wrong!

brendamyheart · Apr 25, 2007

I HAVE A QUESTION. PAGE 3-100 IN THE UPDATED MDS MANUAL, THE EXAMPLE (RES PERFORMED ALL THE TASKS OF PERSONAL HYGIENE EXCEPT SHAVING. THE BARBER VISITED HIM ON THE UNIT 3 TIMES A WEEK TO SHAVE HIS THICK BEARD) THEY HAVE IT CODED AS A 3 2. I WOULD HAVE FIGURED SINCE HE DOES ALL OF HIS OWN PERSONAL HYGIENE I WOULD HAVE CODED IT AS A 2 2. THE SAME SENARIO. A WOMAN DOES ALL OF HER OWN CARE AND DRSG AND ONLY NEEDS HELP BRUSHING HER LONG HAIR, AND ITS ALSO CODED AS A 3 3. AGAIN I WOULD HAVE CODED IT AS A 2 2. IN YOUR OPINION, WHAT WOULD YOU HAVE CODED THESE 2 PEOPLE?
THANKS ,
CHRISTINE:monkeydance:

3/2. Rules of three

nursy711 · Apr 25, 2007

i understsnd the rational behind coding a 3 2 for the woman that needs her hair brushed every day, but for the man that only needs to be shaved 3 times a week? Limited assist on the actual MDS = .......or other non-weight bearing assist 3 or more times. Shaving is a non-weight bearing act. At first I thought it was just me, then I gave all the unit managers the senario, 4 out of 5 said they would code it a 2 2. . I dont mean to be a pain, im just trying to understand and do the best job i can. Even the current MDS Coordinator said she would have coded it a 2 2. Thank you for taking the time to answer my questions...

nursy711 · Apr 25, 2007

i answered my own question after i thought about it... its still physical assist and that meets the criteria

Rizpah · Apr 25, 2007

I would have coded both as a 3/2 (because that is the right way to do it AND it's the way the RAI - AKA MDS bible - states to do it!)
I teach this way:
Supervision (#1) = talk
Limited (#2) = touch only with an opened hand. (Like w/ the weeble-wobbley little ole lady walking down the hall - open hand just guiding them to keep their balance)
Extensive (#3) = closed hand &/or your muscles are involved (but resident also participates at least w/ something)
Therefore it would take a closed hand to hold and "power" the brush/razor. This makes it an extensive assist.
I find to many people that think limited = "little bit of help", extensive = "lot of help". This is wrong!

WOW! this is great........I've been doing MDS's for 10 years now and never had the coding explained in this way. I printed it off and took it to work and plan on talking to my director, who also does MDS's. It's a huge help in trying to figure out exactly how to code something. Got any hints on section E? Sections E and G on new admits... I hate 'em! But I know, it all boils down to the documentation we have to follow up on and if the staff nurses don't understand the coding criteria, we have to decipher it, but then our deciphering doesn't match the charting...... :uhoh3:

Nascar nurse, ASN, RN · Apr 26, 2007

WOW! this is great........I've been doing MDS's for 10 years now and never had the coding explained in this way. I printed it off and took it to work and plan on talking to my director, who also does MDS's. It's a huge help in trying to figure out exactly how to code something. Got any hints on section E? Sections E and G on new admits... I hate 'em! But I know, it all boils down to the documentation we have to follow up on and if the staff nurses don't understand the coding criteria, we have to decipher it, but then our deciphering doesn't match the charting......

Glad I could help. Sorry, no good hints for section E - it is what it is and the most difficult task is just getting someone to document what they see. I'm always teaching/preaching to throw comments like "A&O x's 3 w/ some confusion present" out of their charting. I want specific memory/mood/behavior examples and DIRECT quotes in the chart. ie: Resident stated "Go to hell" when I asked them to get up for breakfast. Now I can count bad am mood and verbal abuse w/ just a 3 word quote.

The very worst part of the job is the constant teaching/preaching.. training and reminding with the staff. We have recently started going with the CNA documentation for ADL's and the aides are doing a much better job then most of the nurses ever did. (Not really all that surprising since they actually provide the care and really knows what goes on).

Nascar nurse, ASN, RN · Apr 26, 2007

i answered my own question after i thought about it... its still physical assist and that meets the criteria

:monkeydance: :lol2: