MDS Questions???????????

MDSlady · Aug 20, 2005

Ok, here is probably the stupid question of the month, but... I don't get how you all can just switch these days so easily mid flow. I must have been sleeping thru that part of training (oh I forgot - I never got any real training - just an RAI manual). Anyways, I am in a case mix state. In this state, we have an annual "medicaide" inspection and this include a large percentage of all MDS's to validate the RUG scores. This includes ALL paytypes, even PPS RUG scores. We do not have any type of computerized charting in our facility for the floor nurses. We set a date, inform everyone (nurses, therapy, dietary, ss, activities) and that is what we go with and hope therapy gets what they were planning. If I move dates around, then I lose the ADL tracker grid and nursing summaries that the nurses complete during the observation period. If I lose this information, then the surveyors come in for their audit and I can not validate my scores. (My state mandates that we have 7 days of ADL late loss ADL tracking for all 3 shifts). I can't see how I can have nurses completing this ADL tracker grid for all open days - they have more than enough to do now, plus without summaries I lose all documentation on speech, hearing, etc. Once in a great while I will ask them to extend their time frame (extra work for them) when I know I really need something such as an unexpected IV, but for the most part - we pick are date and stick with it. 95% of the time, therapy keeps right with us and gets the minutes they need. What am I missing here? Is this just because my state works different w/ all the validation obligations?

Hey there....Here in Ct at my facility we have computerized charting. Everything is entered into computers. Meds, tx's, dr's orders, etc. When I open say a 5d MDS I calculate the day of admission to day 8. The computer will tell me the highest day to pick because of all information mostly therapy minutes. I never use grace days on my 14d and on my 30 day, I calculate days 21-34 and so on with my 60 and 90d. I have a large calendar on my desk and when someone is admitted, I just plot their name on the calendar Day 8, 15, 35, 65, and 92. Then on that day I open the MDS and pass that day onto everyone. 99% percent of the time, the day agrees with what therapy will say, but sometimes they forget to chart correctly and call me to change the date. I am also responsible for all quarterly and annual assessments for medicaid. Some of the buildings around me have charge nurses do these assessments, I am hoping that this happens at my facility but working as a charge nurse too, I agree that they don't need anymore paper work than they have. Hope this helps!!!!!

Nascar nurse, ASN, RN · Aug 21, 2005

How many PPS residents do you have at a time? My facility varies from 15-35. Seems like we have a revolving door most of the time. The residents I start the month with have all gone home and new residents in at the end of the month.

MDSlady · Aug 21, 2005

How many PPS residents do you have at a time? My facility varies from 15-35. Seems like we have a revolving door most of the time. The residents I start the month with have all gone home and new residents in at the end of the month.

We have one sub-acute unit with 30 beds on it. They are mostly all PPS however we do have private pay people who like this rehab wing there. So on the average 30 PPS.

The hardest time I have is with "repeat offenders" who come in and out of the facility numerous times. I had one resident on Med A who went in and out 4 times!!!!! That was 4 5d Assessments /c RAPS that I had to do!!!!! :rotfl:

Talino · Aug 21, 2005

Our therapy team leader sets the ARDs for our therapy residents. She uses grace days on EVERY 5 day assessment. She doesn't take into consideration the 'estimated # of minutes thru day 15'. In fact, she doesn't use those in her projected RUG level. I never get to use the hospital look back days because we go past day 5. I have a hard time talking to her because she is a little quick tempered and becomes very defensive and my administrator thinks she can do no wrong..
I would appreciate any suggestions on how to handle this!!!!
Thanks in advance
Dana

What are the RUG scores for these therapy residents?

RUG scores of Ultra High and Very High are usually achieved by using grace days. The only way to avoid a grace day, therapy must begin on day of admission then daily up to day 5. The estimated therapy (days/mins) in Section T do not affect these RUG levels.

If you will not be getting Ultra High or Very High, the use of grace days may not be necessary. The estimated therapy mins/days in Section T will dictate RH, RM, and RL. So you can discuss this matter to your therapist but arm yourself first by reading the RAI Chapter 6, p10-13.

Ultra High and Very High bring the most $$$ to the facility (so forget the hospital lookback). For these revenues, Adm. will definitely butter-up therapists.

Ultra High requires a minimum of 720 mins of therapy time from 2 therapies to be reflected in Section P1b (abc) in the last 7 days. That's 120 mins/day x 6 days of treatment or 140 mins/day x 5 days. Adding that to the therapists' current workload, attitude brews. Don't take the therapist's attitude personally. It's her behind that's actually at stake here.

As long as the therapy is actually provided, I see nothing wrong with the practice.

robin_mds_nurse · Aug 23, 2005

Just when I was about to post my own question about the MDS....do any of y'all have suggestions for how to keep track of the dumb thing? I am new to the job...have between 25 and 30 Medicare residents at any given time. Most of them are rehab so the RC picks the ARD. I get MY part done the same day, but it seems I am forever chasing the rest of the team, and then I forget to pick the old ones up and almost miss the 14 day cut off for the Triggers and Raps. Anyone have a good form or method ??? HELP!

Hi Mermaid, since I know you & I work for the same company, I will tell you what I do. In datawarehouse on Knect, I print the 100 day scheduler for Medicare residents. It gives you the range for all the assessments. I pick all the dates for the assessments. I do consult with the RC for the 5 day if they are to have therapy. I make copies for all the disciplines, and pass it out. I figure out what my Rap completion date & care plan date is going to before I pass it out, and write it on the bottom. The data entry person types in those dates on the raps so everyone knows what they are. I keep all the 100 day schedulers in a book. I do have a calendar that I make to visualize what I have due. It has worked well for me, & my team. No late raps, the assessments are to be done by 12pm one day after the ARD. If they are not done, I am calling the other disciplines to find out why.

~Robin

CapeCodMermaid, RN · Aug 23, 2005

Robin-Thanks for the advice...(.KNECT...they should have had a teenage boy set up all the sites on there...would've made it easier to use.) I gave up being the MDS nurse by choice....hated the job....have been the ADNS since October.

Nursie_34LPN · Feb 23, 2006

We have one sub-acute unit with 30 beds on it. They are mostly all PPS however we do have private pay people who like this rehab wing there. So on the average 30 PPS.
The hardest time I have is with "repeat offenders" who come in and out of the facility numerous times. I had one resident on Med A who went in and out 4 times!!!!! That was 4 5d Assessments /c RAPS that I had to do!!!!! :rotfl:

I call them my frequent flyers lol

but why do you have to do raps each time?

Pepper The Cat, BSN, RN · Feb 23, 2006

I just started doing the co-ordinating job for MDS/FIM (replaceing someone who is replaceing someone who is replaceing someone who is replaceing someone who just had a baby! ) Anyway - this is what I have been doing. At the start of each month, I send out a message saying who needs their MDS done that month, what type - quarterly or full - and when it is due. I then check in about once a week and send out reminder message if nec. Seems to be working so far, but I've only been doing this since Jan! Also - we are all computerized so it make checking things really easy.

jaimemds · Mar 3, 2006

I started my own MDS QA which I turned in at the monthly QA meeting. At my facility we go around to each department and bring up any problems. So I would rattle off, Activities was late on 19 out 0f 20 ax's this month. SS late 15 times, etc. After a couple of months being called out in front of the Adm and DON, they were perfect angels!

JPR12 · Jun 26, 2007

We use a company that comes in and does training and auditing of all our mds charts. www.harmony-healthcare.com

JPR12 · Aug 17, 2007

We used Harmony Healthcare. www.harmony-healthcare.com