MDS 3.0

Told my consultant pretty much the same thing last week.

Hopefully it won't be too bad after we get used to it......

As for On call/Working the Floor Nonsense....Won't do it.

MDS is Reimbursement NOT Clinical.

Haven't worked the floor in years.....

Not putting my license on the line.

Of course the MDS is clinical...why do you think it's called an ASSESSMENT and why do you think you have to be an RN to sign it???? Any boob can gather information and put it on a form. It takes the knowledge and skill of a nurse to make an assessment of the gathered information and formulate a plan based on that info.

Of course the MDS is clinical...why do you think it's called an ASSESSMENT and why do you think you have to be an RN to sign it???? Any boob can gather information and put it on a form. It takes the knowledge and skill of a nurse to make an assessment of the gathered information and formulate a plan based on that info.

MDS brings in the $$$ for the building.

MDS Coordinators are all about Reimbursement.

If we don't make budget; Corporate wants to know why....

I'm not sure I believe it won't take as long to complete either. I've looked at the 3.0 and was quite taken back by the number of pages....which will also create a storage problem for us. My Coordinator is secretly still hoping the date for the 3.0 gets extended further out yet.

Of course the MDS is clinical...why do you think it's called an ASSESSMENT and why do you think you have to be an RN to sign it???? Any boob can gather information and put it on a form. It takes the knowledge and skill of a nurse to make an assessment of the gathered information and formulate a plan based on that info.

Not really, boobs don't have the education required to understand the questions. Any of them who want to argue, just tell them the difference is 2 more years of college and 8 more classes.

Reminds me of an old blonde joke called "The Breast Stroke" but I would probably be banned from the site for sharing it.

hi--guess that joke is the real "bs"...am blonde, so i can say it...

• as to time--
  

1. the rand study showed less time to complete because the studied and recommended mds was shorter and much, much simpler. cms continued to claim that it took less time even after several version changes. however, after many persons presented convincing evidence to certain cms staff that this statement was no longer true, it was removed from the mds 3.0 website and is no longer part of any cms presentations. (it is more efficient)
   
2. pps--there are now 125 items versus 108
   
3. pps--requires more assessments--sot, entry tracking, and discharge assessment (not just tracking)
   
4. obra--requires more assessments--scsa--for hospice, whether or not there truly is a significant change, entry tracking, and discharge assessment (not just tracking)
   

• as to deforestation and 8 inch chart binders...
  

1. the rai manual reminds us that each state actually designates the resident assessment instrument that is used. as long as it contains the currently specified content, it can contain more, and be formatted in a different manner. if we want different formatting, the state rai can change it. however, vendors must agree (since they would do the actual programming for printing options such as font size and placement on page)
   
2. if your state rai coordinator will not spec this, there may still be the option of using "printer options" in your local printer set-up--2 per page is easily read. 4 per page not so...
   
3. perhaps help (verbally and in writing) your administrator, corporate contact, consultant (and anyone else who might listen) understand that the number of pages will be tripled and what this means in paper costs, ink costs, printer usage "life", time to print, space requirements, pages to be faxed/copied if requested by outside party, long term storage requirements and cost, etc. perhaps the increase in real costs may spark contact with cms...or at least an understanding of what is coming...oh, and don't forget to mention that there's no more pps "free ride" for a hospital iv med
   

• as to "delay" of mds 3.0 implementation or the mds itself--
  

1. if you are just barely able to do a credible job now, you just will not be able to do it beginning october 1, 2010 (even if you have 4 b __ __ bs, 4 more years of college, or 44 more classes ). every day remind your corporate "bigwigs", dn's, administrators, etc. that the workload will be increased by at least 15% (and time studies may prove an even greater increase).
   
2. if you don't agree with mds content, usability, instructions, frequency, applicability, etc. nothing will be changed unless you (and each of us) comment, comment, and comment more. to whom? your state rai coordinator, during the snf open door forum, to the mdscomments e-mail, to persons directly responsible for the new mds, to medpac, to your regional cms office, etc.
   

I think some of the problems with printing and storage will be better when we all go to EMR. Does the reg. state that you have to have 15 months of MDSs readily available? If they are on computer and there is a computer at the nurses' station, does that make them readily available enough? I don't know who would argue that the MDS 3.0 isn't going to take longer to complete. Just looking at it without even getting involved in a resident interview is proof enough that it will significantly increase the work load.

In the MDS 3.0 Final Report posted on the CMS website, on page 71, I see the following:

"MDS 3.0 was able to improve assessments and decrease time to complete. The average time to complete MDS 3.0 was 45% less than the average time to complete MDS 2.0 on the same sample."

and

"We hypothesized that the new instrument would take longer, on average, because staff would be unfamiliar with the form, tracking systems and charting would not be set to it and all MDS 3.0 assessments were full assessments (without section T). However, analysis of the actual times revealed that collection times were actually considerably less for MDS 3.0 than for MDS 2.0 (see Table 4.1)."

Table 4.1 shows MDS 2.0 average entry time at 111.6 minutes and MDS 3.0 average entry time at 61.5 minutes.

My experience suggests that the forms you use to collect the data and the software you use to enter the data can affect your times. Some forms and software make things easier and faster while others slow you down.

I think some of the problems with printing and storage will be better when we all go to EMR. Does the reg. state that you have to have 15 months of MDSs readily available? If they are on computer and there is a computer at the nurses' station, does that make them readily available enough? I don't know who would argue that the MDS 3.0 isn't going to take longer to complete. Just looking at it without even getting involved in a resident interview is proof enough that it will significantly increase the work load.

Yep the reg says accessible and accessible is as accessible in a computer as accessible in a binder...hehe

I have not seen the 3.0 sys yet but will next week, It would b alot easier if there were no oncall.. and simply closing the door to block out everyone from the office would b great too..

At first blush, I thought 3.0 would be a lot more time consuming. However, putting some of it into practice has been a little refreshing. First of all, please note the LARGER PRINT, as a deference to an aging work force. Then, if certain items are not answered by the interviewee, certain sections are skipped. We have a working class session with MDS coordinators from various facilities around town and we are wrapping our minds around this slowly. We meet monthly for two hours, (work time, employers paying, hosted by medical directors group) No one bothers us and we are free to say whatever. So far, we have agreed:

a) if we could, we would only hire people that never did the 2.0

b) our regional people have not been and will not be much help.

c) we've got each other for support.

Try some regular meetings with your colleagues in other buildings, because NO ONE will understand your concerns. And by mid-November when those smaller checks start rolling in, we will probably all be facing some "serious 'splanin to do," because no one is listening now.

My regional person can do an MDS, but there is no way in HADES she knows how to do MY JOB. Even if the MDS is less complicated, the fact that there are so many more of them, with more dates to set is just boggling.