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mds 3.0 - what WERE they thinking??

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You have got to be kidding me!! I just finished my first D/c return not anticipated and I am fuming! took me 1 3/4 HOURS to complete it! For someone who has gone home! Thankfully we had just done a 30 day assessment 4 days prior and I took a lot of info from that. How is it that the powers that be came up with such a labor intensive process?? Did anyone who had input into this new process actually WORK in a nursing home? Did they actually try to DO the new MDS in a real, true NH environment? I work in a 180 bed facility with 8 d/c and 6 admissions between OCt 1 and Oct 4. Not to mention the medicare census 0f 26 with the SOT, EOT, 5,14,30,60,90 day assessments due. Plus this week we had 6 annuals, 2 significant changes and 11 quarterlies - all needing the 3.0.

So....by the end of next week I will have approx 1400 pages of assessment to do, not to mention 16 sets of CAAs!! There is only me and one other full time person to do all this. We've been advertising for a 20 hour person (whooppee) but no takers yet - who want this job now??

WHAT WERE THEY THINKING????????:eek::mad:

Ruas61, BSN, RN

Specializes in MDS/ UR. Has 38 years experience.

Just remember if the discharges are spontaneous - i.e. off to hospital for an MI. You don't have to try to do every thing complete. Unable to assess can be your friend. I am not suggesting to glide over everything but don't beat yourself into the ground either. I had 4 of them in the first week. All unexpected- and it took me about an hour in general for each of them. Hugs to you. :hug:

Bella'sMyBaby

Specializes in MDS/Office.

glm777.....I hear you!!

My boss & I did our first 3.0 today & it was a total disaster!

Spent about 3 hours on it!

Our Corporation did NOT even go over all the different 3.0 Assessments!

We were told that we can read for ourselves..... :icon_roll

Magaly63

Specializes in medsurg, everything in LTC.

Agreed, who ever did this hasn't ACTUALLY worked in the average NH.

Golden Standards Nurses??

Software this time really messed up, no prior testing, still having major issues, still can't work on D/C.....No one knew 10/1/10 was coming up I guess....

I have never felt this stupid before..........

Ruas61, BSN, RN

Specializes in MDS/ UR. Has 38 years experience.

I personally have wanted to beat the software a few times today.

katoline

Specializes in long term care - MDS. Has 22 years experience.

my coworker and i went to a myers and stauffer seminar recently. one of the speakers kept kicking a large trash can out of the way in the isle as she spoke. me, being the stupid that i am, kept wondering who in the world left that there? they were using them filled with ice for drinks. my parter was the first to realize every now and then the speaker would pause and ask if anyone in the audience needed the trash can to get sick in. this from the state auditors! she was poking fun (or not) at the govt way of thinking that these assessments were faster and easier. go to the aanac website and watch their interview video.

i feel that our corporate execs have their heads in the sand as well. at least at our company. i'm glad for you who have support. this is a doozy and we're not exagerating!

rukiddingme

Specializes in Long term care. Has 14 years experience.

I'm sure the whole 3.0 thing will get easier for us all, but it's going to take time -- and that is one precious commodity that we don't seem to have. The transmission time has been cut in half, we have more triggers/CAA's now, and interviews with residents (or staff depending on their interview abilities).

my coworker and i went to a myers and stauffer seminar recently. one of the speakers kept kicking a large trash can out of the way in the isle as she spoke. me, being the stupid that i am, kept wondering who in the world left that there? they were using them filled with ice for drinks. my parter was the first to realize every now and then the speaker would pause and ask if anyone in the audience needed the trash can to get sick in. this from the state auditors! she was poking fun (or not) at the govt way of thinking that these assessments were faster and easier. go to the aanac website and watch their interview video.

i feel that our corporate execs have their heads in the sand as well. at least at our company. i'm glad for you who have support. this is a doozy and we're not exagerating!

I watched that AANAC video, but I was so "lucky" to be in Vegas to hear the Gold Standard Nurses speak. It was a joke then, and it's a joke now. Their video is even more a joke. They really don't know what they are doing. They have been out of patient care for so long, that they are clueless to what an MDS coordinator does. They kept saying that this was going to take less time. Everyone in the audience knew better. One nurse got up and said "this is like a vacuum, and SUCKS" people started clapping.

Ruas61, on a discharge return not anticipated and discharge return anticipated may I ask what you think is absolutely neccessary to code since we have the option of the dash or did not assess option? For me if I have 3-4 discharges in one day all unplanned why would i assess ADL's,skin,pain, etc...and I would love to know what state is expecting to see on these type of discharges/assessments.

Ruas61, BSN, RN

Specializes in MDS/ UR. Has 38 years experience.

If I had current documentation for adls, continence and such I would do them.

The majority of mine were dashed out except diagnosis and health condiditions.

As theywere all emergency situations. We had no charting to support correct documentation for anything else.

I am not going to run around and interview staff for someone who had an MI or such just because CMS thinks it will help them with their whatever.

I honestly think that this needs to be changed.

I can see this for a discharge to comunity, another nursing home or such but not to the hospital for acute things.

Just ny 2 cents on the topic.

THANKS RUAS, I agree with you completely and it is scary to think about. Obviously ADL's may be at odds given the acute process and possibly incontinence for a continent person. And the reason for dr. visits and orders? Our facility for our medicaid residents do not have a ADL flow chart to justify ADL's. We get this info from staff observation and the occassional nurses note regarding a area of a ADL. This part has me a little worried. For our skilled resident's though we have a check off that the nurses do. What are your thoughts on this?

susanthomas1954

Specializes in Assessment coordinator. Has 35 years experience.

I guess my chief concern with the dc MDS is that when we dash through certain items that pertain to the QI's, there will be repercussions down the road. Apparently I am not the only person who feels the dc MDS process is unsustainable. I plan to bring this up to my regional director on Monday. Note that a number of us do not feel comfortable burdening the entire team with the unplanned dc MDS. Any other concerns regarding this particular problem? I want to do good for all of us and not just my company.

rukiddingme

Specializes in Long term care. Has 14 years experience.

We've been so busy trying to learn new software, how to read our MDS error check, trying to fix errors, and waiting on validation reports (when their actually being processed) that we've had LITTLE time to actually keep track of the residents on our caseload.

a.sparks90

Specializes in Greriatrics / Prison Clinic. Has 30 years experience.

With one ream of paper (500 sheets) you can print 8 comprehensive 3.0 MDSs, and 11 quarterlies. They don't fit in the charts. The CAA prints out in all assessments , needed or not. Can't select print. The discharge MDS asks for an assessment. A whole assessment! Hey creators of 3.0, what are you thinking. Why should we spend an hour and 1/2 on a document that is just meant to tell the Feds a person left the building?? 3.0 is not integrating well with our software. I have a friend in another facility who has the same problem, slow slow slow, time consuming sluggish work. I have anothe friend in a different facility using different software with the same problem. It seems to me that the NH industry was sold a bad bill of goods. 3.0 asks some good questions, the interviews are a good tool for getting the cognitive status identified, but even that now, takes more time. A formal sitting with the resident going throught the questions takes time, add that to the time it takes to complete just one assessment.......It is hardest (my opinion) on the PPS nurses. I end up doing all my own interviews, not much cooperation. Constantly on the phone with the computer guys. They are trying to figure out if they have a problem, or if the 3.0 program just runs SLOW! They have admitted they don't know right now. IT isn't cost effect to think that all the NHs need to hire extra MDS nurses, but it may come to that. Who ever invented the program needs to go back to the drawing board.

Edited by a.sparks90
typo

Ruas61, BSN, RN

Specializes in MDS/ UR. Has 38 years experience.

QI's are dark for a year if I recall right. I suspect it will be alot longer given all this ruckus we have with everything else.

Honestly, I want to complete every MDS completely and accurately. I am compulsive that way. Inside I cringe at the thought of letting something through the gate without every I dotted and T crossed.

However, I am realistic at this point. The discharge assessments are purely hypothetical statistics at this point in a pregame season. Given with all the othe thngs on the plate, this one is fallinng to the bottom.

The discharge MDS is the CRAZIEST thing anyone could have ever thought of . If the resident goes home, they have obviously met their goals. If the go to the hospital and come back you have do another return assessment and a 5 day if it is a MED A. If they die they go to heaven so what in the world does anyone want to or have the time to read a discharge that prints out 41 pages. The poor trees!!!

SunnyAndrsn

Specializes in LTC/Rehab, Med Surg, Home Care.

I thought we only had to restart the med a schedule if the person was actually admitted to the hospital? If they are kept as an observation pt. and then return the next day, I was told by my supervisors we do NOT restart the med a schedule. It's in section 2 of the RAI manual, I can't remember the page right now.

I also thought that for a death in the facility, it's just the death in the facility record, not the discharge assessment, which is absolutely pointless for someone who is dead.

The discharge MDS is the CRAZIEST thing anyone could have ever thought of . If the resident goes home, they have obviously met their goals. If the go to the hospital and come back you have do another return assessment and a 5 day if it is a MED A. If they die they go to heaven so what in the world does anyone want to or have the time to read a discharge that prints out 41 pages. The poor trees!!!

katoline

Specializes in long term care - MDS. Has 22 years experience.

i wonder how it works for someone who went home for less than 24hrs. i bet i have to start over because they were d/c return not anticipated. two unplanned discharges while i was out. both to home, the one return is no surprise and the other will probably return as well. i think the d/c summary, esp about notifying the community resources will have some impact.

the death in facility is only a page or two. a tracking device only.

i recently switched facilities. this one only prints page Z with the signatures and the front page. everything else is electronically stored and can be pulled up if needed. i guess the state pull all that up before they come anyway. being the nerd that i am, i print a working copy and will keep that for a while. didn't someone say something about a template? hmmm...