pixie120 4,440 Views
Joined: Jul 30, '11;
Posts: 255 (30% Liked)
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Our charting is pretty straight forward thanks to our software. We select MC: and the admitting diagnosis... it then takes us through whatever assessment it is looking for. For example MC: Rehab for functional loss, or MC: Pneumonia, MC: Hip fracture, etc. Our nurses do the assessments but it is up to us to interpret the information and incorporate it into the MDS and CP process.
We have report every morning. We make copies of our 24 hour report and head off to the meeting. We do not have "MDS" nurses. We are nurse managers in charge of everything that gets thrown our way. I would not want floor nurses to do the MDS process. It is not as easy as pointing and clicking. The question on the MDS might sound simple until you check the RAI and get a 2 page explanation on what NOT to include in the one loaded sentence they asked. Furthermore, I do not want them to do care plan because in the end, I will be the one answering to the state. My nurses do not have time for such things. I need them to perform assessment on critical patients, run the unit, supervise the CNAs, ensure showers and cares are getting done, medications passed, orderd transcribed, MDs called, labs reviewed, family dynamics, admission and discharges, etc. They have enough on their plate. I'm sorry but if your MDS nurse is having such a problem, then I suggest she spend some time with the nurses and explain what she needs from them. I apologize again, because it sounds like she is pawning off her work onto others.
IDT signs the same sections on the MDS depending on what it is. You will see this with electronic signatures. For example, I open the MDS and put in the ARD, section A. SW comes around and answers the questions about mental disabilities. I put in information regarding O for treatment and procedures, but therapy puts in their own minutes. I don't touch mood, behavior, swallow, cognitive, activities. There is a reason why it is called an Interdisciplinary Team. They can code their own speciality. I just oversee that they do things correctly and timely. They are also responsible for their respective CAAs and CP... again, I ensure that they are timely, correct with appropriate interventions
FYI, in this building we have 3 RN MDS/RCM's, is probably why they do the "extra" work that some don't? Max patients per MDS/RCM is 20, Medicare mixed thru out all caseloads
Thanks for the information. Perhaps I asked the question wrong. In our building the SW does D,E, Q Activities does F and RN/MDS does the rest....so (including CAA's) so my question is this: RN signs for and puts these alphabet letters:
A,b,c,g,h,i,j,k,l,m,o,p,V and Z Correct? (RN's imput all data from Dietician, Therapies, only other disciplines who data enter, in this company, are the SW and Activities, RN's do the cognition section).
RAIM3 (RAI Manual MDS 3.0) pg 2-41 says, "The requirement to complete a change of therapy is reevaluated with additional 7-day COT observation periods ending on the 14th, 21st, and 28th days after the most recent Medicare payment assessment ARD and a COT OMRA is to be completed if the RUG-IV category changes."
In other words, the COT is repeatedly reevaluated every 7 days starting from the most recent PPS assessment ARD.
Primary responsibility for accuracy lies with the person selecting the MDS item response. Each person completing a section of the MDS is required to sign the Attestation Statement (AA9, AD, and AT7) that reads:
�I certify that the accompanying information accurately reflects resident assessment or tracking information for this resident and that I collected or coordinated collection of this information on the dates specified. To the best of my knowledge, this information was collected in accordance with applicable Medicare and Medicaid requirements. I understand that this information is used as a basis for ensuring that residents receive appropriate and quality care, and as a basis for payment from Federal funds. I further understand that payment of such Federal funds and continued participation in the government-funded health care programs is conditioned on the accuracy and truthfulness of this information, and that I may be personally subject to or may subject my organization to substantial criminal, civil, and/or administrative penalties for submitting false information. I also certify that I am authorized to submit this information by this facility on its behalf.�
This is what I base my practice on. It would be interesting to see how people interpet it.
Pixie, you are smart and you are passionate. tread lightly, do the MDS nurses report directly to you? or do they have a corporate, regional/district sometimes consultant like person? I've seen you from other posts under MDS and am an MDS nurse myself, have been an ADON, offered DON (wouldn't think about it ;-)
and no, i don't feel that submitting an assessment without all the information is fraudulent, submitting incorrect information knowingly is fraudulent. If an assessment will be late if you don't submit and you can't get the information you need from therapy, it doesn't change the assessment, only the reimbursment. If there is a regional/district whatever MDS person, he/she should get involved. Issues such as these are going to make a BIG BIG difference and you're right, it didn't take long, did it? you are new, intelligent and have knowledge that apparently others there don't have. you are seen as a threat. you might know too much to be able to tone it down. in that case, a better organized, more knowledgable company may be your best bet. Good Luck! you'll find your nitch.
Post acute unit: 27 patients day shift 2 licensed, 4 cna's, 1 nurse manager, evenings 2 licensed 4 cnas, nights 2 licensed 2 cnas
2 long term units 39 beds: days 2 nurses + manager, 6 cnas, evenings 2 licensed, 6 cnas, nights 1 licensed 4.5-5 CNAs
dementia unit: same as above, but nights has 3 cnas
This is the best staffed facility I have ever worked in.
My last building on sub acute for 41 residents we had 4,3,2 cnas, long term / dementia for 41: aides were 5 5 and 2, and the other unit 4,3, and 2 with 41 residents half of whom were independent with adls.
Thanks to both of you. This QIS survey process is somewhat frustrating. I'm used to trying to manage a survey process. I'm used to knowing what they were digging into, I'm used to trying to "argue" why we did what we did, etc.
Heck I might as well go on vacation with this process. I don't have a clue how we are doing. Could be good/could be bad. Think that makes me more nervous than anything.
Yes every 7 days starting with the first ARD in October.
Best words of advice I ever got were 1. Never let them see you sweat 2. Tell the truth 3 Continue the best practice care that you always give, as if it were just another day!
I don't know if this will help, but here goes. i worked at a 120 bed facility and did mcr assessments. when we got to 35, it was getting hard for me and i had to ask my coworker to help. but then i have never worked in a facility, maybe one, where the other team members did their part of the assessments, at least timely. nor did they do RAPS/CAAS. They did do thier own careplans. That said, i guess it would depend if you just do certain sections.
an unlicensed person could do data entry and scheduling as you said. how about section A if taught? maybe even enter ADLs, mood or behavior if you just go from print outs off a kiosk. doing the entries/reentries would be a help as well as opening the assessments. printing out, organizing with notes for review, signatures, and to do filing. we have unlicensed people put MD orders in the computer, diagnoses, once taught or given by others and those populate the MDS. But with all the new discharge assessments and now COTs, i believe you need another licensed person, at least part-time if you have the unlicensed person as well, could be an lpn/lvn. all you would have to do is sign as complete, not that it is correct.
And oh yes, very overwhelmed, especially because i think other disciplines don't have a clue sometimes what all we do and how much.
Ok, here is my question. please check my math here"
In looking at all of this, for PPS/Med A, potentially there are ONLY 4 COT's that could possibly trigger? In a perfect world:
5 day: if a COT triggered, would be a combo for 14 day, right? (No matter what day chosen, if even day 8, cot would be due day 15, but the 14 day would also come into paly
14 day: could have one COT on or about day 21
30 day: if a COT triggered, on or about day 37
60 day: if a COT triggered, on or aboutday 67
90 day: if a COT triggered, on or about day 97, but there would also be an opportunity for a quarterly in here, as well.
....and then,.... if 6 people get off at the last station,....what is the name of the conductor> lol!! (My administrator says that what a PPS meeting sounds like to her, if this was 6 then this would be 8 and then if this is 9, that is an RUX, lol!!).
And of course, we will review daily for any possible COT's, correct?
I went out in June of last year just as we were gearing up for 3.0. I was on bedrest for 26 weeks with my son and after he was born discovered they had replaced me so I have been home with him for the last 9 months. So a total of 16 months out of the loop.
I had an interview today for MDS at a similar nursing home (60 beds, similar mix) and the admin who interviewed me made me feel like my experiance was of no use since 3.0 was started. I have been doing my homework to prepare for the interview and while there were many changes it seems that the process is still very similar to what I have been doing for many years.
Is the admin correct? Am I now in the same place as any nurse walking in with no training/experiance in MDS? I'm not sure where to go from here. There are no on site trainings avalible in my area and I'm not sure about a online training. Any advice?
WHen I worked Assisted Living, the pharmacy did our MAR's, and they were always written as per community prescription, ie Tylenol 2 325 mg tabs twice daily as needed. LTC: pharmacy will begin doing our MAR's when we switch over to E-Mar this month, HOWEVER the kicker is, only for the meds they supply...so we still have to input the OTC's. We anticipate lots of tinkering is going to be needed. Are the pharmacies giving any guidance on this issue? FOr years, it has been written as the total dose to give, then it's up to the nurse to supply that dose, in as many tabs is needed, however I haven't liked that system since I saw how more accurate the Assisted Living MAR's are. I would think that best practice is WHAT you are actually going to give, BUT a surveyor during med pass audit will say if you give that long acting Tylenol 650 mg it is NOT the same as Tylenol 2 tabs of 325.... Suggestions?
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