15 months of MDS ....

[CapeCodMermaid, RN]

So, we're having a discussion (read argument) where I work. The MDS nurses are saying we should keep the charts of any resident who has been sent to the hospital for 30 days if we think they are coming back because we have to have 15 months of MDSs in the chart...and the activities director says we should keep them because she doesn't want to have to do another assessment. I have told them (and I am the DNS) that if someone goes past their 10 day Medicaid bed hold, we will start a new chart because that person has been discharged.

How do you all do it? I'm having trouble with the MDS nurse anyway. I was doing chart audits today and couldn't find many of the MDSs..'oh' she said, "they're still in the office. I haven't filed them." These were MDSs from December and January.....

[caliotter3]

CCM

I don't know the correct answer to this, but I would tend to agree with the others. I would utilize the old info. However, if longer than a three week break, then I would start over again. If given the leeway. JMO

[rukiddingme]

My facility does the same as you described - if discharged, and gone past 10 day bed hold.

[Talino]

the mds nurses are saying we should keep the charts of any resident who has been sent to the hospital for 30 days if we think they are coming back because we have to have 15 months of mdss in the chart

altho' you need a copy of 15 months of mds placed in the new record, is the medical record storage room remote?

...and the activities director says we should keep them because she doesn't want to have to do another assessment.

on readmission, unless a sig. change occurred after 10 days, the initial assm't or history by other disciplines may remain unchanged. rather than rewriting the entire narrative, why not make a copy of the original and place it in the new record. simply capture resident's readm status in the discipline's progress notes. of course, this practice should rely on good clinical decisions and be indicated in the p&p.

[amylpn24]

I believe the answer to this question depends on facility policy. We do keep the chart for 30 days and start over after that. As far as the MDS's being on the chart, I'm not quite sure what one has to do with the other. If the patient has been discharged, the file goes to med records where it is kept should the state want to pull the chart for some reason.

[susanthomas1954]

15 moonths of MDS's have to be kept where they can be easily accessed. (LAW)

All companies have some policy on when to start a new chart, and the bed hold really shouldn't have anything to do with it. If a patient went to the hospital, they probably (85+% of the time) need a SIG CHANGE OF CONDITION MDS, even if they don't come back skilled, so the activity director needs to do a new assessment anyway. We have a 72 hr policy, which works very well. Doing a completely new admission is a good idea, if for no reason other than the skin assessment, the Braden, the falls risk, elopement risk and bowel and bladder assessments from nursing. If we kept all our nursing assessments current, a lot of minor problems would be caught before the patient gets sick enough to be sent out. (at least that's how it is where I've worked, 4 facilities in 8 years.)

A new admission seems like a lot of work to a facility, but it is worth it for the patient's health. If we did regular assessments monthly, we would notice decline a lot sooner.