Mood and Behavior tracking

PsychNurseWannaBe, BSN, RN · Mar 18, 2008

We use a behavior and mood tracking sheet. It is placed in the MAR. So when I am giving my last med for the night I just go through it real quick. For one lady she has several sheets... anxiety, depression, stricking out, etc. It doesn't take me too long to go through it. It just ask if that mood/behavior was present, if it was, how many times, what was my interventions, 1:1, counseling, distraction, offer food, offer drink, etc... and if it was effective. The additional thing we have to do is if it was behavioral...such as hitting...then we fill out another chart in a behavioral log. Where we can write more info.

noc4senuf · Mar 18, 2008

Is your form something you can share?

Talino · Mar 18, 2008

Ok, now I need to see if someone has any suggestions. When our state case mix review was in here, they said that in order to capture payment on Section E, we need to have some sort of tracking or documentation in that 30 day window to show what the mood and behavior issues were.
We already have the CNA's completing behavior tracking due to psychotropics but, they want something more specific to also cover mood. Anything I have looked at is time consuming for the nurses and am trying to prevent giving them additional work to do.

To be able to factor the signs of depression in a higher case mix (CC2, CB2, & CA2), it has to meet 2 requirements:

- A score of 1 or 2 in Section E1, AND

- There must be at least 3 indicators (as outlined in Section E1) scoring 1 or 2.

To score a 2 (Indicator of this type exhibited daily or almost daily, 6 or 7 days a week), you would likely need to provide documentation of occurrence on a daily basis. Thus, identify the common symptoms a resident exhibits. Enter these symptoms in an MAR format (as you would the name of a medication) See attached sample. You can also integrate your behavior symptom monitoring into one sheet.

To score a 1 (Indicator of this type exhibited up to 5 days a week), all that is needed is one documentation that a symptom occurred during the 30-day period. Therefore, one nurse's note identifying 3 different symptoms suffices. Or 3 separate nurses' notes each identifying 3 different symptoms.

BEHAVIOR AND MOOD MONITORING.pdf

noc4senuf · Mar 18, 2008

I know the requirements needed, just trying to find something that would not add additional excess work to the nurses. I do have a couple of different forms I have looked at including the grid you have but, it requires that they have to do that for 30 days, and then if you factor in that each week new residents start/stop the grid, it becomes a mess since it is only required to be tracked during the ARD to be counted.

But, I do appreciate the help.

Talino · Mar 18, 2008

I know the requirements needed, just trying to find something that would not add additional excess work to the nurses. I do have a couple of different forms I have looked at including the grid you have but, it requires that they have to do that for 30 days, and then if you factor in that each week new residents start/stop the grid, it becomes a mess since it is only required to be tracked during the ARD to be counted.
But, I do appreciate the help.

Just change the dates to begin 29 days prior to ARD :wink2:

CapeCodMermaid, RN · Mar 18, 2008

We have recently changed from paper documentation to a system called CareTracker...kiosks on every unit on which the CNAs and everyone else in the building documents the patient care, behavior, mood...you name it. Really all you need is a one page form using language from the MDS mood and behavior questions. Put it in the MAR and the nurses can chart for the period before the ARD.

Talino · Mar 18, 2008

Definitely worth the investment! I would wait pushing for one until the specs for the new MDS 3.0 is ironed out.

noc4senuf · Mar 19, 2008

I just watched a webcast on the Caretracker last month. Seemed simple enough. Now, it's up to the CFO and CEO to get around to deciding when we will go computerized. The MN Govenor has mandated by 1/1/2015 that everyone needs to be but, at our facility... the way they look at it, that's 6 more years they can wait.

In the meantime, it takes a crane to lift some charts and we try not to come up with new forms without doing away with one of the old.

CapeCodMermaid, RN · Mar 19, 2008

CareTracker may seem simple, but if you go for it at your facility, insist on hours and hours of training. Once you get the hang of it, you'll like it, but it takes a while. We spent hours and hours a day the first few weeks inputting documentation the CNAs had missed, but now we are at 99% compliance. The best part of it is the reports you can generate from the system. We have everyone, social workers, nurses, housekeepers, in the system so if they see a behavior they can document it right then and there. We'll be going totally electronic by the end of the year....nurses' notes, careplans, labs, MD progress notes...everything will be electronic. I can't wait!!

noc4senuf · Mar 19, 2008

CCM what computer program other than Caretracker are you working with? What are the pro's and con's of the different programs out there?

CapeCodMermaid, RN · Mar 19, 2008

The other program, which we haven't started yet, but is in place at a few of our sister facilities, is Keane. From what I'm told it integrates with the Care Tracker system so when you want to do an MDS for example, you enter the resident's name and section G is automatically populated with the information entered into Care Tracker by the CNAs. The nurses' notes will be done on the computer,the care plans and eventually the lab results will be electronically inserted into the medical record without the need of faxing results on paper. At the moment, our lab and xray company have a web site and we can get our results on line. Our pharmacy has an online refill page...E-Refill. We use a little bar code scanner, scan the meds and sync up with the computer. It's all very cumbersome to use so far because it is still new, but I think in the end, it'll be wonderful. Remember when IVACS first came out we all were perplexed and now they are obsolete.

There are many medical software companies and I guess they all have their good and bad points. I'll let you know as soon as we go live with Keane.