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According to the OIG that just reviewed our charts, restorative and therapy should be used as supportive documentation to determine ADL function. The previous MDS coordinator would not use them one example was she would code w/c bound but therapy would code walking with walker assist. Needless to say we lost $$$.

Has anyone been able to print validation reports yet? I have been able to submit but still cannot download any validation reports from Casper. Maybe I'm not going to the correct place? or are they not available yet?

It seems you can plan all you want, but you will never be prepared enough. How are you all doing your discharges? It's crazy!! I had "3" residents sent to Hospital and Admitted over the weekend. So how do I assign everyone their sections?? How do they assess?? They were admitted friday nite and saturday nite. I can see us doing the whole 'planned' discharge. Can anyone help, please?!?

Our DON has mentioned that she might take some medical leave d/t her father diagnosed with cancer, but is uncertain due to her father's lack of interest in chemotherapy. But our ADON is an LVN and our ADM mentioned very loosely that since no one else was available that maybe "WE" could cover her while she was away. Since I know the ADON is not a take charge person and we don't know for how long she will decide to stay out, I'm getting a little spooked about being able to handle both DON and MDS especially with the upcoming changes! Have any of you managed MDS and DON???

We just finished our annual survey! It was my first year as MDS. We faired pretty well. But it's so stressful when they are here. Our nurses did awesome with cbg's, med pass, and treatments. Our infection control went well but our restraint policy did not pass their standards. We had admitted a little lady with fx femur in a leg immobilizer and she would turn it like it was nothing plus she kept pulling out her f/c, even though we had her in a low bed managed to crawl out of it with immobilizer and all and she barely weighed but 88lbs! Anyway, the night nurse called md and family and agreed on mittens, the night before THEY showed up. Needless to say we got dinged on not having a proper pre-assessment for restraints in place. Our restraint nurse has a follow up and reduction form that she uses but they want one for pre assessing the resident? Does any one have something similar to that? We had our documentation in place but it was not enough. Other than that sliding scale was looked at very closely. Oh and before I forget, like I said they look into every cranny-our toilet seats in resident's rooms need updating apparantly our housekeepers have over cleaned them. This was part of the infection control. But I was very happy to see them leave.

Unfortunately, these incidents do occur. Sorry for the RN and LPN involved. It is a very stressing situation. We had a similar situation, except in our case. Per daughter's request, the night LPN did not even start CPR. 90-something, frail resident was found unresponsive, daughter requested no CPR. When RN arrived to pronounce realized CPR was not initiated and had to call incident to state. Our facility was placed in IJ. HORRIBLE TO SAY THE LEAST. Both the LPN and RN were referred to the board. Still pending outcome. So if you want to be a resident advocate. Start with talking to responsible parties or POA on admission or during stay, PRIOR to any situation. ITS OUR LICENSE ON THE LINE! Even if we don't agree. I think that has to be one of the hardest things to accept working for LTC.

maybe its different in ltc than in a hospital where there might be more staff. but i would hate to be the only nurse on the floor because you did not feel like working today and did not bother to find someone to cover for you! you would not like it if it happened to you. i work in a small facility with only 2 full time rn/1 part-time rn charge nurses that alternate to have rn coverage. it would be very difficult to find last minute replacement. our nurse scheduler, which happens to be one of the ft rns, post nursing schedule for a full month at a time. so, they have plenty of time to find someone to switch shifts or get coverage if they know ahead of time or if something comes up. it is understandable that we do get sick or kiddos get sick. but "just because" call ins, should not be acceptable. as for me, i would definitely ask why? if i have to come in on my day off to cover your shift, it better be a good reason.

Thank you all for your comments. He stated he was worried she would break off the tip, which I have seen happen, or break a tooth. And yes we're having an inservice to discuss this, among other things. I'll keep you posted.

Hello everyone, I am in need of some clarification. Our night nurse had a situation with one of our residents. She was in need of oral suctioning, when he went to suction her, she had her mouth tightly shut and would not open for suctioning. After much coaxing and with assist of the CNA, he was able to suction a little but on the third try she clench her jaw and would not let go of the yaunker. After she did let go, he noticed some redness to her jawline and was later reported by the CNA that a bruise was forming to her left cheek. He did give her a svn tx after suctioning, made incident report, called MD, RP. Family requested resident be sent to ER for further evaluation. Came back to facility 2 hrs later after labs, xray, another svn tx with no orders. This morning our Administration decided it should be reported to the state, due to excessive force to remove yaunker. Some of us agree. The other half disagree. Have any of you come across something like this? What has been your experience with difficulties during suctioning?

That would be great to have someone take care of the mds while on break or vacation! So how do you when your social worker is on vacation? Who completes her section? We have a out of town social worker that comes to our facility once a week. She has been doing this for a few years. But I'm always concerned that she won't make it. I've been told that as an RN I can complete her section. Have any of you come across this situation?

I did not say that they chart to "fluff" their entries. What I am trying to say is that they do not do ANY type of assessments- new admits/readmits, or chart on any resident that has to do with MDS information because in the past they have been told that surveyors frown on DON/ADONs doing the assessments. But my question was can I as the MDS coordinator do an entry when I do my assessment for the MDS or should a floor nurse(RN or LVN) do them? We have our floor nurses doing the monthly summaries and a corresponding head to toe assessment charting each month but they don't always address everything needed for the mds.

Hello everyone! In the past our ADON(LVN) was also doing the MDS but our DON would sign them. Since I have started to do MDS, the ADON has insisted on continueing to do the Careplans. Fine with me, but I'm concerned since in the past surveys her careplans have not been " well liked" by the surveyors. Her excuse has always been that she has too much on her plate. But from what I have been reading here. She nor the DON have been doing a whole lot. They are under the impression that they(DON and ADON) are not to do any assessments(admits/readmits) on any of our residents and chart a little as possible on residents especially our medicare residents. They have been told in the past that since the ADON is doing MDS, their entries or assessments can "fluff" the payment levels. This also goes to any changes to ADLs, tx, svn tx. I have since worked a few weekends to relieve some of the RNs as charge but have been told to limit my charting to a minimum and any changes need to be charted, to have one of the lvns working to chart. Is this common practice? I know that in order to complete the MDS, I have to do a current assessment of the resident and audit the chart to make sure I have documentation to sustain the MDS. But according to them any changes or discrepencies that I find, either I will not be able to claim, and have someone correct it at that time so that I will be able to claim it. I think that by doing this we are not claiming the maximum $$. Any suggestions will be greatly appreciated.

Thanks for your reply. I believe that is what the MDS trainer was trying to point out. That in order to be able to claim all 14 days, we had to d/c on 15th or when medical necessity no longer needed, whichever came first but the previous MDS person kept stating she would get in trouble when she was audited due to keeping past the initial 5-10 days.

I've been doing MDS for about six months now and everyday is like the first but I think I'm getting my rhythm. I have a situation that we can't agree on. I have a PPS resident, hospitalized, came back, we are monitoring for post IV meds, weakness, etc. So went ahead and did the 5day. The problem is that the previous MDS states I should only keep her on for 5 to 10 days, while the MDS person that trained me is saying that I should keep her on for the full 14 days and d/c from PPS on 15th day. But wouldn't that make me have to do a 14day assessment? If so, then should I d/c her on day 13th to eliminate having to do a 14th day?

I have been your replies and I still don't understand why any nurse would feel threatened by a CMA. I guess I don't see it. I am currently doing MDS but not too long ago I was RN Charge Nurse with 2 LVNs that split about 75-80 residents to do peg feedings, treatments, cbgs, svns, plus would also keep up with their odering of supplies, monthly summaries (10-12) each month plus labs needed to be collected, and assist with any falls, suctioning, or transfers to and from dialysis, hosp, etc. RN would report labs, keep up with appt and follow up plus admissions, readmissions, dialysis, assist MD with weekly rounds(such as podiatrist, psychiatrist, local mds). So passing oral meds was delegated to CMAs. As much as I see our nurses doing daily I can't imagine any of them upset because they are not passing meds! Maybe because we do 12 hr shifts makes a difference.