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NurseMomDori

NurseMomDori

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  1. NurseMomDori

    After 2 months..what do you think of the MDS 3.0?

    Susan, I recently quit as MDS coordinator and thought about just traveling even to fill in for sick or vacationing MDS coordinators around our state. On our monthly MDS call before I left, I mentioned it and the response was an overwhelming "YES, PLEASE!" It is too hard to take a week off--you push some back and other MDSes forward, so basically you pay for vacation by having the weeks before and after twice as full. (I was taking work home to get everything done, or clocking off when I hit 40 hours and still working, due to the strictly enforced "no overtime policy." After many months of frustration, pulling floor shifts when nurses called in, and too little sleep/family time, I resigned and now work two 12s at a hospital.) I think just doing the basic assessments and entry would work with skeleton care plans.
  2. NurseMomDori

    After 2 months..what do you think of the MDS 3.0?

    With the short time period, can't you just use the same information...as your lookback period is nearly the same? Take this in a common sense format. Who looks at the info, who uses it for anything worthwhile? I am not saying to falsify info at all, I am saying to simplify and use the same info for both assessments.
  3. NurseMomDori

    ARD's, care plan dates & information

    I did the same with short deadlines for the shorter sections. Soc Services, dietary, and activities start their interviews during the AR period. Our ARD is Wednesday, family conference is the day before. We try to address the family concerns, and care planning issues on Tues, and Wed, then have MDS due Thurs, and CAAs on Friday. I wrap up and verify all other sections by close of business on Friday, and if necessary, use Monday to finish my sections. Sections may be done anytime in the AR period, with signing done after the AR date. I also have a note sheet for the family conference which all participants sign at mtg, then we mail a copy (a week or so later) to the family with resolution of problems addressed at the mtg. This helps to keep families updated if they don't come to conference, or if they want a record of what was discussed. After the family leaves, we go over current care plan with the CNA, CP team, and identify changes and new problems to address. The team member responsible (or me if that person is slow or computer ignorant) then is resposible to make the changes in the computer for printing the following week.
  4. NurseMomDori

    Something random to brighten this frigid Tuesday

    Here's a funny: our new DON charted about "advantageous" lung sounds! I guess I would say those would be inspiration and expiration! When I summarize for the quarterly MDS, I get to read over the nurse's notes and chuckle. So a sign for me would be people walking past my open door hearing me laughing to myself.
  5. NurseMomDori

    After 2 months..what do you think of the MDS 3.0?

    Sharon, I made a sheet with all of the residents' names for the nurse who gave the flu shots this year. She dated when she gave the shots. I gave a copy to our billing dept so they could bill them all, and I kept a copy so I have a quick glance for the dates. Our software has an "order text search" feature, and I use this to check all residents with specific orders, ie. psychotropic meds, wanderguards, flu shot dates, etc. to make sure I have these items care planned or medically reviewed periodically. I also keep my sheets in my files so I can quickly reference the last MDS or problems we dealt with at the last family conference. We do interdisc. progress notes and cover pain, new meds or problems, ADL, rehab/PT, B&B, mobility, act, nutritional risk, etc. It presents a quarterly summary and our surveyors seem to love it.
  6. NurseMomDori

    After 2 months..what do you think of the MDS 3.0?

    We print the MDS four pages to one sheet and most of us can still read it. Noone does except survey team anyway! Also, use the dash now that it is an option. Pain interview on DC to hosp--dash all except meds given in last 5 days. Also, most of the info is the same as the last MDS and your software should be able to populate the prev info into the new MDS automatically. Since I do most of the sections, I give the others (ACT, SOC SER, DIETARY) 24 hours after a DCRA to hosp to finish their sections--from notification if it happens over the weekend. Also on changing the DCRA to DCRNA, that is where section X comes in and you can modify without having to change anything else. Noone else even has to do anything, and you sign again for changing X on the date you modify, then submit. Way easier than doing a new MDS when you send a resident to the hospital and he dies there a week later.
  7. NurseMomDori

    CAAS summary language how

    Simple. Nature of the problem: Acute pain following joint replacement Causes/cont factors: surgical repair, arthritis, delayed healing due to poor nutritional intake...etc. Risk factors: increased fall risk,impaired physical mobility, risk for constipation, depression, impaired surgical healing, anorexia..... Analysis: Complaints of pain have decreased resulting in 2 requests per day for PRN pain meds on day 10 versus 6 requests/ day on day 2 following surgery. Jane walks approx. 100 feet per episode with rehab now versus only 5-10 feet on day 2. Jane refused scheduled pain meds as she states she did not want to become dependent upon them, and will ask when she feels she needs medication. Jane plans to return home when she is able to ambulate independently without pain. Simple, to the point:>) Besides, the only ones who really read or use this info are the surveyors once a year. Your summary of the CAA tells a story. Dori
  8. NurseMomDori

    CAAS summary language how

    Karen, If you explain the problem simply, you are meeting the requirements. Example: "Jane had a total knee replacement on 10/10/10, and continues to have complaints of pain when ambulating. She participates in PT 3x week and nursing rehab walking and strengthening exercises 6x week. She has scheduled Ibuprofen QID and may have Lortab Q 4-6 hours PRN. She may have heat packs as needed. Her pain is assessed Q shift by the charge nurse. CNAs are instructed to report c/o pain or non-verbal expressions of pain." The nurse's notes for that shift should explain any complaints and treatments offered. Be brief and to the point. We also summarize our RAPs/CAAs in an IPN at the end of the care plan process and attach that to the MDS in the chart. Good luck! Dori
  9. NurseMomDori

    Critical hint for Medicare MDS 3.0

    The MDS coordinator enters the completed box on the summary screen then presses the audit button. We use Keane care and I have to be logged in to sign the complete date. Then the MDS is locked and ready to submit to EDS. You can email me for more info or I can send you some of our tracking sheets if you want. I developed a two page document to complile all the required info for my sections, and I use it to input all of my info at one time. ddware@aol.com personal or hlrcmds@hlrc.us for work. Use the hlrc address if you would like a response during the daytime. Good luck! Dori
  10. NurseMomDori

    CAT & CAA's...help!!!

    We are printing the MDS 4 pages to a sheet. You get 4 small pages but you can still read the print and it saves a ton of paper! Our state (Montana) survey office said it is okay for us to place "See IPN dated 10/05/10, DW (initials)" in the CAA documentation location and do a summary of the CAAs. I do that anyway, so it eliminates duplication. Noone looks at the CAAs anyway except on a state survey. As long as you cover all of the info in your IPN you are providing the necessary documentation. Using the CAA roms means you have to print them out and keep them with the MDS if you use paper charting. What a waste of time and PAPER! Just cover it in the IPN.
  11. NurseMomDori

    Interview an RN

    What do you need to know?? ddware@aol.com
  12. NurseMomDori

    Today is Oct 1st. All set?

    Katoline: Our software is Keane care, and we have a section for IPNs in addition to the Assessment and Care plan sections. We each type our IPN (activity, nursing, SS, and dietary) and then print them out and put them in the chart with the paper copy of the MDS. My section covers pain, new medications and medical issues, mobility, G items, bowel and bladder, skin, infections, falls, rehab, etc. I summarize the quarter, or shorter for medicare 5, 14, 30 days. Our surveyors seem to like the summary, except when I neglect to mention a fall, or accidentally write that someone is independent instead of supervised! I just discussed with our state rep about referencing the IPN instead of writing a RAP documentation note explaining each RAP. She stated it would be fine...and it would eliminate the duplication. So now, on the CAA summary, I will write "see IPN dated 10/9/10 DW (my initials)" instead of "CAA documentation note." All of my team are happy with this as we now are writing the IPN (which takes about 45 minutes each) and doing RAP or CAA documentation notes too. I have been the MDS coordinator for just over a year and found in our last survey that this seems to answer a lot of the questions before the surveyors have to ask for additional info. I hope this helps you. Also, I have changed my original worksheet as I have done more MDSes. Is there a way to post it in a message if I am not a GOLD member in allnurses? I suppose I should just officially join, but I just don't seem to get around to it!
  13. NurseMomDori

    Today is Oct 1st. All set?

    Katoline: Chief Operating Officer (former HIMS manager who now is in charge. We have a CEO who is mostly absent.) is the one who submits my MDS, and the IPNs are the interdisciplinary progress notes we write to summarize each MDS. I cover pain, med changes, new problems, bowel and bladder, G items=mobility, skin, etc. Each of our care plan team members write one covering their sections. It ties all of our assessments together. Also our state office says we can reference the IPN instead of writing a RAP documentation note for each triggered RAP or CAA now. Dori
  14. NurseMomDori

    Signing 3.0

    I set my dates for the other sections to be completed by ARD+5 so that I can do my sections and find out what they have not completed by +7. That gives me 7 days for emergencies. Also as time goes by and we settle into a routine, I can have my dates ARD+5 for them, then have time to fudge before the S**t really must hit the fan and be submitted. We can have the due date as early as ARD+1 and have their interviews completed and entered on that date, then work with your submission dates to work around vacations, sick times, etc. This works well for our facility and getting others to submit their info on time.
  15. NurseMomDori

    Mds obra scheduling tool

    Dont you have one of those MDS wheels where it shows grace days etc.??
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