Carrie162

Shanti2u, I am also in Massachusetts and familiar with MMQ's. There is a manual; it can be downloaded from the mass.gov website. Look up instructions to complete the mmq. There are also courses; look on the mass extended care federation website; they usually have mmq related courses every 6 months or so. Also, Lorificen Allen (formerly Landa & Altshier) in Randolph has some good educational opportunities. The MMQ is less complicated than the MDS; fewer questions, but on-site audits are completed by nurse reviewers that encompasses all documentation, so there is a big potential for recoupment if you are not on your toes. Good luck!

You can project a rehab medium or a rehab high, not a very or ultra.

RondaS, it sounds like you will only have one day billed to Medicare. You can project a rehab medium even with zero actual minutes of rehab achieved. If you can take any IV's in the lookback period, then you have a RML or an RMX. You did have eval orders, sounds correct.

RondaS, I agree with the above. If you have not submitted the 5-day MDS, use day 8, project a RMX or an RML. If the patient is going to still be there on day 15, do the PPS 14-day assessment and capture the therapy and the IV abx.

I have been an MDS/PPS coordinator for two years. I would ask, before you accept the position, what kind of training will you receive? Especially considering you are new to MDS. I would ask, are you responsible for LTC assessments, such as the quarterly and comprehensive assessments, or are you also responsible for the PPS assessments, the 5day, 14-day, 30-day etc? How many beds in the facility? IF it is a large facility and you do both LTC and Medicare/PPS, that is a lot of work. Do the floor nurses and unit managers participate in any sections of the long term care MDS? Who is your resource person if you have questions? And does this facility have a good survey history with MDS or are you going to be responsible to clean up if there have been scheduling problems?

RondaS, check out the AANAC website. You can capture the nine new rug categories when residents are receiving therapy and extensive services, specifically IV meds, IV fluids, vents, trach's, or suctioning. Minutes of therapy have not changed. It is important to track the ADL sum score; residents will only make the nine new rugs if they are heavier care, ADL sum score of at least 7.

I have sent a patient out without a doctor's order in cases of SOB or sudden changes of mental status. I had another patient, full code, who was crumping, oxygen sat 85% on 10L via non rebreather, pulse 120, and the doctor told me to start IV Levaquin. I sent him out 911 with my DON's full approval and no MD order. The paramedics wanted to know why we waited so long.

Thanks so much for your response DONMom. I have been thinking long and hard, and I love the place where I work, I love the CNA's, the administrator, the ADON, but I just don't think I'm a DON type of person. I think the headaches and the churnings in my stomach say a lot. I don't know if I have the constitution to take the 24 hour accountability. I've seen a lot in my career, but it hasn't all been on my shoulders before. I know I've made a lot of headway; I've had to use the disciplinary process a LOT, and I don't like that side of my personality. It's a great building; pay scales are low, but we have the best staffing ratio in the area, and the patients aren't that acute. I've just got a big decision to make before I throw in the towel. I enjoy your posts!!!

Six months ago I took a position as a DON at a 40 bed LTC/rehab unit within a CCRC. My previous experience is in LTC as a unit manager and MDS nurse. This is my first DON position, and I wonder if I made a mistake. Lots of teamwork issues, Nurses out to get each other, some clinical competency issues. CNA's are pretty good but I feel like I neglect them dealing with all the other nonsense. I'm also the SDC, and I haven't put together a good plan; I really neglect the education part. There's been no supervisor on weekends but i'm about to hire. It's pretty busy on the unit, but staffing is good; there's just some serious accountability issues. I miss the quiet of the MDS. There's a position available in another building that I'm considering; I gave my notice this week and Admin. agreed to add an SDC 20 hrs to help out; they think it's coming together and want me to stick it out. Any advice? I'm tempted to stay and I'm tempted to go.

The Happy faces that are used to rate pain in a nonverbal resident or other resident that is unable to use the 1-10 scale are called Wong-Baker Faces. (I think). Unconscious patients are not my area of expertise, but isn't there some kind of a coma scale?

I am currently working as an MDS Coordinator in a LTC facility. Our census runs about 120, with a medicare census of about 10 right now, but that's really slow. Usually it's about 20-25. Right now I'm doing it alone because a colleague left, but I'm doing some overtime. I've never kept it to five eight hour days. I do all the Medicare assessments, and all the LTC annual assessments, admission assessments, and SCOS assessments. It's a job that I love, and you will like it if you are a detail-oriented person who likes making lists, searching for the smallest details, and crunching the numbers. It's really a job for someone very anal-retentive, as I've been called. The MDS is time sensitive, so you have to be right on top of your game. If I were you I would advocate for a strong orientation or training with outside agencies. I would ask what tools they have to make sure they capture the information to make the best rug category. Some tools and checklists can make your life easier. Best of luck!