RAI and insanity

RAI stands for Resident Assessment Instrument, it is the bible for the MDS..SO TO SPEAK. The MDS is important because it drives how a facility is reimburse, but more importantly it is suppose to guide management staff in focusing on resident care. Specifically, the MDS alerts nurses by triggering areas that need a closer look to determine if the resident needs additional care in a specific area. For example once the MDS is complete you may be alerted to write a RAP summary for Delirium. When writing this RAP you should look at why the resident triggered for delirium... are they experiencing change in mental status over the course of the day or is he or she having a deterioration in mood. If so why are these occurring? Is it because the resident Sun-Downs and has varying mood and behaviors or experiencing these changes because they were being treated for a UTI during the assessment period and now there symptoms are resolved. The trigger for delirium alerts you to evaluate and investigate do you know what is going on with the resident? Is this an acute change or chronic and has the resident been treated.

The RAI process is quite complex and cumbersome...does your facility have a designated Coordinator? I hope this helps you a little....

As a nurse surveyor conducting federal surveys in LTC you must realize that surveyors utilize the MDS document and RAI/RAPS to determine compliance with federal regulations regarding resident assessments. As a previous DON in LTC for ----years I learned that nothing replaces the interdisciplinary process which stems from the MDS assessment. If you utilize this document to assure that residents are properly assessed and that interventions are put into place for identified areas resident care will be improved.

As a nurse surveyor conducting federal surveys in LTC you must realize that surveyors utilize the MDS document and RAI/RAPS to determine compliance with federal regulations regarding resident assessments. As a previous DON in LTC for ----years I learned that nothing replaces the interdisciplinary process which stems from the MDS assessment. If you utilize this document to assure that residents are properly assessed and that interventions are put into place for identified areas resident care will be improved.

A question for the Federal Surveyor please:

why do the State Surveyors expect the MDS Coordinator to have every answer to every resident's MDS memorized ?

I do my best, but I still don't know everything they ask me at survey.

thanks.

In my opinion the surveyors do not expect you to know the answers on the spot, but the RAI manual states that the MDS must be reproducable...that means that any person doing the MDS should be able to research the information in the MDS and determine the rationale for the answer. As an MDS coordinator, I rarely do MDS, but I do audit MDS done by the 2 MDS nurses I work with, when auditing the MDS I pose to them the same questions the surveyors ask me to assure that the answer is appropriate and meets the criteria outlined in the MDS. When asked a question by a surveyor, I rarely answer on the spot, I always take the time to research the answer and question those staff members involved to assure that I am answering the question the highest level of accuracy.

Here's an example: last survey (early Jan x 5 days), State walked in at 1215 lunch time, HR/Personnel Mgr was the next in line as being the boss at the time, so when the Surveyors asked for someone to walk with them on each Hall, HR told me to. I said I do not know the residents enough to answer what needs they each have. They all looked at me weird. Later someone asked me, "you're the MDS nurse, why don't you know each resident?". I said, "yes, I enter the information into the MDS but I cannot possibly remember everything about each resident". We have 65. A CNA walked with them. The LPN/floor nurse was busy. It concerns me that other staff think I am not doing as well as I should be. I think they just don't understand the complexity and details of the MDS/res asmt process.

I am just wondering if anybody else feels this way or gets treated like they should know and memorize every single detail about every resident? Am I too old to do this (40) re: not able to memorize it all? Do you young MDS people memorize it all?

Thanks.

The staff needs to be educated on the role of the MDS Coordinator, there is no way possible you can memorize everything on every resident. The staff on the other hand needs to be prepared to answer direct care questions, because they are the one that provide the care. The health department knows that you most likely do not provide direct care and therefore rely on the nursing staff to inform you of the needs and management of the residents. HR needs to be educated as well and the staff needs to be informed of there role and responsibility when the DOH enters the facility. I believe you should initiate this...discuss with the DON how the staff was not prepared to make rounds with DOH. Also do your nurses on the units update a weekly roster [Form 802]. If so, than if the DON wants to make you responsible for making rounds than you can use this roster to answer most of the question DOH will ask you.

Being an MDS Coordinator can be a daunting task. I believe in the system because it assists all long term care staff to be a part of the life of each resident. There is no short cut unfortunately. Knowing everything about all residents is an unrealistic expectation, and having been a former state surveyor, I can say I did not expect staff to know every detail, however I did expect them to know where to pull the information from and to be able to say I don't know the answer but I will find someone who does. The RAI process is a unique opportunity for nurses in long term care to teach other nurses that LTC nursing is as complex as acute care nursing.