RAPS--should CMS keep, change, or delete?

cadburypam · Mar 25, 2008

I would be interested in participating.

I think changes need to be made to the current RAPs, adding some and possibly deleting or combining others.

Pam

poohmdsnurse · Mar 25, 2008

OHHHHHH please my partner and I would definately love to participate in a evaluation of RAPS. That is truely one part of the MDS I absolutely HATE!!! It takes up so much time to complete and no one reads them unless they are the chosen one by the ODH surveyors.

cadburypam · Mar 25, 2008

Wow, I guess I'm lucky, or mean:madface:, I make my nurse's read the RAPs. I also make them read the care plans and review them with the aides. That way they know the resident, know what I do and how I pull all the information together from everywhere to form the RAPs,:typing it gives them a broad picture of the resident more so than just throwing pills at them. :cool:

Rexie68 · Mar 25, 2008

wow, i guess i'm lucky, or mean:madface:, i make my nurse's read the raps. i also make them read the care plans and review them with the aides. that way they know the resident, know what i do and how i pull all the information together from everywhere to form the raps,:typing it gives them a broad picture of the resident more so than just throwing pills at them.

i'd say you're lucky....our floor nurses don't have time to read the care plans and have no clue what a rap is. hopefully the raps will become more pertinent...include pain and such. but really, i hope most of us know what to care plan anyway.....are raps necessary?

poohmdsnurse · Mar 25, 2008

THANK-YOU !!! There is no way I would have time or them to have time

to listen to me or reading themselves what is involved in completing a RAP or a careplan. Heck I can't get them to listen to me as it is.... they think in their mind I have this peachy office job M-F and sit behind a computer -- if they only knew what was all involved. I truely do not feel RAPS are necessary-

cadburypam · Mar 25, 2008

I agree RAPs are cumbersome and a pain in the you know where, but to me it rounds out the MDS process. I am fortunate that I am in a very small facility and have had the opportunity to "train" my nurses. We are a brand new facility (took our first resident in Dec) and we have all new staff so they have to adhere to my compulsiveness, so they make time (10-15 minutesa week) to read the RAPs on their assigned resident's (they are responsible for monthly summaries on resident's so they have to write , why not read?. When I print out the care plans I review them with the nurse and instruct her to review them with the aide. I follow up with the aide with questions about the care plan.

I wish every facility would hold nurse's responsible for the care they provide. It is not our responsibility as MDS coordinators to do all this work for nothing, nurses have to have some responsibility in this process too. :spbox:

MrsK1223 · Mar 25, 2008

I am a new MDS coordinator and I hate raps and have heard from the best and she hates them as well. Our new DON used to do MDS and she hates them as well. It's too time consuming and I really don't see the point when you're doing the care planning anyway.

Rexie68 · Mar 25, 2008

i just don't think we need the raps. i know my residents....i know what needs care planned. all the raps do is add unneccessary things. i know my resident has cognitive impairment...i know to care plan that. my nurses also know this and act accordingly. it doesn't take a rap to tell me this, and i don't have any reason to spend precious time (mine and theirs) educating them. there are so many other things that both of us need to do, or be educated about. i want them out there interacting with residents and staff and making their notes accurate. giving them more "busy work" isn't going to help. perhaps i'm jaded because i have 139 residents to do mds' and care plans for (plus icc and pps meetings) and just don't see the point in senseless paperwork (not that we don't already have enough of that)! :twocents:

CapeCodMermaid, RN · Mar 26, 2008

Call me weird, but I LOVE RAPS. When I was the PPS MDS coordinator, it was always my favorite part of the process....of course I was the oddball kid who liked essay questions better than multiple choice!

Talino · Mar 26, 2008

You all made valid points!

The RAP is a very good learning tool that can guide a discipline to develop a more individualized care plan. However, to a more experienced or seasoned discipline who is responsible in completing portions of the MDS, the process becomes redundant. Completing Section V is overkill! It only serves one purpose - convenience for an auditor or a surveyor, as one pointed out. It gives them one quick reference on what to zero in with regard to resident care.

A well trained discipline should be able to identify the items that would normally trigger a RAP and incorporate them in their initial evaluation, plan of care, and review their goals/interventions in a progress note, even before they actually complete the MDS.

Should a tool be necessary for auditing purposes, use the Trigger Legend instead (see Appendix C-3) which simply identifies what items triggered what RAP. The trigger legend will be calculated after the MDS is completed and entered into the the computer. Then it will be the auditor's responsibility to pore over the legend and peruse the medical records on how the staff addressed the triggers.

The disciplines will not need to respond to a Section V or write a separate RAP summary note. The triggered items will likely be located and addressed in a care plan, a physician's eval or progress notes, behavior tracking, the MAR/TAR, a CNA assignment sheet, a dietitians nutrition assm't, an Activity's recreation plan, a social worker's resident interaction notes, etc.

To sum it up - keep the RAP (Appendix C) as reference and use it as a training tool for the less experienced discipline. Eliminate Section V.

disney158 · Mar 26, 2008

:down:Remove them, they are a reitteration of data already exhisting and do not lead me or the team to any further defination of the resident or the residents care needs, I find them an exercise in redundencey, I believe a better thing would be to expand on the triggered areas in the Care Plan, no one reads the raps in the several places I have worked, but everyone reads the care plan:up: