sig change question

[glm777, BSN, RN]

I have a resident who elected Hospice services 9/1/09. I initiated a change in status MDS to be completed by 9/15. She went to a vascular surgeon today and on 9/18 will be having an AKA for comfort (currently in a lot of pain d/t heel wound). I can't see doing a COS by 9/15 d/t election of hospice services then doing another one due to her new AKA. Do you think it would fly if I write an addendum note to my COS note statin that the IDT will hold off on completeing the COS until the resident return from the hospital but in the interim, the care plan will be updated to reflect her current end stage status?

[Talino]

rationally postponing the scsa may fly but this would entirely depend on an auditor's frame of mind. accdg. to the rai guidelines, the scsa must be conducted no later than the 14th day. hence, we must comply.

since the idcp team is cognizant of the upcoming amputation, it would be prudent to incorporate in the care plans the expected course of change from this condition. simply carry out the plans when he comes back from surgery. in doing so, you would have abided by this guideline, p2-11, last bullet --

complete subsequent scsa's based upon the degree of decline and the impact upon the comprehensive care plan. consider the following criteria:

• completion date of the last mds;
  
• clinical relevancy and accuracy of the mds to the resident's current status; and
  
• the need to change the resident's care plan to reflect the current status.