Survey says.......!!

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Specializes in Vascular Access Nurse.

ouch. the doh was in last week....and, for the second year in a row....i'm getting dinged for not doing significant changes. i truly didn't think that i had to do a significant change for medicare a residents getting rehab because they're supposed to get better....and my boss saw it that way too. obviously we were sadly mistaken. umr and doh never mentioned the med a residents before this survey. i just know that administration is seething. i told me boss she could fire me as their plan of correction...but for some reason she didn't like that idea. i checked our computer system...i've done 1,158 assessments from january 01, 2008 through november 14, 2008. they found 5 that they thought should have been significant changes. of those, i agree that one should have been.....but i didn't document well enough about the others. my own fault. going to school full time and having responsibility for mds' and care plans (oh, and the kids......i think i remember what they look like...) is getting to me. i could quit and take out more loans. i dunno.....i know i'm good at what i do (or thought i was) and this job is the only one that gives me the flexibility to work weird hours, but if i'm not giving them 100%, then perhaps someone else could do it better. anyone else have suggestions? ideas? sanity? :banghead:

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Specializes in ER CCU MICU SICU LTC/SNF.

Significant impovement is a most commonly overlooked SCSA. While the treatment is still ongoing, the progress can be documented as an expected outcome. Once stabilized and the resident is not what he presented when a full MDS was completed, the SCSA is compelling.

Seasoned MDS coordinators are hard to come by and 'am sure your employer won't fish for an untested one.

Live to fight another day. Remember, you are now one further step smarter!

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Hi--don't despair! The most important thing about "care"--is that you still do!!

A few tips for your MC/PPS patients:

  1. Most software programs calculate and SHOW you the ADL score--compare that score from assessment to assessment
  2. Pay attention to the actual RUG derived from the MDS--the "A, B, C" and "1, 2, 3" values. Print a sequential per patient RUG report every so often, and compare the end values.
  3. Some software programs offer you the option for the software to check your MDS for the significant change criteria--or at least a report which shows you the changes from one MDS to another in certain sections. Let the software do the work! (if your software DOESN'T have such options, or if you don't know how to find/use the options, call your friendly software support team!)
  4. Educate your team members so that they, too, can participate in recognizing whether or not a "significant" change has occurred. You are not the only one responsible for the process.

And don't :nono: YOU consider a significant change in your employment status!

Good luck!

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Specializes in Vascular Access Nurse.

ouch again. today our administrator told me that we (i) received two deficiencies for our mds'. the second one was apparently because i transposed two numbers on an mds (made the person bowel continent and bladder incontinent when it should have been the other way around) and they cited us for an "inaccurate assessment." wow......i'm not perfect....not even close....but pennsylvania's umr has my (our) error rate at 1.58%......and the norm is around 7%. i explained what happened to the (charming??) surveyor while she was here and said we'd do a modification, but i guess that wasn't good enough. our administrator said that we'll just make a plan of correction and deal with it....i realize we don't want to make waves, but gosh, that seems harsh. *sigh* this gal also told me that she "thinks i don't understand how to do an mds." hello....i've been doing them for 5 years and this is the first i've ever been told that. we have a consultant company who comes in every three months and we always get rave reviews. do you think this has anything to do with our high case mix? we've brought it up about 30 points in those 5 years........

or am i just super-sensitive? :cry:

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I don't think you are being super sensitive, I would like these "surveyors" to walk a mile in our shoes. We are over worked and unappreciated. I mean MDS Coordinators have a lot of work to do, papers to see and information to collect. So give me a break if you accidentally mixed them up, it is called a mistake that can be corrected. Think of it this way if we didn't make mistakes, they would be out of a job. Just kidding, they keep us on our toes. They have a job to do too, I guess.

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Specializes in Gerontology, Med surg, Home Health.

Don't think you're oversensitive....the whole survey process is horrible.

Most surveyors don't have a really good understanding of the MDS process. One hollered at me once for inaccurate coding because the patient was on Seroquel and it wasn't on the MDS. I had to point out to the rude woman that the ARD was XYZ and the Seroquel wasn't ordered until 9 days after the ARD. It took her 10 minutes before she got it. And then one told me we should have done a sig. change on a resident because he had gone out to the hospital. ...he went for a new dialysis catheter and ended up staying because he got an infection. He was exactly the same when he returned so there was no sig. change.

At least take comfort in knowing that no matter how many MDS mistakes you might make, no resident suffered any harm from that mistake.

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Specializes in Legal, Ortho, Rehab.

Survey time! The greatest time of the year! :no: When I was working in MDS we were overloaded!!! But what MDS nurse isn't? I know where you are coming from...they are supposed to get better. I guess it would depend on HOW significant? Two or more changes? Usually we just scanned section G,H,M or the other usual suspects. We checked manually for S/C checks. That section H thing though is just a miscode, really unfair. I always said inspectors needed to be vengeful to get the job...Ok, ok they're people too...

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Specializes in Vascular Access Nurse.
survey time! the greatest time of the year! :no: i always said inspectors needed to be vengeful to get the job...ok, ok they're people too...

are you certain they're people too? *sigh* some were actually nice...it was only one surveyor on one unit who was extra tough....and i do the mds' for all of the units. but it was my mistake, so i'll toughen up and live with it. just frustrating when no matter how hard you work it's not good enough. only 162 days until graduation...then i can go work in the hospital....:yeah:

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