The QI report is not my fault

[susanthomas1954]

The QI report from CMS is NOT MY FAULT!

Yet another management team has decided to screw with the MDS process, and when my partner and I try to explain that QI's for the next three months are going to look REALLY BAD, we get the deer in the headlights looking back at us. For years, untrained nurses have been completing quarterlies and annuals in this 200+ bed facility, and they now decide trained professionals need to do them. Excellent choice, but they have to understand that we are going to CODE THE FACTS! We are appalled at what we are finding in the long term care MDS's of the past. The floor nurses have done all the basic mistakes you would expect:

#1) Doing the MDS from "knowing the patient." Like coding the unusable side of Ms. S's body as having no limit to range of motion. Yes, I know it's "normal" for her, but that is not what they are asking, so....QI will flag for the way we are coding this.

#2) Coding all the meds that are ordered, not just the ones given in the look back period (plus the monthly ones, I know) Hasn't used prn tylenol in two years, but it's on the standing orders, so let's just count it.

#3) No behaviors. Honey, I know that Ms. B bangs her cup on the table when you put her in the dining room, and she has for every meal for six years. IT'S A BEHAVIOR, EVEN IF YOU ARE USED TO IT.

#4) Even if the bed rail is a mobility device, you have to code it as such. (Bed rails used for mobility) IF SOMETHING IS A RESTRAINT, assess for it and care plan it!

#5) The surgical wound was over a year ago, news flash-It's healed. Stop coding it.

And we're only two weeks into the new process.

SO: Have any of you ever had to deal with management killing the messenger here? I have been through this before, so I know what to expect at QI, but can I somehow use this as a teaching opportunity for the people in management? I don't make the news I just report it.

Thanks, ST

[rapkeygurl]

Yes - I got screamed at by a previous administrator that I dont know what in the h### I am doing in the mds because of the casper reports. She was so upset that according to the report it said we have 22 contractures. But that line that asked if you have limited rom or contractures they are on the same line and it counts it ask such. crazy lady plus I had been on maternity leave for 4 months and another fresh grad never done mds was doing them . They sent her to a tile to rugs training she was oblivious to the whole process. She said I did not learn a thing they did not teach her the basics. Anyway a lot of what she was coding ended up on the QI stuff. But I got the chewing. Thank God we have a new admin!!! I am trying to update those mds survey worksheets weekly now to keep from that crap. at least that is how my crazy mds software works and I had not training on it until 6 months after using the dare program

[nyteshade, BSN]

I feel for you!!! This is terrible! In my facility, the MDS nurses do their own assessments. So our problems are slightly different. However, we do get blamed for the QIs by the admin. What admin fail to understand is that care starts on the floor. We collect data. If our short-term rehab residents have daily moderate pain, someone on the floor should have noticed that and advocated for the res! Why should someone wait for me to evaluate the chart?? I could go on and on, but that's the current trend in our facility.

As for teaching management...I'd explain to them the need to inservice the floor nurses on how and what to chart, now that you will be collecting their data now. Do you have behavior sheets for the psychotropics? Management will hear you when you it's about raising RUG levels. It seems management only cares for two things: 1. Raising more $ 2. Passing inspections (at whatever cost). So, I would try manipulate my argument around those two things. Hopefully they will listen.

P.S. That's a lot of significant changes!

[CapeCodMermaid, RN]

ah....the memories your post brings back. When I arrived at the facility, the previous MDS people had never strayed from their offices...never looked at the residents. The new MDS person and I had been doing MDSs longer than most of the nurses had been alive, so naturally we did them correctly. The first new QI came out and the 2 of us got dragged into the DON office by the DDCO asking us why our number of residents with contractures went through the roof. I let her go on and on and finally I stopped her and said "It's because the MDSs are finally correct. Now if you'd like us to go back to the way they were being done before we arrived let me know". What can you say to the truth. It's just annoying. I had an MDS nurse at one place I worked code mental status as a O..no problems. I asked her if she had ever looked at the patient, or read the chart, or if she had spoken to the CNAs. No she says...the lady says hi to me in the hall so she must be OKAY. Yikes!!! The patient was known to go 'fishing' in the toilet thinking that the (it's going to be gross so if you don't have a strong stomach skip this) poop was fish!!! But this MDS person thought she was mentally intact. This was also the place where the social worker thought dementia was a 'psychiatric diagnosis'

MDS coordinators who know what they are doing are invaluable to the facility.

[susanthomas1954]

You know what I would love to see? I would love to see the DON and Administrator take the nurses into the conference room and talk to them about the QI's. And talk to them the same way they talk to the MDS coordinator. A few night shifts on the med cart would become available real quick. At least I have an Ass't Administrator right now who understands that I just report the news I don't make it. I am known to drive a bus through stand-up and say, "It looks to me like our QI's are going to reflect thus and so this month." about a week before QI's are calculated. (I am VERY ARROGANT, if they want the re-imbursement, they have to take the bad with the good.)

ST

[123becky]

As far as contractures, the best thing would be to document their presence in the admit assessment, most are admitted with these damn things anyway. All assessments should include that range of motion was done & resident shows limitations. Why else would they be here? I haven't had a recent admit over the age of 75 w/o contractures.

[amglpn]

I know the feeling! It is nice to know Im not alone though. hehe