What Sections of the MDS do you fill out :)

sls73 · Jun 5, 2010

Social Services completes: AB, AC, AD, A, B, E, & Q. They write their own raps on those Cognition, Behavior, Mood and Psychotropic Drugs(she is the one who coordinates and sits in Psych MD visits). I then go back and review her RAPS and add to if I need to.

Activities completes: N If they trigger Activities Rap---rarely do---they would complete that with me reviewing.

Dietary completes: K They then complete Dehydration, Feeding Tube, and Nutritional RAP. I again review and add to as I need to.

Restorative Nurse completes: G, H, P(restraints) and does her own RAPS.

Treatment/Wound Nurse completes: C, D, M- She was already doing the communication and Vision prior to taking on the wound nurse position so she asked if she could just keep all. She does the Vision, Communication, and Pressure Ulcer Rap.

Therapy: Does the therapy section of P

I then do: AA3, A3, I, J, L, O, P(rest of), Q, R, S(state of PA), and the remainder of RAPS. I also overlook all of the RAPS so that an RN is overseeing the coordination- but it helps also keep it Interdisciplinary. Took some training on my part to get the other staff comfortable doing these. I am looking at it from an assessment point of view- they are generally listing the facts and what they are doing.

They are all responsible for updating the careplans.

Hope this helps.

edhcinc · Jun 6, 2010

Hi--and that is also the answer to your question--HIGH resistance.

If you are just starting in that position, please be sure you understand the "territory" before you "lay down the law"--especially since you don't KNOW (or make) the facility's law or the "territory" and its sinkholes, potholes, sandtraps, political (professional) boundaries, or "camps." Is there a facility policy or procedure about MDS completion? They may state that the MDS coordinator will complete...There are many "models" used by facilities to complete the MDS and analyze triggered care areas and other problems found during clinician's assessment.

Do all disciplines have access to the MDS software? Do all disciplines have easily accessible computer terminals? Have all disciplines been trained on how to use the MDS software? Do they know how to use their own notes to fulfill RAP summary requirements? Does the team know how to put together triggered RAPs and state one problem instead of many? Do they the MDS-specific definitions ?

The MDS coordinator cannot "supervise" other clinicians--or "tell" them what to do. In most facilities the clinicians who assess and plan care with the resident are supervised by the administrator. So go in on Monday--meet with YOUR supervisor. Look at policies/procedures. Talk with your colleagues. Take time to establish professional relationships. Educate the administrator/DN if needed. Is the administrator in support of changes and committed to support and supervise his/her staff?

Your task is not easy. We all need to remind ourselves sometimes that we deal with patient problems, not dietary problems, social service problems, rehab problems or nursing problem. Any patient problem (and the patient needs to agree that it IS a problem) requires analysis by all.

Good luck!

kujhawkrulz · Jun 6, 2010

Thank you so much. I've talked to a local MDS Coordinator in this area and she said the same thing...the resistance you will meet will at times be unreal, but educate and not criticize. I thank you for your words of advice, Monday will probably be one of the longest days of my short career, but I'll do my best to get to know everyone and feel things out.

With the new changes coming on the 3.0, I really need to make sure that everyone is ready, and the owner of the facility has put that on my shoulders. I hope to be able to explain to them what the word "holistic" means and that their input on the residents stay while at our facility is just as important as any nurse.

We'll see how things go, your advice is wonderful. Thanks so much :)

SelenaMDS · Jun 12, 2010

Hi there,

In our building the SS dept has firmly dug in for years and ONLY does F and Q, despite my requests to do the mood and cognitive assessments. They assigned the Admissions Nurse to do AB, AC. I gave up long ago and do all the rest, except K and N.

Lucky for me we have been having some MDS 3.0 seminars given by our consultant, who said Social Workers are the trained professionals who should be doing the cognitive and mood sections, as well as psychosocial.

I am sure they will be HIGHLY resistant but I'm sure as trained professionals they will keep it to themselves.

Please let us know how your first week went!

kujhawkrulz · Jun 12, 2010

First week has been really different. I found out that 4 ARD's had come and gone and there were like 13 assessments not printed and in the charts, so it really made me think that perhaps the care plans hadn't been updated, so I went searching and found that there was an admission assessment over looked, so I'm going in on Sunday to fix it.

I took the first day to get in there and check dates, and make a list of all the delinquent assessments and the next night I stayed and worked until almost midnight trying to make heads or tails of what was going on. I put out a very "polite" memo to dept heads with their sections of the MDS and made sure they realized I needed them back ASAP so that I could get the default assessments done and when I went to find out what was going on in the chart...I found that not one nursing assessment had been completed ugh I spent the next day trying to update assessments and get things in order.

Basically for my stand point, it's literally been a mess, but I'm working hard to try to change things without ruffling too many feathers. I was called into the office and basically told that I was pushing too hard and when I explained what I was asking and showed the administrator my letter, he stood there and said "they haven't been doing their part of the MDS!!" Well he was amazed and told me he'd deal with them and to keep on doing what I'm doing and keep him in the loop so that he could stave off the naysayers!!

Anyways, the dynamics of the facility are quite strange, I don't think that the DON will be there very much longer...there have been a few firings as of lately and I was given permission to hold an education session with the CNA's and CMAs on documenting ADLs properly and working on behavioral charting. I feel like I bit off a bit more than I could chew, but I'm not a quitter. Hopefully, when all is said and done, I might actually have some documentation to properly code from.

Anyways, on top of all of this...I take state boards for my RN soon, so that's been in the back of my mind as well...life is good all in all, but it sure is stressful right now!!