Yall will think that this is stupid....

psalm, RN · Jul 3, 2008

My understanding is the more care given to the resident, the more is charged...which is why it is so important to document each and every milk of mag, every suppository and every enema in the bowel regimen. Each med given =nursing care as well.

Those with antipsychotic meds may need interventions, such as 1:1?

Those on diuretics may need extra attention to get to the toilet in time, or if in briefs/diapers, a brief count? Just guessing, I am not MDS nurse but asked when I worked at an LTC what the big deal was with charting every brief and intervention was.

flashpoint · Jul 3, 2008

A lot of it is for QI/QA..."they" want to know how many of our residents are on psychotropic meds...and they want to know that they are necessary. Same with diuretics. Things like injections can change the level of care. They also want to ensure that we are taking steps to control pain. Everything we do can affect reimbursement.

:)

cadburypam · Jul 3, 2008

The reason we look at these medications is to determine if there is a need for further evaluation and development of a care plan to address the problem. For example if the resident is on a diuretic they have the potential for a fluid volume excess and deficit; with the psychotropics we look to see if they are having behaviors PLUS we need to look to see if there is a diagnosis to support the use of these medications, if not it will show up on your quality indicators, so you need to make sure that the docs are putting diagnosis with these meds and that there are attempts at least every 6 month to decrease the dose or documentation as to why this is not attempted.

Lastly, there is NEVER, EVER :no:such a thing as a dumb question, the MDS process is an ongoing learning process and with its ever changing regulations we need to ask questions to keep ourselves informed!

Rexie68 · Jul 3, 2008

wow...double whammy....a new nurse and a new mds nurse. god bless you!! as cadburypam said, the reasons for checking psych meds is d/t qi, behaviors and physician documentation. i certainly understand your frustration with counting the number of meds, though....does it really matter whether my resident had 18 meds in that 7 day period or 21? i doubt it. but it does show that many of them have just too many meds! you'd think that the simple question "did the resident take more than 9 meds in the last 7 days" would be better than an exact number of meds. umr and i always have fun counting them up.

and i also agree that they're aren't any dumb questions here....if so we'd all be guilty...'cause an mds makes us all ask why sometimes!! (such as why isn't pain a rap? what would my mds look like...how many raps would i trigger...short term memory loss....oh no...cognitive deficits!) :devil:

feel free to post....we all learn new things every day! (especially when cms puts out new guidelines)

oh, and do y'all think the therapy caps will be lifted again?? luckily my administration said "if they need therapy, so be it. we'll just eat the cost! thank you sister mary!! :saint:

Callinurse · Sep 2, 2008

I have been a nurse for awhile and an MDS nurse for 4 years and there are days that I still feel like your icon "head into brick wall" because that would be better than the headache of the day. LOL

Antipsychotics, Antianxiety, Antidepressant, Hypnotic and Diuretics all place the resident at a greater risk for FALLS !!! That is first on my mind. Each of them has a potential to cause the blood pressure to go down and that will cause dizziness, lightheadedness and a potential fall.

Diuretics will cause someone to just getup and go to the bathroom. They can forget they just had their leg amputated or that they had a stroke and one side of the body doesn't work.

When you have your monthy staff meetings and they give informaiton about the psychotropics and the regulations just make notes. You will learn over time what you need to know.

You have one great quality.... Never stop asking questions !

Not all of us can teach but we all can certainly learn. We can never know it all.

Good luck! There are many helpful people on the site. Come back often and read the threads.

Callinurse

:banghead:Can someone please explain to me the reason why we look to see if the resident is on antipsychotics, anti anxiety, antidepressant, hypnotic, diuretics painmeds, injections, etc....how does each effect the resident??? when im doing my raps, etc...im sorry, im a new nurse...and im in MDS...and im new to it too, so you will see many more stupid questions!!!
Thanks in advance.
Kristi

Rexie68 · Sep 10, 2008

when you have your monthy staff meetings and they give informaiton about the psychotropics and the regulations just make notes. you will learn over time what you need to know. callinurse

*smile* monthly staff meetings? we don't have staff meetings very often....and even when we do.....not much seems to apply to the me, as an mds nurse. it's usually teaching the floor nurses basic things that i thought they already knew (yes, you call the doctor with a potassium of 6.8, you don't just fax it and put in the chart........no, you can't leave that stat med for the next shift since it's 2 hours away.....etc, etc).

i agree with your reasoning about concerns for falls, but if that were the main reason we do the psychotropics and diuretics individually, they'd have to include so many more categories (narcotics, antihypertensives, etc.).

i really think that when 2.0 came out, 9 meds was considered a lot.......oh how things have changed. who would have thought we'd have vent pts in a nursing home? or be giving iv push meds? at least we still send them to the hospital for surgery.....

:eek: