aipp/oltc regional training: mds 3.0: resident interview … · i will ask you to answer using the...

MDS 3.0:Resident Interview

Cue Cards

A I P P/ O LT C R E G I O N A L T R A I N I N G :

MDS 3.0:Resident Interview

Cue CardsFor more information, visit

afmc.org/aipp or call 501-212-8630.For more information, visit

afmc.org/aipp or call 501-212-8630.

Section B: Hearing, Speech and VisionB1000 Steps for Assessment

1. Ask direct care staff over all shifts if possible about the resident’s usual vision patterns during the 7-day look-back period (e.g., is the resident able to see newsprint, menus, greeting cards?).

2. Then ask the resident about his or her visual abilities.

3. Test the accuracy of your findings:

• Ensure that the resident’s customary visual appliance for close vision is in place (e.g., eyeglasses,

magnifying glass).

• Ensure adequate lighting.

• Ask the resident to look at regular-size print in a book or newspaper. Then ask the resident to read

aloud, starting with larger headlines and ending with the finest, smallest print. If the resident is

unable to read a newspaper, provide material with larger print, such as a flyer or large textbook.

• When the resident is unable to read out loud (e.g. due to aphasia, illiteracy), you should test this by

another means such as, but not limited to:

• Substituting numbers or pictures for words that are displayed in the appropriate print size (regular-

size print in a book or newspaper)

Section B: Hearing, Speech and VisionB1000 Steps for Assessment

1. Ask direct care staff over all shifts if possible about the resident’s usual vision patterns during the 7-day look-back period (e.g., is the resident able to see newsprint, menus, greeting cards?).

2. Then ask the resident about his or her visual abilities.

3. Test the accuracy of your findings:

• Ensure that the resident’s customary visual appliance for close vision is in place (e.g., eyeglasses,

magnifying glass).

• Ensure adequate lighting.

• Ask the resident to look at regular-size print in a book or newspaper. Then ask the resident to read

aloud, starting with larger headlines and ending with the finest, smallest print. If the resident is

unable to read a newspaper, provide material with larger print, such as a flyer or large textbook.

• When the resident is unable to read out loud (e.g. due to aphasia, illiteracy), you should test this by

another means such as, but not limited to:

• Substituting numbers or pictures for words that are displayed in the appropriate print size (regular-

size print in a book or newspaper)

Section B 1000 Vision Steps for Assessment 1. Ask direct care staff over all shifts if possible about the resident’s usual vision patterns during the 7-day look-back period (e.g., is the resident able to see newsprint, menus, greeting cards?). 2. Then ask the resident about his or her visual abilities. 3. Test the accuracy of your findings: Ensure that the resident’s customary visual appliance for close vision is in place (e.g.,

eyeglasses, magnifying glass). Ensure adequate lighting. Ask the resident to look at regular-size print in a book or newspaper. Then ask the

resident to read aloud, starting with larger headlines and ending with the finest, smallest print. If the resident is unable to read a newspaper, provide material with larger print, such as a flyer or large textbook.

When the resident is unable to read out loud (e.g. due to aphasia, illiteracy), you should test this by another means such as, but not limited to:

Substituting numbers or pictures for words that are displayed in the appropriate print size (regular-size print in a book or newspaper)

This maTerial was prepared by The arkansas FoundaTion For medical care inc. (aFmc) under conTracT wiTh The arkansas deparTmenT oF human services, division oF medical services. The conTenTs presenTed do noT necessarily reFlecT arkansas dhs policy. The arkansas deparTmenT oF human services is in compliance wiTh TiTles vi and vii oF The civil righTs acT. Qp2-sbvis.ccar,3-8/10

SuggeSted lAnguAge FOR eXPlAInIng VISIOn ASSeSSMent:“ I would like for you to look at the first box. Can you read it aloud?” (If the resident is able to read

the larger print, then ask the resident to read the next box. Keep moving to the smaller font to determine

visual acuity.)

SUGGESTED LANGUAGE FOR EXPLAINING VISION ASSESSMENT:“ I would like for you to look at the first box. Can you read it aloud?” (If the resident is able to read

the larger print, then ask the resident to read the next box. Keep moving to the smaller font to determine

visual acuity.)

THIS MATERIAL WAS PREPARED BY THE ARKANSAS FOUNDATION FOR MEDICAL CARE INC. (AFMC) PURSUANT TO A CONTRACT WITH THE ARKANSAS DEPARTMENT OF HUMAN SERVICES, DIVISION OF MEDICAL SERVICES.THE CONTENTS PRESENTED DO NOT NECESSARILY REFLECT ARKANSAS DHS POLICY. THE ARKANSAS DEPARTMENT OF HUMAN SERVICES IS IN COMPLIANCE WITH TITLES VI AND VII OF THE CIVIL RIGHTS ACT. • DECEMBER 2016

The fox jumped over the lazy dog.

1 3 7

14-point

The children like to play ball.

2 8 6

♥ ▲ ■

10-point

Section B: Hearing, Speech and VisionB1000 Vision Assessment

The horse ran in the field.5 10 15

22-point


SUGGESTED LANGUAGE TO INTRODUCE THE INTERVIEW:“I would like to ask you some questions. We ask everyone the same questions. This will help us provide

you with better care. Some of the questions may seem very easy while others may be more difficult.”

Section C: Brief Interview for Mental Status (BIMS) C0200, C0300, C0400, C0500 Suggested language for explaining the BIMS interview: “I would like to ask you some questions. We ask everyone the same questions. This will help us provide you with better care. Some of the questions may seem very easy while others may be more difficult.”

Section C: Cognitive Problems Brief InterviewC0200, C0300, C0400, C0500 for Mental Status (BIMS)


Section C: Cognitive Problems Repetition ofC0200: Brief Interview for Mental Status (BIMS) Three Words


Something to Wear

A Color

A Piece of Furniture

Section C: Cognitive Problems RecallC0400: Brief Interview for Mental Status (BIMS) Cueing


SUGGESTED LANGUAGE FOR THE REASON FOR THE INTERVIEW:“I am going to ask you some questions about your mood and feelings over the past 2 weeks.

I will also ask about some common problems that are known to go along with feeling down.

Some of the questions might seem personal, but everyone is asked to answer them.

This will help us provide you with better care.”

Section D: Resident Mood Interview (PHQ-9) D0200 Suggested language for the reason for the interview: “I am going to ask you some questions about your mood and feelings over the past 2 weeks. I will also ask about some common problems that are known to go along with feeling down. Some of the questions might seem personal, but everyone is asked to answer them. This will help us provide you with better care.”

Section D: Mood PHQ9, D0200 Resident Mood Interview


DESCRIPTIVE NUMERIC

Rarely Never or 1 day

Several days 2 – 6 days

Half or moreof the days 7 – 11 days

Nearly every day 12 – 14 days

Section D: Mood PHQ9, D0200 Resident Mood Interview

Symptom Frequency:


SUGGESTED LANGUAGE FOR DAILY PREFERENCES:“I’d like to ask you few questions about you daily routines and preferences. The reason I’m asking you these

questions is that the staff here would like to know what’s important to you. This helps us plan your care

around your preferences so that you can have a comfortable stay with us. Even if you’re only going to be

here for a few days, we want to make your stay as personal as possible.”

SUGGESTED LANGUAGE FOR DAILY PREFERENCES:“I am going to ask you how important various activities and routines are to you while you are in this home.

I will ask you to answer using the choices you see on this card. (Read answers while pointing to cue card.)

‘Very important’, ‘Somewhat Important’, ‘Not Very Important’, ‘Not Important at all’, or ‘Important, but can’t

do or no choice’.”

Section F: Interview for Daily & Activity Preferences F0400, F0500 Suggested language for Daily preferences: “I’d like to ask you few questions about you daily routines and preferences. The reason I’m asking you these questions is that the staff here would like to know what’s important to you. This helps us plan your care around your preferences so that you can have a comfortable stay with us. Even if you’re only going to be here for a few days, we want to make your stay as personal as possible.”

Suggested language to introduce Activity Preferences: “I am going to ask you how important various activities and routines are to you while you are in this home. I will ask you to answer using the choices you see on this card. (read answers while pointing to cue card.) ‘Very important’, ‘Somewhat Important’, Not Very Important’, ‘Not Important at all’, or ‘Important, but can’t do or no choice’.”

Section F: Interview for Daily & Activity Preferences F0400, F0500 Suggested language for Daily preferences: “I’d like to ask you few questions about you daily routines and preferences. The reason I’m asking you these questions is that the staff here would like to know what’s important to you. This helps us plan your care around your preferences so that you can have a comfortable stay with us. Even if you’re only going to be here for a few days, we want to make your stay as personal as possible.”

Suggested language to introduce Activity Preferences: “I am going to ask you how important various activities and routines are to you while you are in this home. I will ask you to answer using the choices you see on this card. (read answers while pointing to cue card.) ‘Very important’, ‘Somewhat Important’, Not Very Important’, ‘Not Important at all’, or ‘Important, but can’t do or no choice’.”

Section F: Preferences for Customary Routine and Activity F0400, F0500 Interview for Daily and Activity Preferences

1. Very important

2. Somewhat important

3. Not very important

4. Not important at all

5. Important, but can’t do or no choice

Section F: Preferences for Customary Routine and Activity F0400, F0500 Routine and Activity


SUGGESTED LANGUAGE TO INTRODUCE THE INTERVIEW:“I’d like to ask you some questions about pain. The reason I am asking these questions is to understand

how often you have pain, how severe it is, and how pain affects your daily activities. This will help us to

develop the best plan of care to help manage your pain.”

Section J: Pain Assessment Interview J0400 Suggested language to introduce the interview: “I’d like to ask you some questions about pain. The reason I am asking these questions is to understand how often you have pain, how severe it is, and how pain affects your daily activities. This will help us to develop the best plan of care to help manage your pain.”

Section J: Health Conditions J0300, J0400, J0500, J0600 Pain Assessment Interview


How much of the time have you experienced painor hurting over the last 5 days?

1. Almost constantly

2. Frequently

3. Occasionally

4. Rarely

Section J: Health Conditions J0400 Pain Frequency


Section J: Health Conditions J0600 A Numeric Rating Scale

10 Worst pain you can imagine 9 8 7 6 5 4 3 2 1 0 No pain

Please rate your worst pain over the last 5 days:

Mild

Moderate

Severe

Very severe, horrible

Section J: Health Conditions J0600 B Verbal Descriptor Scale


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