AdditionalResources

StateOperationsManual http://surveyortraining.cms.hhs.gov/sp/MDSResources.aspx

http://www.cms.gov/NursingHomeQualityInits/

MDS3.0:AnIntroductionforSurveyors

SandyBiggi

SchoolofPublicHealth

NYSDepartmentofHealth

MDS3.0AnIntroductionforSurveyors

Lesson1:IntroductiontoMDS3.0

Lesson2:MDSSectionOverview

Lesson1:IntroductiontotheMDS3.0

WhatistheMDSusedfor? GlobalchangestotheMDS3.0 Howwillthesechangesaffectsurveyors?

Lesson1Objectives

DefinethepurposeoftheMDS Identifyimprovements/newfeaturesoftheMDS3.0

DescribethefocusoftheMDS3.0 ExplainhowMDS3.0relatestoresidentcare

RecognizewaysthatMDS3.0willaffectthesurveyprocess

WhatistheMDS?

MinimumDataSet PartoftheResidentAssessmentInstrument(RAI)

MinimumdatacollectionrequiredforallresidentsinnursinghomesparticipatinginMedicareand/orMedicaid

PurposeoftheMDS

Identifyresidentcareproblems Medicare/Medicaidreimbursement

Monitoringqualityofcareprovidedtoresidents

WhyChangetoMDS3.0?

Concernsaboutclinicalrelevancyof2.0 2.0failedtoincluderesidentinterviews

FailstoobtaincriticalinformationDisenfranchisesresidents

Desireforstandardizeddefinitions

Howwillthechangeshelp?

MDS3.0itemsincrease:ReliabilityAccuracyUsefulness/clinicalrelevance

IncreasingResidentVoice

Residentinterviews Arepreferredoverstaffassessment Givesresidentmoreinputandcontrol

Increaseresidentwellbeing

GlobalChangestotheMDSGlobalChanges TotheMDS3

StructuredInterviews

Increaseresidentvoice SectionC:Cognitivepatterns SectionD:Mood SectionF:Preferencesforcustomaryroutineactivities

SectionJ:Healthconditions

IncorporatingStandardsandProtocols

Standardtoolsandprotocolsusedinothercaresettings

Example:PressureulcerstagingProtocolfromtheNationalPressureUlcerAdvisoryPanel(NPUAP)

Instructions,Definitions,Clarifications

Instructionsprovidedontheform DefinitionsoftermsprovidedontheformandinUsersManual

ClarificationsoncodingprovidedontheformandintheUsersManual

MoreUserFriendly

Largerfont Easierformat Increasedreadability

LookbackPeriods

7daylookbackperiodsforallitems Exceptions:

SectionD:14days SectionF:Nolookback SectionJ:Differentlookbacksfordifferentitems SectionK:Differentlookbacksfordifferentitems SectionO:14days

SectionM:SkinConditions AdaptedfromNationalPressureUlcerAdvisoryPanel

Noreversestaging Evaluate:

Numberofpressureulcers Stagesofpressureulcers Ageofpressureulcers Dimensionsofworstpressureulcer Mostseveretissuetype Otherskinconditions

Therapy

PartAvs.PartB Concurrentvs.Grouptherapy Recording:

Days Minutes Startandenddates

SectionQ

Q0500:ReturntoCommunityReferral Discussionwithresidentandfamily Careplanningrequirements

AssessmentReferenceDate(ARD)

Determines: assessmentschedule MDScompletiondate CAAcompletiondate Careplancompletiondate Transmissiondate

MDSasaFoundation

MDSisasnapshotofinformation Informationusedtodevelopcareplan Careplanusedtohelpresidentreachgoals

MDS3.0

CarePlan

EffectonSurveyors

Sampleselection Validatinginterviews Careareaassessment(CAA)process StateOperationsManual

SampleSelection

QI/QMreportsunavailable Nogenerationofoffsitesampleselection

UseRoster/SampleMatrix

ValidatingInterviews

Residentobservationandinterview Verifythatrecordedinformationisaccurateandcorrect

Verifythatinformationisintegratedintothecareplan

Ensurethatcareplanisimplemented,evaluated,andrevised

CareAreaAssessmentProcess

ProblemIdentificationProcess CAAProcessIncludes:

CAATriggers(replacedRAPTriggers)

CAAs (ReplacedRAPs) Chapter4:UsersManual

CareAreaAssessmentDocumentation

Residentscondition Relatedunderlyingcauses,contributingfactors,riskfactors

Complications Careplanconsiderations Careplandecisions Needforevaluation Resource/assessmenttoolused

Roster/SampleMatrix:CMS802

Revisionsto802form Falls/fracturesisaseparatefieldformAbrasions/Bruises

BehavioralSymptomsisaseparatefieldfromDepression

Residentcharacteristicsrenumbered

Roster/SampleMatrix:ProviderInstructions

MDS3.0coding/manualcodinginstructions ResidentCharacteristicfieldsrenumbered

Roster/SampleMatrix:SurveyorInstructions

ReferencestoQIs/QMs removed Residentcharacteristicfieldsrenumbered

ResidentCensusandConditionsofResidents:CMS672

672Form:Norevisions 672Instructions:

MDS3.0codingreplaces2.0coding Manualcodinginstructions Useofformremainsthesame

ResidentReviewWorksheet:CMS805

NorevisionstoCMS805 CMS805Instructions:

MDS3.020CAAs replaceMDS2.018RAPs

StateOperationsManual

AppendixP AppendixPP CMSupdates

Summary MDSdatacollectedforLTCresidents MDSisfoundationofcareplanning Newitemsincrease:

Reliability Accuracy Usefulness Residentvoice

Effectonsurveyors: Sampleselection Interviewvalidation CAAprocess

Lesson2:MDS3.0SectionOverview

SectionbysectionreviewIntentofeachsectionGuidanceforsurveyors

Lesson2Objectives

IdentifychangestoeachsectionoftheMDS

Explainhowchangesaffectthesurveyprocess

SectionA:IdentificationInformation

Intent:Uniquelyidentify:

ResidentNursinghomeorswingbedproviderReasonforconductingassessment

A1500SurveyorGuidance

ItemA1500PreadmissionScreeningandResidentReview(PASRR)

HasresidentbeenevaluatedbyLevelIIPASRR?

Hasspecializedcarebeenincludedintheplan?

SectionA:NewItems

A0200Typeofprovider A0310cPPSOMRA,Start&EndofTherapy A1100Language A1500PASRR A1700TypeofEntry A2000DischargeDate A2100DischargeStatus A2200PreviousARDforSig.Correction A2400MedicareStay

SectionB:Hearing,SpeechandVision

Intent: Document:

Residentsabilitytohear,understandandcommunicate

Residentsvisuallimitations Difficultiesrelatedtodiseasescommoninagedpersons

SectionBSurveyorGuidance

Observationtoensure: Accuratecodingofappliances

SurveyorGuidanceB0100

Istheresidentinapersistentvegetativestate/nodiscernibleconsciousness?

Needphysiciandocumentationofdiagnosis

B0700SurveyorGuidance

B0700MakesSelfUnderstoodResidentinterviewsSkippatterns

SectionC:CognitivePatterns

Intent:Assessabilityto:

ThinkcoherentlyRememberrecenteventsRememberpastevents

SectionCSurveyorGuidance

Residentinterviewsversusstaffassessment

ReferenceItemB0700Lookfornoresponse/nonsensicalresponseonatleast3questionstojustifyconductingSAMS

ConductingtheBIMS

Handout1 Reviewexamples Discusscoding

BIMSAnswers

2

3

2

1

BIMSAnswers

2

1

2

1 3

SectionC:NewItems

C1300FromConfusionAssessmentMethod

CodedaftercompletingBriefInterviewforMentalStatus

UsingtheCAM

Handout2 Examples Coding

CAMAnswers

2

1

2

0

SectionCSurveyorGuidance

Talktoresident Validateresidentresponses Talktostaffaboutassessments Usehandouts/cuecards

SectionD:Mood

Intent:Addressmooddistress Identifyunderdiagnosed/undertreatedconditions

Providetreatment

SurveyorGuidancePHQ9

Askaboutsymptompresenceandfrequency(ifapplicable)

Codedforhigherfrequency Readquestionsasworded,nointerpretations RecommendedtoconductonARDoronedayprior

ConductingthePHQ9 Handout3 Example Coding

PHQ9Answers

0 0

1 1

1 2

1 3

0 0

0 0

1 2

0 0

0 0

D0350SurveyorGuidance

D0350SafetyNotification D0650SafetyNotification

SectionDSurveyorGuidance

Determinecodingaccuracy Askdirectquestions Interviewstaff

SectionE:Behavior

Intent: Identifybehavioralsymptoms Identifypotentiallyharmfulbehaviors

E0200E0500SurveyorGuidance

Codedforpresenceofbehaviors Behaviorsshouldnotbeminimizedornormalized

E0800SurveyorGuidance

Itemshouldbecodedas0 afterfirstinstanceiftherejectionofcare:

Hasalreadybeendiscussedwithresidentandfamily

HasbeencareplannedfororIsconsistentwithresidentsvalues,preferences,orgoals

SectionESurveyorGuidance

Observeresidentbehavior Determine

CodingaccuracyAppropriatestaffresponse

Reviewrecord Interviewstaff

SectionF:PreferencesforCustomaryRoutineandActivities

Intent: Obtaininformationregardingresident:

Preferences Dailyroutine Dailyactivities

SectionF:SurveyorGuidance

Nolookbackperiod Useofcuecards

ConductingthePreferencesInterview

Handout4 Example Coding

Activity/PreferencesAnswers

2

1

1

9

1

2

1

3

Activity/PreferencesAnswers

9

1

2

1

2

1

1

3

SectionF:SurveyorGuidance

Observeresident Interviewresidentandstaff Reviewresidentrecord&careplan

10MinuteBreak

SectionG:FunctionalStatus

Intent Assess:

Needforassistance Levelofability

ReviewActivitiesofDailyLiving Reviewgaitandbalance Reviewrangeofmotion

ActivitiesofDailyLiving:SurveyorGuidance

Changestoselfperformancecoding: 0:Independent:nostaffhelp/oversightatanytime 4:Totaldependence:fullstaffperformanceeverytime

7:Activityoccurredonlyonceortwice ADLflowchart:Ruleof3 Column2:Codedforhighestlevelofsupportprovided

G0300Balance:SurveyorGuidance

Residentsshouldbeobserved: Movingfromseatedtostandingposition Walking15feet Turningaround Movingonandofftoilet Transferringbetweenbedandchair/bedandwheelchair

G0400G0900:SurveyorGuidance

G0400Joints: Upperextremities:Shou