MDS Alert

Avoid the trap of not triggering the RAP.

Facilities that overstate the time residents spend in activities at N2 may end up with a spate of F tags under the revised activities survey guidance. Surveyors could even accuse you of overcoding to avoid triggering the activities resident assessment protocol (RAP).

The problem: You code a "1" at N2 if the resident spends one-third to two-thirds of his waking hours in activities. And some facilities tend to code "1" so the activities RAP won't trigger, says Jane Belt, MSN, RN, a consultant in Columbus, OH. But with the new interpretive guidance for activities and the Psychosocial Severity Outcome Guide now in effect, surveyors will be increasingly scrutinizing the accuracy of N2, in Belt's view.

Solution: Use a simple tool for estimating how much time a resident really spends involved in activities, suggests Belt. First calculate how much time the resident is awake and how much time he is involved in his ADLs, therapy and other care. Subtract the latter from the time the resident is awake and you'll have the amount of time he has available for leisure pursuits. "A cognitively impaired resident will on average be awake and not involved in care issues for about nine hours a day," says Belt.

Also keep in mind that the MDS item N2 asks you to code the amount of time the person is "involved" in an activity, emphasizes Belt. "There's a difference between watching TV and sitting in front of it," she points out.

But in coding N2, you can count the time a resident spends in activities on his own--for example, working crossword puzzles, knitting or interacting with visitors, says Cindy Mahan, the MDS nurse for Woodbriar of Wilmington, a nursing facility in Wilmington, MA. By calculating and coding N2 correctly, you will know whether to work the RAP for a resident coded as "2" or "3" (spending little or no time in activities). That gives you a chance to revise the activities care plan, if needed--and stave off F248 tags.