MDS Alert

Compare your coding to the resident's care plan.

Balance problems coded in Section G3 can flag a resident who may be a fall waiting to happen. But you may not know it if you don't take a close look at the MDS.

That's because coding a balance problem sitting or standing won't trigger the fall RAP, cautions Rena Shephard, RN, MHA, FACDONA, president of RRS Healthcare Consulting in San Diego. "The balance test for sitting, coded as 1, 2 or 3, triggers the psychotropic drug RAP," says Shephard. "The balance test while standing doesn't trigger anything," she adds. 

Even so, if you code the resident as having a balance problem--and he falls--the facility has a potential liability and survey issue on its hands if the care team didn't address that fall risk factor, Shephard cautions. For example, surveyors could compare coding at G3 to a resident's fall management care plan.

Look for the Underlying Cause

If the MDS team codes a resident as having a balance problem in Section G3, the physician and nurses should look for an underlying medical cause--for example, orthostatic hypotension or medications, advises Pauline Franko, PT, MCSP, in Ft. Lauderdale, FL. "The interdisciplinary team can then decide whether to request a therapy evaluation to look for treatable causes such as decreased range of motion at the ankles or knees or lower-extremity muscle weakness," she says.

Did you know? "About 70 percent of falls result from balance problems ... and most are due to lower extremity weakness and posture" that a structured exercise program can help, according to Denise Wassenaar, RN, MS, speaking at the recent annual American Association of Homes & Services for the Aging conference in San Antonio.

Editor's note: For more expert tips on fall risk assessment and management, see "Stay One Step Ahead Of Falls And Fall-Related Injuries" in the March 2006 Long-Term Care Survey Alert. For subscription information, call 1-800-508-2582.