MDS Alert

CMS sets guideposts for navigating this clinical conundrum.

The RAI manual provides the following guidelines to help you determine when a resident may have undergone a significant change requiring a comprehensive assessment to update the plan of care.

Decline in two or more of the following:

• Resident's decision-making changes from 0 or 1 to 2 or 3 for Item B4;

• Emergence of sad or anxious mood pattern as a problem that is not easily altered (Item E2);

• Increase in the number of areas where behavioral symptoms are coded as "not easily altered" (i.e., an increase in the number of code "1"s for Item E4B);

• Any decline in an ADL physical functioning area where a resident is newly coded as 3, 4, or 8 (Extensive assistance, Total dependency, Activity did not occur) for Item G1A;

• Resident's incontinence pattern changes from 0 or 1 to 2, 3 or 4 (Item H1a or b), or there was placement of an indwelling catheter (Item H3d);

• Emergence of unplanned weight loss problem (5% change in 30 days or 10% change in 180 days) (Item K3a);

• Emergence of a pressure ulcer at Stage II or higher, when no pressure ulcers were previously present at Stage II or higher (Item M2a);

• Resident begins to use trunk restraint or a chair that prevents rising when it was not used before (Items P4c and e);

• Overall deterioration of resident's condition; resident receives more support (e.g., in ADLs or decision-making) (Item Q2 = 2);

• Emergence of a condition or disease in which a resident is judged to be unstable (Item J5a).

Improvement in two or more of the following:

• Any improvement in an ADL physical functioning area where a resident is newly coded as 0, 1, or 2 when previously scored as 3, 4, or 8 (Item G1A);

• Decrease in the number of areas where behavioral symptoms or sad or anxious mood are coded as "not easily altered" (Items E2 and E4B);

• Resident's decision-making changes from 2 or 3 to 0 or 1 (Item B4);

• Resident's incontinence pattern changes from 2, 3, or 4 to 0 or 1 (Item H1a or b);

• Overall improvement of resident's condition; resident receives fewer supports (Item Q2 = 1).