Hone your coding skills with these RAI patient scenarios E0100: Potential Indicators of Psychosis RAI Coding Instructions: Code based on behaviors observed and/or thoughts expressed in the last 7 days rather than the presence of a medical diagnosis. Check all that apply. RAI Manual Coding Tips and Special Populations: RAI Scenario No. 1: A resident carries a doll which she believes is her baby and the resident appears upset. When asked about this, she reports she is distressed from hearing her baby crying and thinks she's hungry and wants to get her a bottle. RAI Scenario No. 2: A resident reports that he heard a gunshot. In fact, there was a loud knock on the door. When this is explained to him, he accepts the alternative interpretation of the loud noise. RAI Scenario No. 3: A resident is found speaking aloud in her room. When asked about this, she states that she is answering a question posed to her by the gentleman in front of her. Staff note that no one is present and that no other voices can be heard in the environment. RAI Scenario No. 4: A resident announces that he must leave to go to work, because he is needed in his office right away. In fact, he has been retired for 15 years. When reminded of this, he continues to insist that he must get to his office. RAI Scenario No. 5: A resident believes she must leave the facility immediately because her mother is waiting for her to return home. Staff know that, in reality, her mother is deceased and gently remind her that her mother is no longer living. In response to this reminder, the resident acknowledges, "Oh yes, I remember now. Mother passed away years ago." E0200: Behavioral Symptom -- Presence & Frequency RAI Coding Instructions: Code 0, behavior not exhibited:
if hallucinations were present in the last 7 days. A hallucination is the perception of the presence of something that is not actually there. It may be auditory or visual or involve smells, tastes or touch.
Code 1, behavior of this type occurred 1-3 days:
if the behavior was exhibited 1-3 days of the last 7 days, regardless of the number or severity of episodes that occur on any one of those days.›› ››Code 2, behavior of this type occurred 4-6 days, but less than daily:
if the behavior was exhibited 4-6 of the last 7 days, regardless of the number or severity of episodes that occur on any of those days.Code 3, behavior of this type occurred daily:
if the behavior was exhibited daily, regardless of the number or severity of episodes that occur on any of those days.RAI Coding Tips and Special Populations:
RAI Scenario No. 1: Every morning, a nursing assistant tries to help a resident who is unable to dress himself. On the last 4 of 6 mornings, the resident has hit or scratched the nursing assistant during attempts to dress him.
RAI Scenario No. 2: A resident has previously been found rummaging through the clothes in her roommate's dresser drawer. This behavior has not been observed by staff or reported by others in the last 7 days.
RAI Scenario No. 3: A resident throws his dinner tray at another resident who repeatedly spit food at him during dinner. This is a single, isolated incident.
E0500A, B, C: Impact on Resident
RAI Coding Instructions for E0500A. Did Any of the Identified Symptom(s) Put the Resident at Significant Risk for Physical Illness or Injury?:
RAI Coding Instructions for E0500B: Did Any of the Identified Symptom(s) Significantly Interfere with the Resident's Care?
RAI Coding Instructions for E0500C: Did Any of the Identified Symptom(s) Significantly Interfere with the Resident's Participation in Activities or Social Interactions?
RAI Coding Tips and Special Populations:
RAI Scenario No. 1: A resident frequently grabs and scratches staff when they attempt to change her soiled brief, digging her nails into their skin. This makes it difficult to complete the care task.
RAI Scenario No. 2: During the last 7 days, a resident with vascular dementia and severe hypertension, hits staff during incontinent care making it very difficult to change her. Six out of the last 7 days the resident refuses all her medications including her antihypertensive. The resident would close her mouth and shake her head and would not take the medication even if re-approached multiple times.
RAI Scenario No. 3: A resident paces incessantly. When staff encourage him to sit at the dinner table, he returns to pacing after less than a minute, even after cueing and reminders. He is so restless that he cannot sit still long enough to feed himself or receive assistance in obtaining adequate nutrition.
RAI Scenario No. 4: A resident repeatedly throws his markers and card on the floor during bingo.
RAI Scenario No. 5: A resident with severe dementia has continuous outbursts while awake despite all efforts made by staff to address the issue, including trying to involve the resident in prior activities of choice.
E0600A, B, C: Impact on Others
RAI Coding Instructions for E0600A: Did Any of the Identified Symptom(s) Put Others at Significant Risk for Physical Injury?
RAI coding Instructions for E0600B: Did Any of the Identified Symptom(s) Significantly Intrude on the Privacy or Activity of Others?
RAI Coding Instructions for E0600C: Did Any of the Identified Symptom(s) Significantly Disrupt Care or the Living Environment?
Coding Tips and Special Populations
RAI Scenario No. 1: A resident appears to intentionally stick his cane out when another resident walks by.
RAI Scenario No. 2: A resident, when sitting in the hallway outside the community activity room, continually yells, repeating the same phrase. The yelling can be heard by other residents in the hallway and activity/recreational areas but not in their private rooms.
RAI Scenario No. 3: A resident repeatedly enters the rooms of other residents and rummages through their personal belongings. The other residents do not express annoyance.›› ››
RAI Scenario No. 4: When eating in the dining room, a resident frequently grabs food off the plates of other residents. Although their food is replaced, so the behavior does not compromise their nutrition, other residents become anxious in anticipation of this recurring behavior.
RAI Scenario No. 5: A resident tries to seize the telephone out of the hand of another resident who is attempting to complete a private conversation. Despite being asked to stop, the resident persists in grabbing the telephone and insisting that he wants to use it.
RAI Scenario No. 6: A resident begins taunting two residents who are playing an informal card game, yelling that they will "burn in hell" if they don't stop "gambling."
RAI Scenario No. 7: A resident yells continuously during an exercise group, diverting staff attention so that others cannot participate in and enjoy the activity.
RAI Scenario No. 8: A resident becomes verbally threatening in a group discussion activity, frightening other residents. In response to this disruption, staff terminate the discussion group early to avoid eliciting the behavioral symptom.
E0800: Rejection of Care -- Presence & Frequency
RAI Coding Instructions:
Code 0, behavior not exhibited:
if rejection of care consistent with goals was not exhibited in the last 7 days.Code 1, behavior of this type occurred 1-3 days:
if the resident rejected care consistent with goals 1-3 days during the 7-day look-back period, regardless of the number of episodes that occurred on any one of those days.Code 2, behavior of this type occurred 4-6 days, but less than daily:
if the resident rejected care consistent with goals 4-6 days during the 7-day look-back period, regardless of the number of episodes that occurred on any one of those days.Code 3, behavior of this type occurred daily:
if the resident rejected care consistent with goals daily in the 7-day-look-back period, regardless of the number of episodes that occurred on any one of those days.RAI Coding Tips and Special Populations:
RAI Scenario No. 1: A resident with heart failure who recently returned to the nursing home after surgical repair of a hip fracture is offered physical therapy and declines. She says that she gets too short of breath when she tries to walk even a short distance, making physical therapy intolerable. She does not expect to walk again and does not want to try. Her physician has discussed this with her and has indicated that her prognosis for regaining ambulatory function is poor.
RAI Scenario No. 2: A resident informs the staff that he would rather receive care at home, and the next day he calls for a taxi and exits the nursing facility. When staff try to persuade him to return, he firmly states, "Leave me alone. I always swore I'd never go to a nursing home. I'll get by with my visiting nurse service at home again." He is not exhibiting signs of disorientation, confusion, or psychosis and has never been judged incompetent.
RAI Scenario No. 3: A resident goes to bed at night without changing out of the clothes he wore during the day. When a nursing assistant offers to help him get undressed, he declines, stating that he prefers to sleep in his clothes tonight. The clothes are wet with urine. This has happened 2 of the past 5 days. The resident was previously fastidious, recently has expressed embarrassment at being incontinent, and has care goals that include maintaining personal hygiene and skin integrity.
RAI Scenario No. 4: A resident chooses not to eat supper one day, stating that the food causes her diarrhea. She says she knows she needs to eat and does not wish to compromise her nutrition, but she is more distressed by the diarrhea than by the prospect of losing weight.
RAI Scenario No. 5: A resident is given his antibiotic medication prescribed for treatment of pneumonia and immediately spits the pills out on the floor. This resident's assessment indicates that he does not have any swallowing problems. This happened on each of the last 4 days. The resident's advance directive indicates that he would choose to take antibiotics to treat a potentially life-threatening infection.
RAI Scenario No. 6: A resident who recently returned to the nursing home after surgery for a hip fracture is offered physical therapy and declines. She states that she wants to walk again but is afraid of falling. This occurred on 4 days during the look-back period.
RAI Scenario No. 7: A resident who previously ate well and prided herself on following a healthy diet has been refusing to eat every day for the past 2 weeks. She complains that the food is boring and that she feels full after just a few bites. She says she wants to eat to maintain her weight and avoid getting sick, but she cannot push herself to eat anymore.
Source:
The Long-Term Care Facility Resident Assessment Instruments User's Manual MDS 3.0, V1.08 (April 2012).