MDS Alert

Cut through the coding confusion.

How would you code this case example in Section B5 (indicators of delirium -- periodic disordered thinking/awareness)?

Mrs. K is a 92-year-old widow of 30 years who has severe functional dependency secondary to heart disease. Her primary nurse assistant has reported during the last two days Mrs. K has "not been herself." She has been napping more frequently and for longer periods during the day. She is difficult to arouse and has mumbling speech upon awakening.

She also has difficulty paying attention to what she is doing. For example, at meals instead of eating as she usually does, she picks at her food as if she doesn't know what to do with a fork. Then she stops and closes her eyes after a few minutes.

Alternatively, Mrs. K has been waking up at night believing it to be daytime. She has been calling out to staff demanding to be taken to see her husband (although he is deceased). On three occasions Mrs. K was observed attempting to climb out of bed over the foot of the bed.

Indicators for B5

a. Easily Distracted -- Difficulty paying attention; gets sidetracked.

b. Periods of Altered Perception or Awareness of Surroundings -- Moves lips or talks to someone not present; believes he/she is somewhere else; confuses night and day.

c. Episodes of Disorganized Speech -- Speech is incoherent, nonsensical, irrelevant, or rambling from subject to subject; loses train of thought.

d. Periods of Restlessness -- Fidgeting or picking at skin, clothing, napkins, etc.; frequent position changes; repetitive physical movements or calling out.

e. Periods of Lethargy -- Sluggishness, staring into space; difficult to arouse; little body movement.

f. Mental Function Varies Over the Course of the Day -- Sometimes better, sometimes worse; behaviors sometimes present, sometimes not.

Instructions: Code for resident's behavior in the last seven days regardless of what you believe the cause to be -- focusing on when the manifested behavior first occurred.

0. Behavior not present

1. Behavior present, not of recent onset

2. Behavior present over last 7 days appears different from resident's usual functioning (e.g., new onset or worsening)

Answer:

a.  Easily distracted: 2 (present, new)

b.  Periods of altered perception or awareness of surroundings: 2 (present, new)

c.  Episodes of disorganized speech: 2 (present, new)

d.  Periods of restlessness: 2 (present, new)

e.  Periods of lethargy: 2 (present, new)

f.  Mental function varies over course of the day: 2 (present, new)

Source: RAI user's manual, chapter 3.