MDS Alert

Comparing notes can tell you that trouble may be brewing for a resident.

The MDS should paint a consistent picture of the resident. So if you see a resident coded in Section F as having recently lost a close family member or friend, take a look at Section E to see if the staff captured any mood or anxiety indicators in E1, or behavioral symptoms in E4. If not, take a closer look.

"You wouldn't expect someone to have a significant loss without some manifestations of anxiety or sadness," observes Sue LaBelle, RN, MSN, a senior healthcare specialist with PointRight Inc. in Lexington, Mass. Thus, PointRight includes in its MDS integrity audit a flag that detects a discrepancy between Section F and E.

"The staff may have missed certain behavioral changes or they may have seen them but didn't document them," says LaBelle.

When the resident has experienced a significant loss, the team should be on the lookout for how that's affecting the resident in terms of mood and sleep patterns, as examples, says LaBelle.

Conversely, if you see unexplained changes in mood or anxiety levels -- or behavioral symptoms -- do a little sleuthing to find out if the person may have experienced a loss. The person may have communicated the loss to a direct-care staff person whom he trusts, says LaBelle. Or perhaps staff may realize that a resident's friend from the community hasn't come to visit for some time.

Survey heads up: Surveyors are using the interview process to identify psychosocial issues that aren't coded on the MDS, cautions Christine Twombly, RN, a consultant with Reingruber & Company in St. Petersburg, Fla.