MDS Alert

Reviewing reports can tell if you may have trouble brewing.

Looking at each resident's QI/QM profile can help you identify scenarios that don't quite add up. Then you can dig deeper to see if you have an assessment, coding, quality-of-care care and/or documentation issue on your hands.

Here's an example of a scenario that "stops you": A resident flags on depression, weight loss, ADL decline, little or no activity, and nine or more meds, said Catherine Kiley-Zofkie, DO, CMD, in a presentation at the March 2007 American Medical Directors' Association annual meeting. Based on that profile, the resident sounds as if he may be terminally ill with less than a year to live, but then you have to ask why he's on nine or more meds, Kiley-Zofkie said. Then again, maybe the staff didn't do a dietary assessment to find out the resident's teeth hurt, which is affecting his eating, and he isn't coming out of his room because he's depressed, she speculated.

Another example: A resident is triggering on falls, depression, nine or more meds and antipsychotics in the absence of a psychotic or related conditions. "You'd better have documentation about the benefit of taking an antipsychotic" outweighing the fall risk, Kiley-Zofkie emphasized. And make sure that one of those nine meds or meds he's taking isn't Coumadin, she warned.

Bottom line: "The QIs/QMs should make sense on every patient," says Reta Underwood, president of Consultants for Long Term Care in Buckner, KY. And if they don't, it's time to check the medical record documentation and, if that doesn't provide an explanation, the MDS assessment and coding.

Example: If the resident is flagging on both the UTI and catheter QIs/QMs, look at the documentation, including the Urinary Incontinence and Indwelling Catheter RAP assessment and summary, Underwood suggests. "Does the person have a UTI secondary to permanent catheter placement, and, if so, has the physician documented that? Or does the person have a UTI due to unnecessary catheter use or care?" Perhaps UTI has been inappropriately coded in Section I2. The January 2008 RAI manual update clarifies that providers should not code UTI if the resident doesn't have a symptom of the condition.

Review the MDS coding: To review QI/QM profiles, you really have to understand the coding of the items that trigger each QI/QM, advises Roberta Reed, MSN, RN, an MDS coordinator for Grand Village Manor in Twinsburg, OH, owned by Sprenger Retirement Centers. In fact, she advises people reviewing a resident's QI/QM profile to look at the technical specs for each QI/QM triggered to see the coding and exclusions, etc. Then she suggests you revisit how and why staff coded--or failed to code--the items.

Example: A resident with a pressure ulcer who is undercoded as requiring limited assistance when he really required extensive assistance  for bed mobility or transfer on the target assessment will trigger the low-risk pressure ulcer QI/QM.

Editor's note: Review the QI/QM technical specs at www.qtso.com/download/mds/qiqm_rpt/Appendix_A_Technical_Specs.pdf.