MDS Alert

Instrument omits reverse staging for decubs, streamlines ADL coding.

In addition to several new assessment approaches, the draft final version of the MDS 3.0 includes several smaller modifications and eliminates reverse staging of pressure ulcers--a requirement that has long flown in the face of accepted clinical practice.

Reasoning: Reverse staging is "not only counterintuitive but also clinically incorrect because the tissue in a healing stage 4 ulcer is different than the tissue in a developing ulcer," says Sandra Fitzler, RN, who served on the technical expert panel and a work group for developing the MDS 3.0. Fitzler is also senior director of clinical services for the American Health Care Association. Section M also includes new columns to capture pressure ulcers (stages 2, 3 and 4) present at admission and not acquired in the facility.

Meanwhile, Section H of the MDS 3.0 no longer requires the assessor to code a resident with an indwelling urinary catheter as being continent. "Just because you have a catheter doesn't mean you are continent," Fitzler notes. Staff can also document unsuccessful toileting trials in Section H.

Additionally, Section G1, activities of daily living, requires staff to code a single score based on the resident's most dependent performance for an ADL for the entire five-day lookback. Coding options include:

0: Independent
1: Set-up assistance
2: Supervision
3: Limited assistance
4: Extensive assistance, 1 person assist
5: Extensive assistance, 2+ person assist
6: Total dependence, 1 person assist
7: Total dependence, 2+ person assist
8: Activity did not occur.

Other changes: Section J allows the assessor to code whether a resident's fall produced no injury, injury (except major), or major injury.

Also, Section K1 (swallowing disorder) provides a checklist of easily observable signs and symptoms of a potential swallowing disorder.