MDS Alert
Personalize A Resident's Care: Check Out The Personal Severity Index (PSI)
These MDS items tell you a resident may be ready for end-of-life care.
You may sense a resident is going downhill, but noting that he has a growing number of conditions included in the MDS-based Personal Severity Index can help you quantify your suspicions. The PSI includes numerous MDS items tied to the resident's risk of dying within six months.
The items in the risk scale vary depending on whether it's a quarterly or full MDS, explains Steven Littlehale, MS, ARNP, chief clinical officer at LTCQ Inc. in Lexington, MA.
For example, researchers who developed the PSI found that residents with nine or more of the following 25 problems on the full MDS are at high risk of death or have a 35.7 percent death rate within six months.
Scale Components Include:
• Age 90 or older
• Cognitive decision making: severely impaired (B4=3)
• Delirium: Periods of lethargy (B5E=2)
• Ability to understand: sometimes/rarely (C6=2,3)
• Transfer ...quot; extensive, total, did not occur (G1bA= 3,4,8)
• Locomotion ...quot; extensive, total, did not occur (G1eA=3,4,8)
• Eating -- extensive, total, did not occur (G1hA=3,4,8)
• Personal hygiene ...quot; total, did not occur (G1jA=4,8)
• Sad mood ...quot; daily repetitive verbalizations (E1c=2)
• Sad mood ...quot; something terrible about to happen ...quot; daily (E1g=2)
• Acute episode ...quot; yes (J5b=1)
• Unstable ...quot; yes (J5a=1)
• Change in care needs ...quot; deteriorated (Q2=2)
• End stage disease ...quot; yes (J5c=1)
• Bowel ...quot; occasional, frequent incontinent (H1b=2,3,4)
• Weight loss ...quot; yes (K3a=1)
• Pressure ulcer ...quot; stages 1 through 4 (M2a=1,2,3,4)
• Stasis ulcers ...quot; yes (M2b=1,2,3,4)
The above items are on the quarterly and full MDS. Additional items on the full MDS include:
• Shortness of breath ...quot; yes (J1b =1)
• Oxygen therapy ...quot; yes (P1g =1)
• Problem swallowing ...quot; yes (K1b=1)
• Time awake afternoon (N1b = 0)
• Cardiac dysrhythmia ...quot; yes (I1e = 1)
• Congestive heart failure ...quot; yes (I1f = 1)
• Skin tears or cuts ...quot; yes (M4f = 1)
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