MDS Alert

Check out these scenarios applicable to E0500 and E0600, and test your coding skills and rationale.

Scenario: Mr. Flaubert doesn’t like sitting still, but staff barely notices him continually walking the hallways anymore. Toward the beginning of his stay, months ago, staff would try to distract him or redirect his restlessness, but they’ve come to accept his pacing. He ambulates safely and watches where he’s going. He listens to staff directions otherwise, showing up for meals and sitting and eating until he’s finished and gladly goes to bed when told. Other residents are mostly oblivious to his trips up and down the hallway, but one team member has observed that Mrs. Evans tenses up every time he passes. How would you code E0500 and E0600, knowing that your coding of E0200 reflects that he paces daily?

Answer: You would code E0500 accordingly:

       E0500A, 0 (No)
       E0500B, 0 (No)
       E0500C, 0 (No)

Rationale: There’s nothing to suggest from this situation that Mr. Flaubert is putting himself in harm’s way with his walking or that his pacing is limiting his participation in social activities.

Answer: You would code E0600 accordingly:

       E0600A, 0 (No)
       E0600B, 1 (Yes)
       E0600C, 1 (Yes)

Rationale: Though Mr. Flaubert is not causing any physical harm, he’s still affecting others. As a team member has observed another resident consistently uncomfortable due to Mr. Flaubert’s pacing, it’s fair to say that his pacing is intruding on others’ privacy, as well as others’ rights to a comfortable, stress-free living environment.

Scenario: Volunteers come in twice a week to lead a group activity with everyone on the hall. Mr. Jarvis becomes exceedingly frustrated during these group activities and consistently talks over everyone else, even when asked to let someone else speak. How would you code E0500 and E0600?

Answer: You would code E0600 accordingly:

       E0500A, 0 (No)
       E0500B, 0 (No)
       E0500C, 0 (No)

Rationale: There’s nothing to suggest from this situation that Mr. Jarvis is putting himself in harm’s way by acting out on his frustrations during the group activity.

Answer: You would code E0600 accordingly:

       E0600A, 0 (No)
       E0600B, 1 (Yes)
       E0600C, 1 (Yes)

Rationale: Though Mr. Jarvis is not causing any physical harm, he’s still affecting others, especially during the organized group activity. He is infringing upon the rights and experiences of others to have a stress-free activity and environment.

Make sure that any behavioral patterns that you code as significant are documented in the clinical record, too. Behaviors recorded on the MDS should have backup documentation, such as when they occur and what interventions have been attempted, says Marilyn Mines, Rn, BC, RaC-Ct, senior manager at MarcumLLP in Deerfield, Illinois.