Educating Fellow Staff

       How do we prepare the next generation of nurses to fulfill the responsibilities of the Minimum Data Set (MDS) coordinator? This job is not to be taken lightly. We need to continually provide education and support for those individuals who are taking over for us as well as those completing the sections in the MDS. Think of all the years that we have been completing the MDS and how there has always been something new, like Section W for nurses. Taking a systematic approach to completing the MDS is the first step in reviewing it for completeness.
       The second step is to describe every system you already have in place. Teach how to use the calendar for assessments and care plan conferences. Be attentive to your student. Find out whether there are any areas of particular concern so that you can review them for full understanding. Some new nurses may be able to code easily but have difficulty learning how to transmit. Taking notes is of the utmost importance, along with practice and actually performing the job. There is no greater luxury than training a new person in the Resident Assessment Instrument (RAI) process while you are still in the job. Whatever has worked for you in the past will be the gold standard for the facility.

Questions and Answers

       Question: I’m wondering if there are any regulations about the other facility members (eg, those from social service, activities, and dietary) when filling out their section of the MDS; do they also need to do quarterly/annual charting? We’re finding that if I must set an Assessment Reference Date (ARD) to capture something after we’ve done an MDS, they’re having to do more work than is unnecessary. They think they need to “back up” the MDS information they fill out in their sections. And [the staff member in the activities department] thinks that she needs to chart with every ARD. Can you please help? (licensed practical nurse, via e-mail)
       Answer: I’ve always been taught that information on the MDS must have some documentation in the chart. So yes, all disciplines must write a note prior to the ARD for quarterly and annual charting. Now, if you set a new ARD for a significant change in status assessment (SCSA) and you have just completed a quarterly, the other disciplines can write a simple note stating that they have been informed of a change of condition and the information remains the same for their section. When setting a new ARD for this, I put a note in the chart stating that the interdisciplinary treatment team has deemed a SCSA and the new ARD is such and such (about a week in the future). This is part of my responsibility as the MDS coordinator. Then all disciplines have that amount of time to gather information and write a note.
       Question: We have a lot of turnover in our building with residents. I’m responsible for all of the residents. How do I prioritize them? Should I first concentrate on the subacute residents or long-term care residents? (registered nurse, Arizona)
       Answer: Good question. I usually spend most of my time on the subacute residents because they are new to the building and their MDSs take longer to complete. I want them to be accurate, and I want to make sure that their assessments—all assessments—are done on time. Develop a strategy and stick to it. For the long-term care residents, I have 14 days to complete the annual and quarterly assessments. I try to keep abreast of what is happening with them. I usually fit those MDSs in between completing an MDS for a subacute resident. I know how busy it can get, and you have to keep track of all of them. Have a good calendar handy so you know what’s due. Try to stay ahead of the calendar in case something comes up, so you aren’t pressed for time. All team members must also keep up with all of their assessments. A bulletin board listing all of the ARDs might be helpful to the team members so that they can see at a glance what is due.
       Question: Our MDS coordinator isn’t coming back after an illness, and I’ve been put in charge of completing the MDSs. What should I do? (registered nurse, Florida)
       Answer: Get a list of what’s due and urgent and develop a strategy to systematically to get the job done. Work diligently, knowing that accuracy is vital. All team members must be there to help you and complete their sections. Recognize that you can only work so fast, and do your best. Remember basic nursing principles, such as assessment, planning, intervention, and evaluation. Bring issues up in the quality assurance (QA) meetings. Get assistance from a coworker, supervisor, or consultant. Eventually, you will develop your own systems and recognize the art of the completing the MDS.
       Question: Can I classify a diagnosis in Section I if it is not stated on the order sheet or history or physical? (registered nurse, Texas)
       Answer: No. It’s best to get those diagnoses down on paper before coding them in the MDS. For example, there are so many drugs used for improving cardiac status that it would be impossible to second-guess the physician or nurse practitioner. It is best for the nurses get the diagnoses prior to an ARD. Putting the diagnoses on the admitting order sheet is the best practice.
       Question: How does the resident participate in the assessment process in order to rate it in Section R? (licensed practical nurse, California)
       Answer: When the resident answers any of the history or subjective statements (eg, on pain), one can code that the resident participated in the assessment. Some residents, particularly those who are classified as subacute, are able to state their thoughts, feelings, and goals, particularly for discharge. When interviewing the resident, allow him or her to talk freely by asking open-ended questions, which can yield much more information yes-and-no questions do.
       Question: The nurses are doing the nursing sections of the MDS. What if I find a discrepancy? (licensed practical nurse, Colorado)
       Answer: I always bring the information to the nurses and ask how and why they coded a section the way they did. Frequently, it is a time for education, for the criteria may have changed since they learned them or they may have even forgotten how to code a section. If there is a discrepancy, I will always bring it to the attention of the nurses and tell them that the coding needs to be corrected.
       Question: How do I explain to a resident what an MDS is? (registered nurse, South Carolina)
       Answer: I explain what it stands for and that it is information that is gathered to assess a resident and develop his or her care plan. It is a picture or snapshot for a certain time frame when the resident is assessed. Over time, the team can compare information with its health and well-being records from the past 3 months and adjust the care plan. (Do you have any other helpful and simple explanations that you use? Let us know, and we will publish the best responses.)
       Question: Does the pressure ever let up? (licensed practical nurse, Washington)
        Answer: We all have pressure in our jobs, and, like stress, it keeps us motivated. I say it’s all in your attitude. Completing an MDS before its deadline always is best, as unforeseen events may arise. Staying organized is a good practice. And finding outlets for stress is also a great way to keep up the good work.
       Question: I am the systems administrator. What exactly does that mean? (registered nurse, Utah)
       Answer: It means different things in different buildings and organizations. A systems administrator is usually in charge of all hardware and software issues. The systems administrator keeps track of inventory and ordering equipment, assisting in maintenance and problem solving. He or she provides passwords for security and educates others in the use of their computers. If you are designated as the systems administrator, find out exactly what your responsibilities are and enlist help from those around you who might be helpful as resources.

       If you have a question you would like to see addressed in a future article, please e-mail it to ryand@hmpcommunications.com.