The Minimum Data Set MDS

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The Minimum Data Set (MDS)

• What you need to know

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What is the MDS?

• Minimum data set
• Set of 425 questions
• Completed on every resident upon admission and
  then quarterly
• Also completed when there is a change in status
  of 2 or more body systems

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Why is it important?

• It provides information that is used to write the
  residents care plan
• 108 of the questions are used to determine
  Medicare reimbursement
• Other questions used to calculate quality
  indicators and quality measures

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Quality Indicators

• Associated with conditions that might indicate
  poor quality of care
• Surveyors use the quality indicator report to
  help decide which residents to interview and
  whos chart to pull
• Sentinel Events Fecal impaction, dehydration,
  low-risk pressure ulcers

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Quality Measures

• Statistical data on how well the nursing home
  takes care of its residents
• Posted to the Nursing Home Compare website
• Incontinence, depression, pressure ulcers, pain,
  restraints, UTIs, bedfast residents, ADL decline,
  things like that

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How is money made?

• The answers to 108 questions are calculated by
  the computer to determine a RUG level.
• RUGResource Utilization Group
• Variables include diagnoses, nursing services
  required, minutes of PT/OT/ST, restorative
  nursing, and ADL levels

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Where Floor Nurses Matter

• ADL Scoring
• Restorative Nursing
• Health Conditions
• Cognitive and Behavior Status
• Special Treatments

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ADL Scoring

• The MDS measures many ADLs, but only four of them
  really matter
• Eating, toileting, bed mobility, transfer
• Late-loss The last ADLs that are typically lost

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Eating

• How the resident eats or drinks
• Irregardless of skill
• Includes tube feeding

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Toileting

• How the resident uses toilet room, bed side
  commode, bedpan or urinal
• Includes transfers on/off toilet
• Includes peri-care and changing pad
• Includes ostomy/catheter management
• Includes adjusting of clothing

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Bed Mobility

• Moving to/from a lying position
• Turning side to side
• Positioning body while in bed

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Transfers

• Moving between surfaces
• Excludes transfers involving bathing or toileting

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Self Performance

• 0/Independent Help/oversight provided two or
  less times in the last 7 days
• 1/Supervision Oversight, encouragement, or
  cueing provided 3 times in the last 7 days
• 2/Limited Assistance Nonweight-bearing
  assistance provided 3 times

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Self Performance

• 3/Extensive Assistance Weight-bearing support
  provided 3 times
• 4/Total Dependence Full staff performance
  resident does absolutely nothing to help
• 8/Activity did not occur

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Support Provided

• 0/No setup or physical help
• 1/Setup help only
• 2/One person assist
• 3/Two or more person assist
• 8/Activity did not occur in the last 7 days

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Whats with the 7 days???

• When the nurse is completing the MDS, it asks
  about ADL performance over the 7 days prior to
  the date the MDS is completed

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Restorative Nursing

• Planned, documented interventions
• Occur over a total of 15 minutes in a 24 hour
  period (15 minutes does not have to be all at
  once)
• Nurse assistants must be trained on the
  techniques to be used
• Can do in groups as long as there are no more
  than 4 residents per helper

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Health Conditions

• Makes us more money
• Fever with dehydration or weight gain/loss
• Internal bleeding
• Diabetes Mellitus with insulin
• 2 or more ulcers due to any cause

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Cognitive/Behavioral Status

• Know your residents and assess changes
  promptly!!!
• Easily distracted, hallucinations, delusions,
  disorganized speech, restlessness, lethargy
• Wandering, abusive, weird behaviors
• Any reason to think they may be depressed

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Special Treatments

• IV medications
• Oxygen therapy
• Suctioning
• Trach care
• Physician visits and orders
• Respiratory therapy

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Respiratory Therapy

• Can be provided by a trained nurse
• Includes coughing, deep breathing, nebulizers,
  chest percussion, etc.
• Does not include MDIs
• Must occur for at least 15 minutes total within a
  24 hour period
• 15 minutes does not need to be all at once

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Questions?