How are you supposed to complete the discharge assessment when a resident suddenly leaves the facility?
Q: My question is related to the discharge tracking forms now with clinical subset items. My understanding is that a discharge tracking form MUST be completed within seven days for any resident who is discharged from the facility with return not anticipated, and for resident’s with discharge return anticipated. This includes discharges to hospitals. How is one to interview and complete an assessment on a resident that is ill enough to be transferred out to the hospital via ambulance or 911? On weekends at our facility the MDS staff are off and made aware on their return Monday of any discharges to the hospital. Even with the MDS 2.0 OBRA assessments, if a resident is in the window for their quarterly or annual and go out to the hospital and are admitted, you do not have to complete the assessment. You have the option of completing within a certain time frame on return to the facility. Is my understanding correct? How can you accurately complete the assessment when the resident is not available? The manual does not differentiate between return not anticipated, and return anticipated. Do you anticipate any changes to this requirement?
A: I understand your concerns and I do not anticipate much more change to this discharge assessment requirement. However, the requirement for discharge reporting has changed dramatically under MDS 3.0 from MDS 2.0. The term “Discharge trackers” is no longer used. Instead, there are 3 distinct ‘discharge reporting’ situations:
- Discharge assessment—return not anticipated (A0310F=10)
- Discharge assessment—return anticipated (A0310F=11)
- Death in the facility tracking record. A0310F=12)
The death in the facility tracking record is only demographic and administrative elements, cannot be combined with any other record, and must be completed within 7 days after the resident’s death.
The other 2 types of discharge require the use of the ND/SD discharge form, which includes demographic, administrative, and clinical items and must be completed within 14 days (rather than 7 days) after the discharge.
Sometimes, due to emergent care, it may not be possible to capture all of the data points on the 27-page discharge assessment. In those cases the use of the ‘-‘ to fill those items is acceptable, as long as all items that can be completed are coded.
A discharge assessment may be combined with another assessment when the ARD dates match. However, this assessment cannot be deferred while the patient is in the hospital as it reflects the resident’s condition on date of discharge to the hospital.