Archive for: Interviewing skills
We were recently told by a utilization review team that we could not use resident/family stated previous weights for admission assessment/MDS completion. They said you could not code a significant weight loss using a stated weight, it had to be documented somewhere in the medical record. We were under the understanding that (as stated in the RAI User’s Manual) we can ask the “resident, family, or significant other” about weight loss and code as such for new admissions. What is the correct procedure?
Q: We were recently told by a utilization review team that we could not use resident/family stated previous weights for admission assessment/MDS completion. They said you could not code a significant weight loss using a stated weight, it had to be documented somewhere in the medical record. We were under the understanding that (as stated in the RAI User’s Manual) we can ask the “resident, family, or significant other” about weight loss and code as such for new admissions. What is the correct procedure?
A: Section K of the RAI User’s Manual states that you can “Ask the resident, family, or significant other about weight loss over the past 30 and 180 days” but that you should also “Consult the resident’s physician, review transfer documentation, and compare with admission weight.” If the admission weight is less than the previous weight, no matter which source you are using, then you must code it as such. However, usually this information is in the hospital records so be sure to obtain everything you need from the hospital discharge planner.
How should we handle a situation in which a resident expresses thoughts of self-harm?
Q: For Section D interviews, if nursing is responsible for doing the interviews and the resident says he or she has had thoughts of hurting him or herself or wanting to die, how should this be handled? Should nursing be the only discipline responsible for getting a hold of the physician? Or should social services be handling the situation?
A: Determining responsibility for doing an interview is a facility option. If nursing is performing the interview and during the interview the resident indicates thoughts of being better off dead or of hurting him or herself in some way, your immediate response must be to notify a responsible clinician (psychologist, physician, etc). Then you would follow your facility’s protocol for evaluating possible self-harm. Your facility (administration) has to decide how best to handle these situations when they arise and which disciplines to involve.
Should we attempt all interviews if the resident is rarely or never understood?
Q: If a resident is not coded as rarely/never understood and the BIMS assessment is conducted, but the resident is unable to answer any of the questions or scores a 99, should the mood interview be attempted?
A: Prior to conducting each MDS 3.0 interview, you should assess whether or not the resident can be understood. If it is determined that the resident is rarely or never understood (and, for the Section F interviews, family or a significant other is not available) you would go on to complete the staff assessment. However, if the resident is at least sometimes understood verbally or in writing, you should attempt to conduct each interview.
MDS 3.0 interviewing questions
Q: We are experiencing some confusion regarding what to do if a resident refuses to do interviews. My three questions concering this issue are as follows:
- It appears that the most confusion is related to the BIMS. We know you have to code the MDS as yes, the resident is interviewable, because he or she is alert and oriented, but just refusing to answer. But on page C-4 of the RAI User’s Manual, it states “If the resident chooses not to answer a particular item, accept the refusal and move on to the next questions. For C0200 through C0400, code refusals as incorrect.” There are staff interpreting this different ways. Although when coded differently it doesn’t seem to be rejecting when we transmit them, we would like to be clear on the correct way to code this. Many staff are just putting the checkmark in for unknown which grays out the area and then moving on to the staff interview. Other staff are marking answers C0200 and CO300 as incorrect and then when they get to CO400 they put in the checkmark to mark it as unknown and then move to staff interview. Which is correct?
- For the Mood Interview, we are coding everything as a 9 as page D-5 states “Code 9, no response if the resident was unable or chose not to complete the assessment, responded nonsensically and/or the facility was unable to complete the assessment.” Leave column 2 blank (this actually grays out after marking column 1 as a 9 anyway). The confusion for section D is that when someone discharges unexpectedly, staff were coding everything as unknown by placing a check mark and then moving to staff interview. It appears that it should be marked as a 9 instead. Do you agree?
- For section F, we are marking everything as a 9 as per page F-5 it states “Code 9, no response if resident, family or significant other refuses to answer or says he or she does not know.” Again though, for an emergent discharge we are marking it as unknown which may or may not be correct. I don’t see this addressed for section F in the manual though. What are your thoughts?
A: These are great questions. My responses are as follows:
- For the BIMS C0200-C0400, a refusal is coded as incorrect, which is Code 0, none. (See example 2 on page C-5 of the MDS User’s Manual.) Then in C0500, you would code 99. The code of 99 indicates the use of the alternative observation items associated with Section C. It sounds as if your software is handling this with the use of a checkmark and ‘graying out’ features, but you might want to check with them, as that is a software convention.
- For the Mood Interview D0200, Code 9, no response appears to cover this situation.
- The Interview for Daily and Activity Preferences only appears on a comprehensive assessment. It is not included on a discharge, quarterly, significant change of prior quarterly, or Medicare only assessment, unless it is combined with the comprehensive assessment.
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