There is and never has been a replacement for good old fashioned
RN assessment. It’s due to the fact that too many nurses these days lack the ability
and fail to initiate, that we even have an MDS, that we have a million assessment
forms, and that they have become the standard and the norm. Truly, again, if done
correctly, the assessment may be on a standardized, in nurses notes, on a flow sheet
with a summary, etc. as long as it’s a thorough and accurate assessment. Correct?
A “good nurse”
does not have to have the MDS, raps and trigger listing to complete a comprehensive
care plan. Unfortunately now we have to. A “good nurse” will still have a better
care plan than what the MDS and trigger mechanism leads you to. It is definitely
not the end all. It is a TOOL.
-----Original
Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]
Sent: Thursday, November 20, 2003
9:40 AM
To: [EMAIL PROTECTED]
Subject: Re: thread
Delores/Rena???
The MDS
is not a stand-alone document. There are two specific issues I'd like to
address in responding to your question.
The MDS itself is a screening tool that assists in identifying possible
functional problems. Further, in-depth assessment of the possible
problems via the RAPs is required to determine whether it is in fact a problem
for the resident. This process is fairly thorough - as far as it
goes. As I said, it is a functional assessment only, and it does
not purport to cover all factors that must be assessed and care planned for a
resident. The RAI Manual lists the following additional areas for
assessment and care planning in nursing facilities (p. 4-34):
--Rehabilitation/Restorative Nursing
--Health Maintenance (monitoring of disease processes that are currently being
treated)
--Discharge Potential
--Medications
While some aspects of these areas may be touched on via the MDS and RAPs, they
are not addressed in a way that prompts assessment of the issues resulting in
individualized care planning.
The other issue has to do with duplication of assessments that are integral to
the MDS-RAPs process. The bottom-line question to ask is this:
Since the RAI process includes within it some thorough assessment tools that
are accepted by regulators and have been represent the standard of practice in
nursing facilities for assessment of the issues they cover, why use some other
form to duplicate the assessment? For example, why not use the RAP
for falls even outside of the MDS process rather than bringing in another form
to use each time a resident falls? In my opinion, there is no reason to
do that. For areas not covered by the RAPs, a separate assessment
protocol would be needed, but why try to reinvent a wheel developed by the same
government that conducts surveys and complaint investigations and rules on the
adequacy of our assessment processes?
Rena
Subj: thread Delores/Rena???
Date: 11/20/03 3:00:23 AM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
There was a recent thread on the listserve regarding all of the assessments
that we do along with the MDS i.e. risk for pressure ulcer, side rail
assessment, oral assessment, pain assessment, fall risk and on and on and on...
As
usual, I never thought I would need the end result of all of this info and
casually reviewed it then dumped it. Well, now of course we are reviewing
the need for the assessments and trying to enter the assessments that we feel
we need to keep into our software then train on their use.
My
question is, what is actually required? We are not JCAHO certified.
The
bottom line is if the MDS is a stand alone document, are the "assessment
forms" really necessary?
Please
email me privately @ [EMAIL PROTECTED]
Thanks!
Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Healthcare Consultant
