The instruction in the RAI User's Manual are to code these items based on information collected across all shifts and all disciplines for the entire observation period.  It would not be appropriate to selectively omit certain periods of time from the observation period. 

Since these items are important for care planning purposes, it is important that the MDS coding be an accurate reflection of the resident's overall status during the observation period.

Rena

Subj: how do I score this??
Date: 12/18/03 8:26:09 AM Pacific Standard Time
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I have a resident on Medicare A that is a hospital return following surgery for an above the knee amputation due to irreversible critical ischemia.  In the 7 day window, since his return, he has had 4 periods of complete unresponsiveness with flaccidity.  These periods have lasted from 2 hours to 16 hours.  When he comes out of these episodes, he is totally alert and oriented, communicates clearly, makes his own decisions, feeds himself, jokes with staff, etc. 
My question is on scoring section B - cognition and memory.  Do I score the way he is when he is unresponsive or do I score for the alert and oriented, awake person?  The episodes of each is about 50% of the window period so neither one is a true picture of the resident throughout the window as they are so completely polar of status.
 
Sara Hayden RN,C
St. Mark's Lutheran Home
Austin, MN







Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
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