Because it is pretty much a 50/50 split I would code for his worse - my rationale is if he exhibits both extremes you need more intervention from staff when he is at his worse vs. when he is at his best; therefore to initiate the process of getting it on the RCP it should be on the MDS and RAPs. Just my opinion. Holly QI in CT
> -----Original Message----- > From: Debbie Settle [SMTP:[EMAIL PROTECTED] > Sent: Thursday, December 18, 2003 12:58 PM > To: [EMAIL PROTECTED] > Subject: RE: how do I score this?? > > Boy, this is confusing.... I think I'd code him either a 1 or a 2 . My reasoning > being he makes reasonable decisions when awake & alert, but obviously when he is > unresponsive someone else has to make decisions for him. > > -----Original Message----- > From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Sara Hayden RN,C > Sent: Thursday, December 18, 2003 12:35 PM > To: [EMAIL PROTECTED] > Subject: Re: how do I score this?? > > > I know that is what the manual says. That is why I am asking for help with > scoring. The window period is 7 days or 168 hours. For 8 + 12 + 8 + 7 + 23 + 2 + 7 > + 5 = 82 hours, he was unresponsive and flaccid. For the other 86 hours, he was > alert, oriented, making valid and reasonable decisions, communicating without > problems. Would I code a "2" for decision making, even though when he is awake his > decisions are reasonable and consistent? > > ----- Original Message ----- > From: [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]> > To: [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]> > Sent: Thursday, December 18, 2003 10:43 AM > Subject: Re: how do I score this?? > > 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 > From: [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]> > Reply-to: [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]> > To: Undisclosed-Recipient:; <mailto:Undisclosed-Recipient:;> > Sent from the Internet > > > > 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 > [EMAIL PROTECTED] > > /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/
