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This is an issue I have had trouble with in
terminal patients. There is nowhere to capture the psychosocial effects of
a terminal condition, which I feel is a REALLY important psychosocial issue, if
not a problem. When you have a resident like your example, who is aware of
his/her prognosis, and makes realistic statements regarding it, I don't really
think you can capture it on the MDS. (unless s/he is exhibiting sadness at the
same time) However, as in any other issue affecting care that is not
captured on the MDS, the facility is still responsible for meeting the
resident's needs. To me, this means documenting the statements, whether in the
nurses notes, SW notes, or wherever your facility designates, and addressing it
in the care plan. Be sure that staff allow her to make these statements
without trying to cheer her up or change the subject. That should be part
of the care plan explicitly, in my opinion.
So, again, as a reminder... not everything
that the resident says, does, or experiences is going to be captured on the MDS,
but that does not release the facility from responsibility for assessing, care
planning and meeting the resident's needs.
Holly
Holly F. Sox, RN, RAC-C
Clinical Editor
----- Original Message -----
Sent: Tuesday, February 17, 2004 4:59
PM
Subject: RE: how to code "I'm going to
die"
Thank you all for your comments, but my question was how to code
this on the MDS in section E. It's not a negative statement (E1a), E1f?
unrealistic fear? E1i is for non health related
complaints/concerns, it doesn't fit E1h either. Where/how should I
code it on the MDS?
I
used to manage an in patient Hospice unit.
Perhaps she's got unresolved issues that she may need someone to help
her get resolved. Unresolved issues can have a very negative impact on the
rest of her life.
Dorothy
Dorothy Wolfe, BSN, MDS Coordinator
The Virginia Home
1101 Hampton St.
Richmond, VA
23220
Phone: 804-359-4093 X227
Fax: 804-358-4075
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I have a hospice resident who is alert and oriented, young. She
has been told that she only has 6-9 months left to live. She has
cancer, trache, peg tube, ambulates with walker. She make
frequent complaints of "anxiety" and receives ativan. She makes
statements of "what am I going to do? how can I end this?" "is
there anything I can do to speed this up? I wish there were a
pill for saying bye bye?" She knows her condition,
she knows she is going to die, she is making statements about
her condition. It's not an unrealistic fear. But how do we code
this? These don't seem to fit in any of the categories in section
E. I'm hurrying here, so am probably leaving something
out. She is obviously anxious and depressed. She is being seen
by psychiatrist. Her antidepressants have been increased.
Help!
Thanks!
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