I know our resident's pretty well. Mr. Smith requires more assist on days he returns from dialysis....this doesn't mean he has changed, however, coding is different on these days. When this comes up, I have dodged a few citations because I documented assessment findings after observation, staff interview etc. that the resident did not significantly change, therefore Sig change was not done.
dawn From: "Nathan" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Wednesday, February 18, 2004 3:25 PM Subject: Re: Significant Change > I am not saying it is absolutely required. The regs state certain > circumstances under which you are required to do an SCSA. They also give > some circumstances where it is up to your best clinical judgment. This is > one of those judgement calls. The problem is, if it is up to your judgement, > it is also up to the judgement of the surveyors when they come in to decide > if it should have been done. I would rather defend the position that I felt > it should be done, rather than defend the position that it did not need to > be done. > > I always would chose make an error on the side less likely to cause a survey > issue. > > Nathan > > ----- Original Message ----- > From: "Brenda Chance" <[EMAIL PROTECTED]> > To: <[EMAIL PROTECTED]> > Sent: Wednesday, February 18, 2004 11:09 AM > Subject: RE: Significant Change > > > Nathan, > > I thought that this had been clarified to mean (like the old days) if > the resident had been newly coded to a 3,4,or 8 from a 0,1,2 ( reverse > as in the significant improvement). Maybe I am mistaken, but this would > not impact the plan of care with these changes? Am I wrong? Any other > ideas out there? > > Brenda W. Chance, RN, RAC-C > MDS Coordinator > > > CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, > is for the sole use of the intended recipient(s) and may contain > confidential > and privileged information. Any unauthorized review, use, disclosure or > distribution is prohibited. If you are not the intended recipient, > please > contact the sender by reply e-mail and destroy all copies of the > original > message. > > -----Original Message----- > From: Nathan [mailto:[EMAIL PROTECTED] > Sent: Wednesday, February 18, 2004 2:00 PM > To: [EMAIL PROTECTED] > Subject: Re: Significant Change > > The RAI Manual says that a SCSA will be done when there is a decline in > two > or more of the ten domains listed below. Dressing and Personal Hygeine > both > fall within domain # 4. However, the manual states on p2-8/para 4, "This > may > include two changes within a particular domain." > > It says on p2-8/para 2, "If there is only one change, however, staff may > still decide that the resident would benefit from an SCSA. It is > important > to remember that each resident's situation is unique and the > interdisciplinary treatment team must make the decision as to whether or > not > the resident will benefit from an RAI" > > BOTTOM LINE - When the survey walks in, would you rather defend your > decision to do the SCSA or the decision not to do the SCSA? Your choice. > I > would do it if it was me. > > > > 1. Resident's decision-making changes from 0 or 1 to 2 or 3 for Item B4; > 2. Emergence of sad or anxious mood pattern as a problem that is not > easily > altered (Item E2); > 3. Increase in the number of areas where Behavioral Symptoms are coded > as > "not easily altered" (i.e., an increase in the number of code "1"s for > Item > E4B); > 4. Any decline in an ADL physical functioning area where a resident is > newly coded as 3, 4, or 8 (Extensive assistance, Total dependency, > Activity > did not occur) for Item G1A; > 5. Resident's incontinence pattern changes from 0 or 1 to 2, 3 or 4 > (Item > H1a or b), or there was placement of an indwelling catheter (Item H3d); > 6. Emergence of unplanned weight loss problem (5% change in 30 days or > 10% > change in 180 days) (Item K3a); > 7. Emergence of a pressure ulcer at Stage II or higher, when no > pressure > ulcers were previously present at Stage II or higher (Item M2a); > 8. Resident begins to use trunk restraint or a chair that prevents > rising > when it was not used before (Items P4c and e); > 9. Overall deterioration of resident's condition; resident receives > more > support (e.g., in ADLs or decision-making) (Item Q2 = 2); > 10. Emergence of a condition or disease in which a resident is judged > to be > unstable (Item J5a). > > > > Nathan > > > > ----- Original Message ----- > From: "Kristen Tryba" <[EMAIL PROTECTED]> > To: <[EMAIL PROTECTED]> > Sent: Tuesday, February 17, 2004 9:54 AM > Subject: RE: Significant Change > > > > I Wouldn't. > > > > -----Original Message----- > > From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of > > Holly McGran > > Sent: Wednesday, February 18, 2004 11:33 AM > > To: AANAC List Serve (E-mail) > > Subject: Significant Change > > > > > > > > > > Would you do a Significant change if a resident went from a 3 to > > a 4 in dressing and a 3 to a 4 in personal hygeine on an MDS with > > absolutely no other change in any other areas on the MDS? Thank you in > > advance. Holly McGran > > /---------------------------------------------------------- > > 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 > > -----------------------------------------------------------/ > > > > /---------------------------------------------------------- > > 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 > > -----------------------------------------------------------/ > > > /---------------------------------------------------------- > 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 > -----------------------------------------------------------/ > /---------------------------------------------------------- > 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 > -----------------------------------------------------------/ > /---------------------------------------------------------- > 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 > -----------------------------------------------------------/ /---------------------------------------------------------- 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 -----------------------------------------------------------/
