Re: Reasons for Sig. Changes

[Hallock]

There are so many factors that can enter into this that this statement generally speaking is misleading. I believe it should say, "may be warranted". We worked up a sheet for comparison and keep a progress note with our MDS's.  Remember if the change is self limiting and resolution expected, having said sheet with doc of changes, reason for changes, and logic for initiating a cc mds can be very helpful when questioned by inspectors.  We keep them in a 3 ring note book, logged alphabetically from one inspection 'til the next. If you are like me, it is difficult to remember your rationale for doing/not doing a cc mds 6 mo down the road.  If meds are being titrated, at least 14 days should be given to reach a blood level and then 2 wks to see if effective.  If there is a wt loss, it could be therapeutic if it was care planned or from Diuresing. Ask the doc to document same next visit. If wt loss happens in conjunction with an acute process and with Care planned interventions it begins to rebound after the acute process clears, doc same and don't do Sig Change.  If there is wt loss and decubitus ulcer I do a Sig Change.Also remember, if the resident cycles with medical status or seasonally of fluctuates R/T good and bad days as with Dementia, Care plan your problem in that manner and then the fluctuation for example has been identified and you do not have to keep doing cc mds. Also, if declines are an expected outcome of a Disease process and physician had documented same we do not do a cc mds. If a resident goes on Palliative care, the palliative care plan is evoked and a change of condition not done based on facility policy. We are given that choice.  Key, does the care plan still apply to the resident? -----Original Message----- From: Holly Sox, RN, RAC-C <[EMAIL PROTECTED]> To: [EMAIL PROTECTED] <[EMAIL PROTECTED]> Date: Wednesday, March 03, 2004 10:20 AM Subject: Re: Reasons for Sig. Changes It's cumulative.  Rena addressed this issue a couple of months back quite eloquently. The gist of it was that the changes need to be taken into account as they occur, and once you have reached 2 or more, then sig change is warranted.   HS Holly F. Sox, RN, RAC-C Clinical Editor   www.careplans.com   [EMAIL PROTECTED] ----- Original Message ----- From: T Prit To: [EMAIL PROTECTED] Sent: Wednesday, March 03, 2004 9:30 AM Subject: Re: Reasons for Sig. Changes So, Holly, what you're saying is that you may have one change on one assessment and then 3 months later have one change and then a sig change should be done?  I thought it had to be 2 changes on the SAME assessment.  Thanks.  Terri "Holly Sox, RN, RAC-C" <[EMAIL PROTECTED]> wrote: According to the manual, the sig change is not required unless there is a pattern of significant decline or improvement in 2 or more areas. I would not do the SC for any of the changes you mentioned in the absence of other changes.  However, like you said, it's better to try to explain why you did than why you didn't.  Whenever I identify any of the changes that you mentioned, I write a progress note explaining the change, and addressing the fact that other areas are stable. I ensure that the care plan is up to date. That way, if another change happens, then I have my documentation in order and proceed with the sig change at that time. If not, then I feel fairly safe that my care plan is appropriate and nothing is being missed.   HS Holly F. Sox, RN, RAC-C  Clinical Editor, Careplans.com www.careplans.com [EMAIL PROTECTED] ----- Original Message ----- From: [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Tuesday, March 02, 2004 10:52 PM Subject: Reasons for Sig. Changes Hello All,      I have a question to pose to the group.  It may sound silly, but I have always been under the impression that if you have a resident with a significant weight loss, you do a Sig. Change.  Also, for new stage 3 or 4 pressure area or  a new restraint.    I thought all of these should stand alone for a Sig. Change.  Here at work recently, some people have really been questioning and trying to get out of doing the changes.  I would rather have the Sig. Changes than try to explain why I didn't do one to the surveyors.  On our recent annual survey we had done a Sig. Change on a lady, then three months later she got a lap buddy restraint.  Surveyors cited us for not doing another change.  Sorta slipped through the cracks.   All info and opinions would be greatly appreciated. You all are a great resource.   Susan Gibbs, RN MDS Coordinator Presbyterian Homes of TN Do you Yahoo!? Yahoo! Search - Find what you’re looking for faster.