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You are absolutely right. (Although I will send
out a plea for you to increase your font size, as I got a headache reading
your reply)
My point was that just because 2 areas of decline
are not identified simultaneously does not absolve the facility from considering
it a significant change. I was going on the assumption that the changes in
question were significant according to the manual definition, and had been
identified, for example, on successive quarterly assessments. (Example, this
assessment, there is a decline from modified independence to moderately impaired
decision making, with no other changes noted. Next assessment, the
cognitive function remains moderately impaired, and there is now a significant
weight loss. This should be considered a consistent pattern of decline in
2 or more areas, and a sig change assessment proceeded with at that point.
I hope this clarifies my original answer to Terri's
question.
HS
----- Original Message -----
Sent: Thursday, March 04, 2004 8:47
PM
Subject: Re: Reasons for Sig.
Changes
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?
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
----- Original Message -----
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
----- Original Message -----
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
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