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I absolutely agree with Holly. The
comprehensive assessment should be the picture of the resident. If there
are 2 changes (sign change qualifiers that are consistent, not short-term
changes) a Significant Change assessment should be done. Just because the
changes did not happen does not negate the need for the SCSA. If there are
2 changes present NOW, then a SCSA is usually called for.
----- Original Message -----
Sent: Thursday, March 04, 2004 7:19
PM
Subject: Re: Reasons for Sig.
Changes
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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