Re: How can an accurate MDS and RAPs help provide good care?

[BRSAMI]

In a message dated 4/4/2004 12:29:47 PM Eastern Daylight Time, [EMAIL PROTECTED] writes: In my facility the MDS/RAPS/CPs do not impact the resident in one way or another.  I am the only person who ever reads them other than consultants and surveyors. I am not allowed to implement any interventions. I am only to document in CP any interventions I see are being done. Most of the RAP related things like interventions for urinary incont or psychotrophic meds aren't done.  The pharmacy consultant can suggest dosage reductions.  Because I am not an RN questions / suggestions are not well recieved and is seen as over-stepping of boundries.  UI, Physical decline, dehydration is considered an inevitable part of aging.  Is this a common view in LTC? I can see where the MDS/RAPS could be an excellant tool if utilized correctly.   Timma I believe that the MDS and RAP process can in fact improve care for the residents.  As I do an MDS from start to finish, issues may be identified that are only brought to light with a comprehensive assessment.  I will make sure that a toileting plan, positioning plan , consults and referrals etc. are in place.  If not, I implement it.   As a new nurse in a facility I had to complete an MDS for a long term care patient with dementia and multiple falls.  I did not know this patient.  Through the assessment and RAP process I was able to identify that this patient was essentially blind in one eye secondary to a dense cataract.  This was significantly impacting her depth perception and she was over-stepping with ambulation.  She was restrained in a gerichair.  This issues was not noted anywhere in the careplan, falls prevention, diagnosis etc.   Upon further investigation the patient had been seen by the opthamologist months prior and identified as a good candidate for outpatient cataract surgery.  The opthamologist had recommended discussion with the primary care physician and family regarding this matter.  It never happened and nobody even reviewed the opth. consult report.  It was just filed in the chart.    To make a long story short... Family and primary physician agreed to the procedure.  Patient tolerated procedure well.  Short course of PT for ambulation and patient had a dramatic decline in falls, improved ambulaton and not to mention restraint reduction.  I believe this improved her quality of  life.    Disease causes disabilities, not age.  Patients are not expected to have decline in function based soley upon their age.  The degree and rate of decline can be avoidable/ minimized with interventions.  Unavoidable declines are usually with an end stage disease process or terminal illnesses.  In any event, the physician should support if decline is avoidable or unavoidable.