MDS 3.0 – Changes in the Survey Process

1. MDS 3.0 – Changes in the Survey Process By Haideh Najafi, RN, BSN, MSED, EDS And Tedi Beckett, RN, MSN September 15, 2010

2. Objectives • Describe the difference between MDS 2.0 and MDS 3.0. • Describe the effect of MDS 3.0 on the survey process. • Identify possible citations resulting from deficient practices regarding MDS 3.0.

3. Important! • MDS 3.0 will replace MDS 2.0 on Oct 1, 2010.

4. Goals of the MDS 3.0 • Introduce advances in assessment measures. • Increase the clinical relevance of items. • Improve the accuracy and validity of the MDS tool. • Increase the resident’s voice by introducing more resident interview items.

5. Goals of the MDS 3.0 (continued) • Increase the reliability, efficiency, and usefulness of the MDS. • Use standard protocols used in other settings. • Improve clinical assessment.

6. MDS 3.0

7. Purpose of the CAA Process • Identify potential resident conditions and issues. • Identify risks and causes of resident conditions.

8. Comparison of MDS 2.0 & 3.0

9. Changes in Selected MDS Sections Section J – Health Conditions (Pain) Section M – Skin Conditions Section O – Special Treatments, Procedures, & Programs Section P – Restraints Section Q – Participation in Assessment & Goal-Setting

10. Comparison of MDS 2.0 & 3.0Section J – Health Conditions Pain assessment requires asking the resident detailed questions about: • Pain frequency. • Effect of pain on the resident’s function. • Numeric scale and description of the pain. Section J requires staff to answer questions about non-verbal indicators of pain and about the resident’s pain medication regimen.

11. MDS 3.0 - Section JHealth Conditions (continued) Falls Prior to Admission and Falls Since Admission • Defines “injury” and “major injury” • If the resident has fallen since admission, the number of falls in which there was injury or major injury must be coded.

12. Comparison of MDS 2.0 & 3.0Section M: Skin Conditions

13. Comparison of MDS 2.0 & 3.0Section M (continued)

14. Comparison of MDS 2.0 & 3.0Section M (continued)

15. Comparison of MDS 2.0 & 3.0Section M (continued)

16. Comparison of MDS 2.0 & 3.0Section M (continued)

17. Reverse staging/backstaging Current clinical standards do not support reverse staging or backstaging.

18. Comparison of MDS 2.0 & 3.0Section O: Special Treatments, Procedures, and Programs

19. Comparison of MDS 2.0 & 3.0Section O (continued)

20. Section P: Restraints • The intent of this section is to record the frequency that the resident was restrained by any of the listed devices at any time during the day or night. • Physical Restraints now codes restraints “used in bed” and “used in chair or out of bed” separately.

21. Section Q: Return to the Community

22. Section Q (continued)

23. Section Q (continued)

24. How does MDS 3.0 affect the survey process? There will be changes in: a) Sample selection. b) Validating interviews. c) Care Area Assessment (CAA) process. d) The tasks & the SOM.

25. Important! • During an interim period after MDS 3.0 is implemented, the QI/QM reports will not be available to facilities or surveyors. This interim period may last up to one year (or longer).

26. How will this affect the survey process? The survey process will go back to the 1995 survey procedures until QI/QM data become available.

27. Are the CMS forms changing? Yes, CMS is changing some of the survey forms. • The Roster/Sample Matrix (CMS 802) • The Roster/Sample Matrix Provider Instructions (CMS 802P) • The Roster/Sample Matrix Instructions for Surveyors (CMS 802S) • The Resident Census and Conditions of Residents (CMS 672)

28. Revisions to the Instructions for the Roster/Sample Matrix • The Roster/Sample Matrix Instructions for Surveyors (802 S) and Roster/Sample Matrix Instructions for Providers (802 P) have been revised to accommodate the changes (i.e., reference to QM/QI reports were removed).

29. Revisions to the Roster/Sample Matrix • Fall/Fractures is a separate field from Abrasion/Bruises. • Behavioral Symptoms is a separate field from/Depression. • Resident Characteristics have been re-numbered.

30. Are the survey tasks changing?

31. Task 1: Off-site Prep Teams will not be able to generate an off-site sample based on the QI’s during this interim period.

32. Task 1: Off-site Prep (Continued) Issues & the off-site sample will be based on: • Ombudsman reports. • Facility reported incidents. • Preadmission Screening and Resident Review Reports (PASRR). • Waivers/Variances.

33. Task 1: Off-site Prep (Continued) • CASPER 3 Report (Facility History Profile) (formerly OSCAR reports) • CASPER 4 Report (Full Facility Profile) • CMS 2567’s since the past standard survey (complaints)

34. Task 2: Entrance Conference • Explain that the QM/QI reports will not be run until further notice. • Explain that the initial tour may take longer and be more in-depth than in the past.

35. Task 2: Entrance Conference (Continued) • Request that the facility complete the Roster/Sample Matrix (CMS 802) by the end of the initial tour. • Facilities must complete the 802 and 672 with the information they have in their clinical records, regardless of the availability of MDS information.

36. Task 3: Initial Tour • Confirm or invalidate the pre-survey information and add new concerns that were identified (if any). • Identify potential residents and areas of concern to be investigated. • Attempt to meet as many residents as possible. (It is not necessary to meet 100% of the residents).

37. Task 3: Initial Tour (Continued) • Identify interviewable residents. • Do not rely solely on facility staff regarding which residents are interviewable. • Interview residents, families, and staff members during the tour to identify concerns and potential residents for sample selection.

38. Task 3: Initial Tour (Continued) • Each surveyor will use a Roster/Sample Matrix during the tour to identify care issues. • Record each resident’s: 1) Name 2) Location 3) Areas of concern that relate to each resident

39. Task 4: Sample Selection • The phase I sample will be based primarily on residents identified during the initial tour. • Phase 1: 60% of the sampled residents will be selected during the initial tour. • Phase 2: 40% of the sampled residents will be selected.

40. Task 4: Sample Selection (Continued) • Sample selection should be case mix stratified to capture: • Interviewable residents. • Non-interviewable residents. • Residents receiving heavy care. • Residents receiving light care.

41. Task 4: Sample Selection (Continued) • Various stages of impairment of: 1) Physical dependency. 2) Functional dependency. 3) Cognitive functioning.

42. Task 4: Sample Selection (Continued) WHP sample selection: • Weight loss. • Hydration risk. • Pressure ulcer.

43. Task 4: Sample Selection (Continued) Residents that are encouraged but not required to be placed on the sample: • Those receiving ESRD services • Those receiving hospice services • Those who are ventilator dependent

44. Task 5: Information Gathering -CAA Process Verify that information obtained and recorded during the structured interviews on the MDS 3.0 is accurate and correct.

45. Resident interview sections • Section C: Cognitive Patterns. • Section D: Mood. • Section F: Preferences for Customary Routine and Activities. • Section J: Health Conditions. • Section Q: Participation in Assessment and Goal Setting.

46. Task 5: Information Gathering -CAA Process (Continued) Review Care Area Triggers (CAT’s). All CAT’s do not necessarily require care planning.

47. Task 5: Information Gathering -CAA Process (Continued) Review the documentation that is the basis for the facility’s decision to care plan a CAT or not. • Consider whether the findings on the MDS 3.0 require an intervention. • Consider the rationale(s) for selecting specific interventions.

48. Task 5: Information Gathering -CAA Process (Continued) Surveyors use the “Location and Date of CAA Documentation” column on the CAA summary (section V of the MDS 3.0) to find where the CAA documentation can be located in the resident’s record. Review this documentation.

49. Task 5: Information Gathering -CAA Process (Continued) The documentation of the CAA findings and decision–making process may appear anywhere in a resident’s records “e.g: flow sheets, progress notes, care plan summary, CAA narrative.”

50. Task 5: Information Gathering -CAA Process (Continued) Look for evidence that the information from the resident’s interviews has been incorporated into a care plan (especially from section Q).