Debra Wright: Alright.
Kasey Stevens | Quality Insights: Good afternoon, and welcome to our series of webinars focused on bringing you information about COVID-19 related topics.
Kasey Stevens | Quality Insights: Information in these weekly webinars is geared toward long-term care facilities and skilled nursing facilities. But we encourage everyone who's interested to attend. My name is Casey Stevens, and I'm communications specialist here with quality insights. Today we'll be discussing the minimum data set. Mbs changes are coming sections BDE and F.
Kasey Stevens | Quality Insights: Everyone has entered the webinar today on mute, but we will have a discussion following the presentation. You have questions or comments. Please submit them, either using the chat feature or the QA feature in your Zoom menu. You can also raise your hand to request to be unmuted, and ask your question aloud.
Kasey Stevens | Quality Insights: We invite you to join us every Wednesday at 2 Pm. For more of our weekly webinars. Next week we'll be discussing the Mbs. Changes and highlight sections, GGH. And I. And now I'd like to introduce our guest today. Deborah. Right?
Kasey Stevens | Quality Insights: Deborah is a quality improvement, specialist, quality, insight. She joined our team after being in the long term care industry. For more than 30 years. She has a wealth of experience and long term care and nursing management, ranging from certified nursing assistant to Vice President of healthcare operations. She's most passionate when working with the Mds process in quality improvement. And with that Deb. Thank you for joining us today, I'll turn it over to you.
Debra Wright: Alright. Thanks, Kathy. So like, she said. Today, we are going to be talking about sections BCDE, and F,
Debra Wright: and we're just gonna go through. A couple of these beginning slides pretty quickly. They are a repeat of what we talked about last week
Debra Wright: mit Ctl, and so here are the 2 links that you'll have to get the Mds forms which have been finalized. The Rei manual is still in draft form, so we're still waiting for that to come out. In the final
Debra Wright: final edition, however, the Mds. Forms themselves have been finalized as well as the link for the Cms. Official Youtube channel where you can get a number of different education that they've put out there little snippets of each different section. And here's some examples of the ones that they have. So you would just go to that Cms library. In the search bar. Put, you know, Mds section
A, BF. Whatever section you're looking for. And then they have some education as well that they've put out on those sections
Debra Wright: some global changes that were made to the Mds. Rei manual. We're not going to go into all of this, but just so that you're aware they've gone through and made all the language general gender neutral. They've had minor updates to wording. They've made some clarifications. They've updated keys to I keys. And then there were revisions that pertain to the legal information for family members, significant others and th the legal representatives.
Debra Wright: There were also changes and revisions made to chapters 1, 2, and 4. We're not going to go through that. But just so, you're aware that there are changes in there, and also here are are all the data elements that have new or revised guidance. In Chapter 3 of the Rei. And these are the sections that we're going to be talking about throughout these series.
Debra Wright: So today, we're gonna start by talking about Section B, the hearing, speech, and vision.
Debra Wright: So the intent of this section is to document whether the resident is comatose, the residents ability to adhere with or without their assistive devices, understand and communicate with others as well as the residents, ability to see objects nearby in their environment.
Debra Wright: So all of these sections be 0 100 to B 1,200.
Debra Wright: All they did was add examples in the Rei manual. So we're not going to go into these sections. And the coding definitions just know that they have added some examples to all of these sections.
Debra Wright: The section that is new is the health literacy. So health literacy is becoming more and more popular and prominent in in the industry, and it's defined as the degree to which individuals have the capacity to obtain process and understand their basic basic health information and services needed to make appropriate health decisions.
Debra Wright: So you can see here that the the choices are never, rarely, sometimes, often, always, they decline to respond, or they're unable to respond.
Debra Wright: So here's the the health related quality of life, examples that they give, how you can better plan for the care and then the steps for assessment. It's intended to be a resident self, reported item, so no other source should be used to identify the response. So it's simply an interview question you're asking the Resident. How often do you need to have someone help you
when you read instructions, pamphlets or other written material from your doctor or pharmacy.
Debra Wright: So again, here are the choices, never. They. They say that they never need help reading instructions, pamphlets, or other written materials from doctors or pharmacies they rarely do, sometimes.
Debra Wright: often always, or then code. 7 resident declines to respond, or code 8 resident, unable to respond.
Debra Wright: So here's the example from the Rei Manual. When asked how often they need help when reading the instructions provided by their doctor, the resident reports that they never need help.
Debra Wright: The Resident's adult child is present, and shares that a family member must always accompany the Resident to the doctor's visits, and that the resident often needs someone to explain the written materials to them multiple times before they understand providing examples of needing to frequently explain to the Resident why they are on a special diet, and why and how to take some of their medications.
Debra Wright: So in this instance, how would we code the answer for this?
Debra Wright: The residents says that they do not need help, but the family is obviously giving examples of how they do need assistance.
Debra Wright: So in this case we would code the health literacy in as never.
Debra Wright: The Resident indicates that that they never need help reading instructions from their doctor or pharmacists, and since this question is supposed to be resident self reported, and not taking information from any other source such as the family members. We need to code, based on what the residents stated. So the residents stated that they never needed help with instructions.
Debra Wright: So then we go into the cognitive patterns. and this the the intent, and again just reading right from the Rei manual. The the intent is to determine the residents, attention, orientation, and ability to register and recall new information, and whether the resident has signs and symptoms of delirium. So again, they've just kind of updated the intent of this section
Debra Wright: steps for assessments. We wanna make sure that we're interacting with them in their preferred language. So you want to go back to Section A, where we had to answer that question, what is their preferred language and communication method.
Debra Wright: And if they need or require an interpreter, that's how we have to complete these interviews. We need to make sure that we are providing that interpreter so that they clearly understand the question if they prefer to communicate, using alternate means, such as writing or pointing or sign language, or those infamous queue cards that I don't know how many of you still use those or not
interview sections. We need to make sure that we're using those.
Debra Wright: This is one of those questions where, if in Section B, we said that the Resident is rarely or never understood, we would then skip to C. 0 600. The staff assessment for mental illness.
Debra Wright: Keep in mind, there is there are some
Debra Wright: caveats. If it is a standalone part, a Pps discharge assessment. In that case, if they're rarely or never understood. Then we would skip to see 1310 signs and symptoms of delirium.
Debra Wright: So here's a screenshot of what the bims the brief interview, for mental status looks like, and it is considered complete if the Resident attempted and provided relevant answers to at least 4 of the questions in C 0 200 to c. 0 400 c.
Debra Wright: Relevant answers do not need to be correct, but they do need to be related to the question that was asked. So 0 200 is the repetition of the 3 words, and then you have the temporal orientation and the recall questions.
Debra Wright: If the interview is stopped. They've had some added some clarifications on on what we do with the coding. If the interview is stopped, then we're gonna dash 0 or C, 0 400 A, B and C, which is the recall questions.
Debra Wright: we're gonna code 99 in the Bim summary score.
Debra Wright: unless it's the. And then if the assessment is completed as a standalone pps, we're gonna move on to the signs and symptoms of delirium. If it's not, then we're gonna proceed to the staff assessment.
Debra Wright: So then, if all the responses in C 0 300 A, B and C, which is your temporal orientation, questions are coded. 0
Debra Wright: because the answers are incorrect. We're still gonna continue that interview and some examples of what those responses could be in order to Code 0 are the incorrect answers, unless the item itself provides an alternative response, the items that are nonsensical and questions that the the Resident chooses not to answer or or refuses to answer.
Debra Wright: Since those zeros results from these 3 situations, we need to make sure that we're treating them differently when coding the vim summary in c. 0 500, and the the interviewer may find it valuable to track the reason so that they can accurately calculate that summary score.
Debra Wright: So then, moving on to the mood section.
Debra Wright: Not too much has changed with this, as far as the intent, the intent is still to address mood, distress, and social isolation.
Debra Wright: so mood distress is the serious condition that's under diagnosed and under treated in the Nursing Home. And it's associated with significant morbidity. It's important to identify the signs and symptoms of mood distress
Debra Wright: so that we can treat them. We can, you know, make sure that the physician is aware we can involve activities so that we can increase their mood. Social isolation is a new area that's now on the Mds, and that refers to the actual or perceived lack of contact with other people intense, which increases with age.
Debra Wright: It's a risk factor for physical and mental illness. It's a predictor of mortality, and it's important to assess in order to identify engagement strategies. And that's what they're really gonna see? Based on how we answer that social isolation and how the resident is feeling really is gonna drive our activity and our engagement with the residents.
Debra Wright: These are just some clarifications for this, for the steps for the assessment. Again, they they have that general neutral
Debra Wright: verbiage in there. And it goes on to say again, this is one of those questions that, based on section B, if they're rarely or never understood. Then we would skip to the staff assessments again unless it's a standalone assessment. In that case we would skip right ahead to the social isolation questions
Debra Wright: so coding instructions. We would code 0 or no if the interview should not be conducted, because the Resident is rarely or never understood or cannot respond verbally, and writing or using whatever method that they use, or an interpreter pointing the queue cards. If they're not able to do that again, we would skip to the staff assessment.
Debra Wright: or we would code one for yes, if the resident interview should be conducted, because the Resident is at least sometimes understood verbally in whatever method that they communicate.
Debra Wright: So here's here's the part that I still struggle and saying, it's no longer a Phq. 9. It's a Phq. 2 to 9.
Debra Wright: the rationale is. It's important to note that coding the presence of clinical signs and symptoms of depressed mood does not automatically mean that the Resident has a diagnosis of depression or other mood disorders, and we, as the assessors, cannot give a diagnosis of depression simply based on the outcome of the Phq. Score. Again. It's used to help
Debra Wright: guide the care plating process and how we're going to engage the Resident.
Debra Wright: So the
Debra Wright: where the Ph. Q. 2 to 9 comes in. They're now saying a lot of it depends on the first 2 questions. So the first 2 questions are little interest or pleasure in doing things and feeling down depressed or hopeless.
Debra Wright: So if we ask those first 2 questions and they're both coded as 9, no response.
Debra Wright: or if they're both coded, but the frequency is never one day or
Debra Wright: 2 to 6 days. That's where it would stop. So that's where the Ph. Q. 2 comes into place.
Debra Wright: If there's any other variations of that scoring, then we continue with the rest of the Phq.
Debra Wright: Going down to the night answering all the resident mood interview questions.
Debra Wright: So here's a screenshot of what the Phq. 2 to 9 looks like again, if they have a 9 in.
Debra Wright: D. 0 1 50, a column, one for one and 2,
Debra Wright: or I'm sorry for A and B. If it's
Debra Wright: a code of 9, the interview stops.
Debra Wright: or if they have a symptom presence for A and B. But then the symptom frequency
Debra Wright: is 0, or one we would stop the interview. Any other combination we continue with with see through I for that section
Debra Wright: again. This is the same repetitive statements. Again, that we're coding
Debra Wright: symptom presence. Know that they indicate the symptoms are not present.
Debra Wright: We would code one if they are present
Debra Wright: and code 9. If there's no response, then column 2 is the frequency never to one day, 2 to 6 days, 7 to 1112 to 14, and keeping in mind that this section is a 14 day. Look back.
Debra Wright: Okay? So I think they they clarified that more in each question by putting in in the during the past 2 weeks. Have you during the past 2 weeks, have you? So that we can remember that this is a 14 day. Look back.
Debra Wright: coding tips same thing again. We are to attempt the the interview with all residents. If both ZD. 0, 1, 50, a. One, and B one are coded as 9, then we would leave a 2 and blank
Debra Wright: and end the PHQ. 2,
Debra Wright: and then we would enter the the frequency.
Debra Wright: So example, I'm just gonna put the whole thing up because it kind of goes back and forth. So over the past 2 weeks, have you had trouble concentrating on things such as reading the newspaper or watching television. And the Resident says, television. I used to like watching the news, but I can't concentrate on that anymore.
Debra Wright: And then we would say something along the lines of In the past 2 weeks. How often have you been bothered by having difficulty concentrating on things like television? Would you say never? Or one day, 2 to 6 days, 7 to 11 days, or 12 to 14 days.
Debra Wright: and the Resident says I'd say every day, it bothers me every day. So in that case, then, we would code 0 1 50 g. One.
Debra Wright: For symptoms we would coded as yes, they. They said that they have had trouble concentrating, and then the frequency would be coded as 3, 12 to 14 days, because they said it bothers them every day.
Debra Wright: The severity score this this slide just I'm not going to read it. This slide breaks down. The total score for the Phq. 2 to 9 breaks down the different levels of depression based on their score.
Debra Wright: This is something again that you can work on your care. Planning processes communicate with the physicians if they've had a change from assessment to assessment with their level of depression. How's it gonna drive your care planning, how are you gonna involve activities and and engage the residents to have them more involved? In activities?
Debra Wright: Then we get to the new question, which is section d. 0, 700 social isolation. And again, social is social isolation is defined as referring to an actual or perceived lack of contact with other people, such as living alone or residing in a remote area.
Debra Wright: again goes back to that social engagement plan that makes them have meaning
Debra Wright: reduces their their feelings of social isolation. And just, you know, trying to enhance their quality of life by keeping them active
Debra Wright: again. This is a resident self reported item. So no other source should be used to identify the response. And it's simply asking the Resident, how often do you feel lonely or isolated from those around you. And again, this is the same. Answers as before. Never, rarely, sometimes, often, always.
Debra Wright: they decline to respond, or they're unable to respond.
Debra Wright: So an example of social isolation. The Resident, upon being admitted to the facility, is asked about how often they feel lonely or isolated from those around them.
Debra Wright: The Resident states that because they don't have very many families family members left who live close by, and they see their friends only a couple of times a month. They often feel isolated. They are hoping that being in the facility will help them feel less isolated and plan to attend activities regularly. So again, they're they're answering the question. They've actually, in their response in this example.
Debra Wright: said that they hope by being in the facility they can become more active in the activities program and not feel so lonely and isolated. So in this case, d. 0, 700 would be coded as 3 often
Debra Wright: based on their responses.
Debra Wright: behaviors. We have no coding changes in Section E
Debra Wright: activities prefer or section F preference for customary routine and activities. There's really no changes in this section. Either. They've just added and clarified some steps for the assessment, stating that there there could be times
Debra Wright: due to the residents. Medical behavioral conditions. A resident may have difficulty communicating and understanding, and and we have to be aware of that when we're conducting the interviews, and we need to use our own judgment when it's the best time to interview them. It it may not always be, you know. Okay, I come in at 7, 30 and 80'clock. I'm gonna go around and get all my assessments completed.
Debra Wright: It may not be the best time to interview every resident at 8 in the morning, so you're gonna have to use your judgment of when to to interview them. And they're saying all conscious residents should be interviewed. I guess that's just a clarification there.
Debra Wright: And the unlike the
Debra Wright: the mood, and the the bins, and the cognition with the interviews. This interview is a little bit differently where we're not basing it on whether the Resident is rarely or never stood. Every resident, if they're conscious, should be attempted to be interviewed for this section.
Debra Wright: If we've exhausted all avenues to interview them different times of the day, different people interviewing them. Then we could talk to the family or the significant other to find out what was important to them when they when they were in the community before they came to us.
Debra Wright: If there's no family member or significant other, then we would move on to the staff assessment for the their daily and activity preferences.
Debra Wright: So that was a lot for for those sections.
Debra Wright: If anybody has any questions. I will let Casey drive that a little bit, and like they said, next week. We will dive into Section Gigi. I know that's everyone's favorite
Debra Wright: favorite section. Kind of say that tongue in sheet there. So we will do. We'll spend a lot of time on section. Gg, so you just want to make sure you have the appropriate staff there for next week's.
Debra Wright: So do we have any questions at this time?
Kasey Stevens | Quality Insights: Not seen any questions roll in yet. Deb. But in the chat I am going to add a link for next Tuesday's Webinar, which is Mbs changes specific to Pennsylvania, and then next Wednesday's Webinar on Mbs changes for sections. GGH. And I. As you mentioned. We do have one question now, Deb. It is, did you go over section queue.
Debra Wright: No, that section queue will be
Debra Wright: probably addressed on August thirtieth, when we get to the end of the sections.
Kasey Stevens | Quality Insights: and just as a reminder, the link to the recording and the slides will be emailed out probably early tomorrow morning. So that way, if you have folks that couldn't attend our webinar today. They're still able to watch that and get caught up on all the section changes.
Debra Wright: And I do wanna thank you, Casey, cause. I actually forgot. I'm glad I asked you in the beginning to to do that. On next week, on August fifteenth, at 10'clock, we will be reviewing
Debra Wright: Pennsylvania, the Osa. The other state assessments, and how? How that's going to change. So that's really a time when your whole interdisciplinary team that's responsible for the Mds should be present. Because.
Debra Wright: you know, some people say I'm gonna use Section G as an example is like, Oh, good. We don't have to do Section G anymore. But for the Osa, there are sections of G that we are gonna have to do. So we're gonna listen to a recording that actually came right from the office of long term living
Debra Wright: Myers and Stuffer and hear right from them what we're gonna be required to do for that, Osa, so that we can continue to get payment, and then we'll open it up for an open QA. Session.
Kasey Stevens | Quality Insights: Fantastic. Thank you so much. Deb. I don't see any other questions rolling in but if you guys do have a question, don't hesitate to reach out you can also join us on
Kasey Stevens | Quality Insights: Tuesday and Thursdays at noon. We have virtual live chats, and Deb will be there to answer questions on quality, improvement, initiatives, infection control, and Mps quoting.
Kasey Stevens | Quality Insights: and you can find find links to those live chats in our webinar and in the newsletter we send out each Friday, called the last minute lowdown. Don't receive that. Feel free to reach out and be glad to get you on that mailing list.
Kasey Stevens | Quality Insights: and before we sign off today I would like everyone to answer a brief evaluation of today's webinar. The evaluation is anonymous, and it will show us a pop up as soon as the webinar ends. If you have a couple of minutes to fill that out, we're really greatly appreciate it. Deb. Thank you so much for joining us today, and thank you all for joining us. We hope you can join us again next week.
Debra Wright: Thank you.