Kasey Stevens | Quality Insights: Alrighty. Good afternoon, everyone, and welcome to our series of webinars focused on bringing information about COVID-19 related topics. Information in these weekly webinars is geared towards long term care and skilled nursing facilities. But we encourage everyone who's interested to attend. My name is Casey Stevens, and I'm a communication specialist for quality insights. Today we'll be discussing the minimum data set. Mds changes are coming sections JKL. And M.
Kasey Stevens | Quality Insights: Everyone has entered the meeting on mute, but we will have a discussion following the presentation. You have questions or comments. Please submit them, either using the chat or the QA. Tool in your Zoom menu, you can also raise your hand and request to be unmuted to ask the question aloud. At the end of the presentation
Kasey Stevens | Quality Insights: we invite you to join us every Wednesday, 2 Pm. For more of our weekly webinars. Next week we'll be discussing the Mds. Changes and highlight sections in OP. And Q.
Kasey Stevens | Quality Insights: And now I'd like to introduce our guest today. Deborah Wright.
Kasey Stevens | Quality Insights: Deborah has a quality improvement specialist here with quality insights. She joined our team after being in the long term care industry for more than 30 years. There's a wealth of experience and long term care in nursing and management ranging from certified nursing assistant to Vice President of healthcare operations. She's most passionate when working with the Mds. Process and quality improvement. Deb. Thanks. So much for joining us today.
Debra Wright: Thanks, Kathy, I'm so used to saying, thanks, Kathy, thanks, Casey.
Debra Wright: Alright. So today, like Casey said, we're going to talk about sections. JKL. And M. So just a recap for those that may be new to
Debra Wright: these Webinar series. These are helpful links, as you're preparing for October first. Here's the link for the Mds forms and the Rei Manual. There's also a link to the Cms official Youtube channel, and on that channel they have a series of webinar trainings that or snippets of trainings of different sections of the Mds. So you can just go to their Youtube channel Google, which section you wanna look for
Debra Wright: Here's just some examples of the Mds sections. There's also a multitude of other trainings that Cms has available in that on that Youtube channel. They're globally. There's changes to the Mds. They've updated the language to be gender neutral. There's minor wording changes for better understanding. They've improved some of the coding examples to improve the clarity. They've changed all of their references from the key system to the I keys, and they made revisions pertaining to the legal information for families significant, other or proxy.
Debra Wright: There were changes made to the chapter guidance for 1, 2, and 4. We're not going to go over those during these webinar series. But just so, you're aware. So you can check those out. And then these are the sections that they either had revised data elements or revised guidance in Chapter 3.
Debra Wright: So, picking up where we left off, we're gonna start with Section J, the health conditions. The intent of this pretty much hasn't changed. It's just talking about the different health conditions that impact the residents, functional status and quality of life. It's where the pain assessment is as well as a number of other topics, such as their shortness of breath, their tobacco use, their conditions. Fall surgeries.
The one thing that has changed. Is the management of pain. And there's different areas that they're now looking at.
Debra Wright: Pain affect their sleep and their interference with their day to day activities. They've added pain interference with therapy, which we'll talk about.
Debra Wright: So to start off in Section J, they just added a couple of coding tips. There's not much change at all to Section J. 0 100 pain management. The big thing to remember. And I have to remind myself sometimes as well is that this is a 5 day. Look back. It's the only section that has that 5 day. Look back.
So did they resident receive scheduled pain, medication, prn medication, and any non medication intervention for pain.
Debra Wright: So some revised pain assessment, coding tips. Here's the pain interview, and we're gonna start off by saying, Have you had any pain or hurting in the last 5 days?
If they answer.
Debra Wright: if they answer No, we're gonna skip right ahead to the shortness of breath section. If they answer, yes, then we're gonna continue with the pain interview. So they were gonna still, ask, how much time have you experienced pain or hurting over the last 5 days. That question hasn't changed. But what has changed is the coding numbers and our responses.
Debra Wright: So you can see here that it's been renumbered. So one is now rarely or not at all. 2 is occasionally 3, frequently 4, almost constantly, and 9 unable to answer.
Debra Wright: Then we're gonna ask how much of the time has the pain made it hard for you to sleep at night? And again the the answers are the same. The coding was just revised. The so, instead of a yes or no, like it used to be. Does it make it hard for you to sleep at night. Yes or no. We're gonna have to dive a little bit deeper and ask the the
Debra Wright: 4 responses that we had up above the rarely, occasionally, frequently, or almost constantly.
Debra Wright: we're gonna do the same thing with jumping down to J, 0, 5, 30 our day to day activities again, instead of it being a yes or no. We're now asking, how much of the time does that interfere with your day to day activities?
Debra Wright: And then the new question that, they, they added, was, How much, how often has the pain limited your participation and rehabilitation therapy sessions?
Debra Wright: So the we've added a code of 0. Be in case the resident is not on therapy, so we would. Code 0 does not apply. I have not received rehabilitation therapy in the last 5 days. If they have received therapy, then we would. It would be the same codes, one through 8 that we have up above.
Debra Wright: and then the pain, intensity, the numeric rating scale, or the verbal description that has not changed at all. That's the same coding.
Debra Wright: So again, this is just a recap the pain assessment. We're gonna ask them the primary question, have they have pain? If they answer, yes, then we're gonna do the 6 follow up questions. Their frequency effect on sleep, interference with therapy activities, interference with day to day, and then their pain, intensity, either that numeric or verbal description.
Debra Wright: And then here is just the definition spelled out a little bit more. They're the same for all 3 sections. So the pain effect on sleep. We would code one rarely or not at all. If the resident responds that the pain has rarely or not at all made it hard for them to sleep over the 5 days
Debra Wright: occasionally same thing? Frequently, almost constantly, and then unable to answer. We would code this if the Resident is unable to answer the question, or they do not respond, or they give an completely nonsensical response to the question.
Debra Wright: The same thing is here with your therapy activities. With the exception of coding, 0 does not apply because they didn't participate in therapy during the past 5 days.
Debra Wright: and the same thing with your day to day. It's the same same definitions.
Debra Wright: If we have to go to the staff assessment, because the residents, unable to answer the primary question on the pain presence in in J. 0 300. Then we'll skip to the pain assessment, or the staff assessment for pain. And then there's no changes to that section. So the same same indicators of pain or possible pain. Have not changed at all from what we're doing now
Debra Wright: and then. For the rest of Section J. There were no coding changes to shortness of breath, tobacco use prognosis, their problem conditions, their fall, history, fall. Since the last admission or entry or prior assessment, no changes to the prior surgery or surgery requiring sniff care.
Debra Wright: So then, swallowing and nutritional status.
Debra Wright: the intent hasn't changed here. It's this section's intended to assess the conditions that affect the residents ability to maintain their adequate nutrition and hydration.
Debra Wright: There are no coding changes to swallowing disorder, height and weight, weight, loss and gain, or percent by artificial route. The only thing that I will point out, because I do see a lot of facilities missed this
Debra Wright: is that the height is supposed to be reassessed annually. So it doesn't mean annual to annual UN annual. It can be if you pick a certain month and every month. That's when you're gonna check the height, then. That you can use that as your annual height, but just make sure that that height is being reassessed at least annually.
So what has changed in Section K, so the changes?
Debra Wright: Really, the the questions and the coding have not changed. They've just expanded and added these 2 additional columns. So while we were always looking at parental and Iv feeding feeding tubes, mechanically altered diets and therapeutic diets, while not a resident, or while a resident. We now also are going to be looking at it on admission and at discharge, and that's defined as on admission days one through 3 of the sniff Pps stay.
Debra Wright: So if they're coming in and we're doing a 5 day. Mds, then that admission column is going to be opened up for us to do it at discharge. If it's an end of a Pps assessment, then the at discharge column will be lit up. Other than that we will still just be doing the while not a resident, or while a resident columns.
Debra Wright: So here's just the the definition spelled out a little bit. On admission again, is checking all nutritional approaches performed during the first 3 days of the Sniff Pps day.
Debra Wright: column 2. While not a resident will continue to look at that during the 7 day, look back, or
Debra Wright: prior to admission or entry or re-entry. This will also be opened up when we're completing an Ipa
Debra Wright: and then column 3, while a resident. Again, we're checking all that apply after admission or entry or re-entry, and within the 7 day look back, and if it's an admission. Mds, but not a sniff. Pps stay. Mds.
Debra Wright: Then K. 5, 20 d. Is not required, which is the therapeutic diet. We wouldn't be looking at that, and then at discharge, we would be coding them if they would check all that apply within the last 3 days of the Snp. Pps stay
Debra Wright: so again. Going back up here we have on admission, which will be opened up
Debra Wright: with your 5 day assessments. and then at discharge this column will be opened up if it's a sniff, pps stay ending
Debra Wright: coding tips that were added. They added, only feeding tubes that are used to deliver nutritional substances or hydration during the assessment are coded, and then the one thing that they did clarify is that we should not be coding if a mechanically altered diet is strictly being done during a trial period. So if
Debra Wright: only speech therapy is trying pureed food, then we would not code that as a mechanically altered diet, I've been trying to come up with examples of when this may be, and the only one that really comes to mind that they wouldn't already be mechanically altered is if they were getting to feed and speech. Therapy was working with them to increase their
Debra Wright: their po intake, and they were trialing mechanically altered diets. But other than that, II really couldn't in my own mind, couldn't come up with examples, because they would already be on mechanically altered diet of some sort. So
Debra Wright: section L. The changes there there are none. So we get a a little break with with no changes to section L,
Debra Wright: and then section M. We could spend a whole day talking about section M. It is something that all of us probably struggle with understanding the different
Debra Wright: terminology that all different nurses use.
Debra Wright: in having that that good assessment during our look back period. So the intent of Section M hasn't changed. It's to document, the risk, pressure, appearance, change of pressure, ulcers and injuries. To note any kinds of wounds or legions and the treatments that they're getting for for that
Debra Wright: Cms also did kind of put a little disclaimer in here that that they're aware of all the different terms that many different clinicians may use or documentation can reflect any of these terms. So while we may call it one thing, and if it doesn't exactly say a pressure ulcer.
Debra Wright: if the intent is, it is still related to pressure, no matter what the clinician calls it, or or our documentation calls it. It's still a pressure ulcer, and they give the example of. If there's a pressure stage to pressure injury, we're still Gonna code the Mds as a stage 2 pressure ulcer.
Debra Wright: because they just felt the need to to clarify that a little bit more.
Debra Wright: Then some changes in the coding tips that I think are gonna be some challenging for some of us to just be able to really go back and and look at all this, the first one they they just clarified the Kennedy terminal also. So skin changes at the end of life.
Debra Wright: or otherwise known as the Kennedy terminal ulcers or skin failure are not primarily caused by pressure. So if we can get that documentation, that that's what the the pressure injury is it? Th it's and it's not pressure. Then we would not code those in Section M. Now, if they're having a treatment, and we're putting some kind of lotion or dressing on it. Then yes, we would code those in Section M.
Debra Wright: But the ulcer itself would not be coded
Debra Wright: for each pressure. Also, we're gonna determine the deepest anatomical stage at admission. We're gonna code based on findings from the first skin assessment that is conducted on or after, or as close as to the admission as possible. So this was put in there because
Debra Wright: a lot of times, if facilities have actual wound nurses, or they have a wound care team that comes into the facility to do assessments of the these skin conditions.
Debra Wright: and maybe our nurses on admission. They're just coding what they see. They're not classifying it. They're not staging it. They're not determining the cause. They're just saying how much skin tissue is involved. And what does it measure? What does it look like? This is kind of getting us
Debra Wright: the clarification that we needed that said, okay as soon as possible. When we have that official skin assessment and we're calling it something, we can still say that that area was present on admission.
Debra Wright: we're still not gonna reverse or backstage. And we have to consider all of the historical levels of the tissue involvement.
Debra Wright: They also clarified that a previously closed pressure, also that opens again should be reported at its worst stage, unless it's currently presenting at a higher stage or unstageable. So if we had a stage 2 that closed and now it reopened. It's still gonna be a stage 2,
Debra Wright: the the part that that we really wanna look at and that's new. And they've given a lot of examples in the Rei Manual is, if a if a resident has a pressure ulcer injury that was documented on admission
Debra Wright: then closes and reopens at the same stage.
Debra Wright: We can code that as pressure officer injury as present on admission, so it was present on Admission Stage 2. It closes
Debra Wright: 9 months later it reopens at the same spot. As long as it's a stage 2 or lower.
Debra Wright: or reopens at the same stage of stage 2. We're we can code that as present on admission. Now, there's still some clarification. I think the last I heard that's coming out on this. If that stage 2
Debra Wright: goes to a stage 3. Then we would go to Stage 3, and it's no longer going to be considered present on admission, because now it's at a higher stage than what it was originally when it was present on admission.
Debra Wright: So II do believe the last I heard. There is still some
Debra Wright: clarifications coming out with all of that.
Debra Wright: So open it up for questions. The last slide. When you get the slides are again just the links to the Rei Manual, the the draft Rei manual because it's not been finalized yet. But the mds forms have been finalized. So you can click on that. And the the Youtube channel.
Debra Wright: Exactly. Thank you. We're gonna begin the QA. Portion here in a moment. If you have a question or comment, please submit it, using the chat or the QA. Tool in your Zoom menu.
Kasey Stevens | Quality Insights: You can also raise your hand and ask to be unmuted to ask your question aloud. Like to invite everyone to next week's webinar, where we will discuss the changes of the Mbs. And sections in OP. And Q. That will be next Wednesday at 2 Pm. And I'll drop a link to that in the chat soon. Here
Kasey Stevens | Quality Insights: we also invite you to bring your questions to a virtual live chat every Tuesday and Thursday at noon, Debra Wright will be there to answer your questions on topics such as quality, improvement, initiatives.
Kasey Stevens | Quality Insights: infection control, or Mds. Coding. You find the links to those live chats in our web and our webinars in the newsletter. We send out each Friday on the last minute, low down. If you would like to receive that letter. But don't and think, and you're not sure if you're on the mailing list or not, please email me at case, Stevens, at quality insights org. I'll get you on the list
Kasey Stevens | Quality Insights: all right. Let's see if there's any questions.
Debra Wright: And while you're looking at that, the one thing I didn't say in the beginning, Casey was know that I mean, we went through. These were some pretty big sections of the Mds. And the Rei Manual has pages upon pages of guidance. These webinars are strictly to make you aware of the changes
Debra Wright: not to go through the entire section. So it's just the changes that that we'll see once October first hits so that you can start looking at your processes and policies and procedures and training the staff that. Do those sections?
Kasey Stevens | Quality Insights: Alright? No questions at the moment. Oh, there we go!
Kasey Stevens | Quality Insights: Can you put the link to the Cms Youtube, Deb, do you care to show that resources slide one more time.
Debra Wright: know where to come. There it is.
Debra Wright: These will also be in the slides when you get the slides either later today or this week. So you'll have those
Kasey Stevens | Quality Insights: any other questions for us today.
Kasey Stevens | Quality Insights: alrighty, before we sign off. We'd like to ask everyone if you've got time to please complete a short evaluation of today's webinar. It is anonymous, and we'll show as a pop up as soon as the webinar ends. You have a couple of minutes to fill that out, we greatly appreciate it. Deb. Thank you so much for joining us today, and all of you. Thank you for joining us. We hope you can join us again next week. Have a great day.