State and federal regulations supersede any information provided in this toolkit.

Transcription

1 DPA Associates, Inc Toolkit author: Diane Atchinson, RN-BC, MSN, ANP, RAC-CT President, DPA Associates, Inc, Kansas City, MO E mail: diane@dpaassociates.com Clinical editor: Kathy Newman, MSW, LSCW, Consultant Social Worker, Coffeyville, KS This competency toolkit is based on data as of 11/1/10. The goal of the toolkit is to provide education for any nursing home team member who completes the mandated interviews specifically the BIM s, PHQ 9, daily and activity preferences and the pain assessment. The VIVE video can be accessed any of the following ways: a) You tube or b) or c) the AANAC web site The CMS instructor powerpoint presentation referenced in the test question answers can be accessed by googling MDS 3.0 and pulling up the CMS training information. Additional training aides are also available on this site. Folders included in this tool: 1) MDS manual sections for A-310: Type of assessments A-2300 ARD A-1100 Language B-0700 Understood C (BIMS) D (PHQ9) F Daily and activity preferences J Pain Z 0400 Signatures Appendix E- MMSE and CPS Appendix F-MDS matrix-mds manual pages F1-23 Appendix D-Interview techniques Appendix H-MDS forms for each type of assessment 2) CMS Instructor slides for each of the above items 3) Competency information including a post test that is open book 4) Interview competency checklist 5) Test answer key and resources for answers 6) Additional MDS completion aides 7) Sample certificate of competency State and federal regulations supersede any information provided in this toolkit. Definitions from MDS 3.0, September, 2010, regarding MDS section completion: In general-unless your state has defined this process more strigenent than CMS: (page 1-6)

2 While nursing homes have flexibility in completion of the RAI, some aspects of the process are dictated by regulation. Federal regulations at 42 CFR (b)(1)(i-xviii), (g) and (h) require that (1) the assessment accurately reflects the resident s status; (2) a registered nurse conducts or coordinates each assessment with the appropriate participation of health professionals, and (3) the assessment process includes direct observation, as well as communication with the resident and direct care staff on all shifts. However, nursing homes are left to determine (1) who should participate in the assessment process, (2) how the assessment process is completed, and (3) how the assessment information is documented while remaining in compliance with the requirements of the federal regulation and the instructions contained within this manual. Providers in the state of Kansas should review the KDOA web site for Providers to review instructions for MDS 3.0 completion. It is highly recommended that each SNF/NF write a policy regarding interview competency. Statement should include that a competency will be prepared, signed and dated by a licensed professional. This competency will be based on the observation of two interviews in the staff member was found to follow the MDS 3.0 manual directions and passed the competency test(s) with a score of at least 80%.

3 COMPETENCY FOR COMPLETION OF SECTION C OF THE MDS 3.0 Brief Interview for Mental Status (BIMS) Step 1: Read Chapter 3 of the MDS 3.0 manual related to who can complete an interview (Section A-1100 and B-0700) and Section C (C0100-C0500) Step 2: Read Appendix D-Interview techniques Step 3: Complete a discussion with the MDS Coordinator that includes the following: A, What the assessment reference day (ARD) (A2300) means and the responsibilities that occur when completing a section of the MDS B. Signing and dating the MDS (Z0400) C. Communication of issues found with the interview D. What to do with the information collected-taking it to the care plan Step 4: Watch the VIVE video for both the interview techniques and BIMS Step 5: Perform 2 practice interviews with observation by the MDS Coordinator, Licensed Social Worker employed by the facility or Consultant Licensed Social Worker Step 6: Complete competency test at 80% or higher Step 7: Keep all documentation of competency completion in employee s personnel folder

4 Competency test for MDS section C-BIMS 1) BIMS stands for: a) Basic intelligence mental assessment b) Brief interview for mental status c) Brief assessment for mental status 2. An interview is attempted when all of the following are present except: a) Resident understands English b) Resident does not understand English but an interpreter is present c) Resident is rarely or never understood d) Resident is usually understood 3. BIMS assesses for all of the following except: a) Cognitive status b) Delirium c) Degree of cognitive loss d) Cause of the decline of cognitive loss 4. The BIMS questions were modified from which document a) AIMS b) DISCUS c) Mini Mental Status Exam (MMSE and CPS) 5. A summary score of 99 means the resident: a) Is alert and oriented b) Is severely demented c) Is mildly confused d) Was unable to complete the interview 6. You are able to give cues a) After the first attempt, if all three words were not repeated correctly b) With the first attempt c) Never d) both A and B

5 7. An inability to repeat the 3 words on the first attempt may indicate which of the following: a) Resident has hearing issues b) Resident does not understand the questions (language barrier) c) Resident is inattentive due to delirium or acute illness d) All of the above 8. All of the following are correct answers except a) Saying blue bird for blue b) Knee high sock for sock c) Twin bed for bed d) I m singing 9. An interview would not be conducted if which of the following were present: a) Resident communicates in a language other than English and an interpreter is not available b) Resident is rarely/never understood c) None of the above d) a and b 10. The BIMS cans be completed any time during the reference period. TRUE OR FALSE 11. The BIMS is attempted for all assessments, if appropriate, except for: a) Admission b) Quarterly c) Any Medicare assessment d) Unplanned or emergency discharges 12. Nonsensical answers are coded as: a) 1 b) 2 c) 0 d) none of the above

6 Competency for Section D Patient Health Questionnaire (PHQ 9) Step 1: Read Chapter 3 of the MDS 3.0 manual related to completion of sections D (0100-D0350); B (B0700) and A1100 (language) regarding who qualifies for an interview Step 2: Read Appendix D-Interview techniques Step 3: Read Appendix E-CPS and PHQ 9 Step 4: Complete a discussion with the MDS Coordinator that includes the following: A, What the Assessment Reference day means (ARD) (A2300) B. Signing and dating the MDS-how and when to do that C. Communication of issues found with the interview D. What to do with the information collected-taking it to the care plan Step 5: Watch the VIVE video Step 6: perform 2 practice interviews with observation by either the MDS Coordinator, Licensed social worker or Consultant Social Worker Step 7: Complete competency test at 80% or higher Step 8: Keep all documentation of competency completion in employee s personnel folder Competency test for PHQ 9 1. PHQ 9 stands for: a) 9 Item Patient Health Questionnaire b) 9 Item Personal Health Questionnaire c) 9 Item Psychological Health Questionnaire 2. PHQ 9 is a screen for a) Mental status b) Mood-depression c) ADL function d) Gait issues 3. Depression is often associated with which of the following: a) Psychosocial distress b) Physical symptoms c) Decreased participation in activities and therapy d) All of the above 4. An interview is attempted when all of the following are present except: a) Resident understands English b) Resident does not understand English but an interpreter is present c) Resident is rarely or never understood d) Resident is usually understood

7 5. It is recommended the PHQ 9 be completed: a) Any time during the look back period b) After the ARD date c) The day of or the day before the ARD date 6. Tips for completion of the PHQ 9 include: a) Read the item exactly as written b) Do not provide definitions c) Ask questions in sequence (presence/frequency) d) All of the above 7. A code of 9 is used for what type of answers a) Unrelated b) Incomprehensible c) Incoherent d) All of the above 8. Residents may respond to questions asked using all of the following except: a) Pointing to cue cards b) Asking for their spouses thoughts b) Verbally c) Writing out the answers 9. The Total Severity Score from the PHQ 9 notes the following: a) Type of depression b) Extent of depression c) Extent of cognitive loss 10. An interview is considered successfully completed when which of the following is present: a) Resident has answered 6 frequency questions b) Resident has answered 7 frequency questions c) Resident has answered 5 frequency questions d) Resident has answered all the questions 11. A summary code of 99 is given: a) Symptoms frequency is blank for 3 or more items b) Resident is crying c) Resident says he wants to harm himself

8 12. The score range for the PHQ 9 is A score of 27 would signify: a) Resident has no signs of depression b) Resident is severely depressed c) Resident s care plan should be reviewed for depression management d) b and c

9 Competency MDS 3.0 Section F-Daily Preferences Step 1: Read Chapter 3 of the MDS 3.0 manual related to completion of sections F (0300, 0400 and 0600); section A (A1100) and B (0700) Step 2: Read Appendix D-Interview techniques Step 3: Complete a discussion with the MDS Coordinator that includes the following: A, What the Assessment Reference day means (ARD) (A2300) B. Signing and dating the MDS-how and when to do that (Z0400) C. Communication of issues found with the interview D. What to do with the information collected-taking it to the care plan Step 4: Watch the VIVE video Step 5: perform 2 practice interviews with observation by either the MDS Coordinator, Licensed social worker or Consultant Social Worker Step 6: Complete competency test at 80% or higher Step 7: Keep all documentation of competency completion in employee s personnel folder Competency Test for Daily preferences 1. An interview can be attempted with all of the following except: a) Resident b) Family member c) Significant other that knows the resident well d) Staff 2. To conduct an interview all of the following must be present except: a) Resident or family must be able to understand English or an interpreter is present b) Resident must be able to be understood at (1/2 level in section B of the MDS) c) Resident or family have the ability to communicate via speech, pointing to cue cards or writing d) Resident must have a BIMS score of at least 2 3. A nonsensical response is: a) Unrelated to the question asked b) Incomprehensible c) Incoherent d) All of the above 4. You would stop the interview and go to staff observation if: a) The resident has given 3 nonsensical or has not responded to 3 of the questions b) The resident refuses to be interviewed after the first question c) The resident is crying

10 5. The interview should be conducted: a) After the ARD date b) Any time in the ARD look back period c) Day 10 of the resident s stay 6. Responses to the daily preferences should be: a) Used to plan daily care b) Reviewed at care plan meeting c) Discussed with the family, if appropriate d) All of the above 7. The goal of reviewing preferences is to: a) Collect research data b) Give the resident a voice c) Design facility activity programs d) Change staffing patterns 8. If the resident says that the question asked is important but can t do, or no choice, the facility should: a) Document the disability that has lead to his inability to do this activity b) Ask more in depth questions regarding his perception with a goal of working to make this activity happen for the resident c) This answer shows the possibility of a depression 9. The look back period for daily preferences is: a) 7 days b) 14 days c) no look back timeframe is set for these questions d) none of the above 10. A resident responds to the question How Important is It to You to Choose between a tub bath, bed bath or sponge bath and he says Very Important. You would code this question: a) 1 b) 2 c) 0 d) 3

11 11. A resident responds to the question How Important is It for You to Choose Your Own Bedtime? He answers I have to go to bed much earlier than usual because they get him up really early to go to therapy. You would code: a) 0 b) 1 c) 3 d) A code of 3 signifies that the question is: a) Very important b) Somewhat important c) Not very important

12 Competency for completion of Section F-Activity Preferences Step 1: Read Chapter 3 of the MDS 3.0 manual related to completion of section F ( ); Section A (1100) and B (0700) Step 2: Read Appendix D-Interview techniques Step 3: Complete a discussion with the MDS Coordinator that includes the following: A, What the Assessment Reference day means (ARD) (A2300) B. Signing and dating the MDS-how and when to do that (Z0400) C. Communication of issues found with the interview D. What to do with the information collected-taking it to the care plan Step 4: Watch the VIVE video Step 5: perform 2 practice interviews with observation by either the MDS Coordinator, Licensed social worker or Consultant Social Worker Step 6: Complete competency test at 80% or higher Step 7: Keep all documentation of competency completion in employee s personnel folder Competency test for Activity Preferences 1. Individualized resident activities should flow from their documented preferences. True or False 2. Activity preferences focus on: a) What they liked to do in the recent past b) What they like to do in the facility c) What they did for a living d) a and b 3. If a resident answers nonsensical to 3 questions you would: a) Skip to observation b) Code the answer as 0 c) Code the answer as 1 4. An activity interview is attempted for all of the following assessments except: a) Admission b) Significant change c) Annual d) Discharge 5. An interview can be attempted with all of the following except: a) Resident b) Family member c) Significant other that knows the resident well d) Staff

13 6. To conduct an interview all of the following must be present except: a) Resident or family must be able to understand English or an interpreter is present b) Resident must be able to be understood at (1/2 level in section B of the MDS) c) Resident or family have the ability to communicate via speech, pointing to cue cards or writing d) Resident must have a BIMS score of at least 2 7. A nonsensical response is: a) Unrelated to the question asked b) Incomprehensible c) Incoherent d) All of the above 8. The interview should be conducted: a) After the ARD date b) Any time in the ARD look back period c) Day 10 of the resident s stay 9. The goal of reviewing preferences is to: a) Collect research data b) Give the resident a voice c) Design facility activity programs d) Change staffing patterns 10. A code of 3 signifies that the question is: a) Very important b) Somewhat important c) Not very important 11. If 3 or more interview items are coded 9 or - you would: a) Complete the staff interview b) Skip to section F 600 c) Discuss this with your supervisor d) a and b 12. If a resident notes an answer as Not very important you would code it as: a) 0 b) 1 c) 2 d) 4

14 Competency for completion of MDS 3.0 Section J-Pain assessment Step 1: Read Chapter 3 of the MDS 3.0 manual related to completion of section J ( ); section A (1100) and section B (0700) Step 2: Read Appendix D-Interview techniques Step 3: Complete a discussion with the MDS Coordinator that includes the following: A, What the Assessment Reference day means (ARD) (A2300) B. Signing and dating the MDS-how and when to do that (Z0400) C. Communication of issues found with the interview D. What to do with the information collected-taking it to the care plan Step 4: Watch the VIVE video Step 5: perform 2 practice interviews with observation by the MDS Coordinator Step 6: Complete competency test at 80% or higher Step 7: Keep all documentation of competency completion in employee s personnel folder Competency Test for Pain Interview 1. The look back period for the pain interview questions are: a) 14 days b) 5 days c) 21 days d) past year 2. The following must be present for an interview to occur: a) Resident understands English or an interpreter is present b) Resident is understood (1/2 level) in section B of the MDS c) Resident does not have a dementia diagnosis d) a and b 3. The pain scales that could be used by the resident to describe his/herr pain on the MDS 3.0 are: a) Verbal description b) 0-10 c) Smiley faces d) a and b 4. Pain definition includes all except: a) Whatever the person says it is b) May be localized or diffuse c) May be acute or chronic d) Focus on addiction

15 5. A interview answer code of 9 indicates: a) Pain is present at that level b) No pain is present c) Refuses or chooses not to answer 6. If a resident does not understand the question it is OK to ask it a different way True or False 7. The pain interview is a screen for pain and should not substitute for an in-depth pain assessment. True or False 8. If a resident is unable to answer a question you would code the answer: a) 1 b) 99 c) 0 9. A pain interview provides a basis for: a) Further evaluation b) Treatment needs c) Response to treatment d) All of the above 10. You can use either scale noted in #9 for MDS coding. For the scale not used it is OK to put --- True or False 11. A pain interview is successfully completed if a) The resident reported no pain (J0300) b) The resident reported pain and the follow up question J0400 is answered c) All questions are answered d) a and b 12. A resident is getting routine pain medications and has used PRN s also and during the interview he notes moderate pain from a migraine headache. You would not code this pain due to the routine use of pain medications. True or false

16 INTERVIEW OBSERVATION Name of Interviewee Date: Name of Observer: Observer should also document the answers to the questions separately 1) Either in the residents room without a roommate present, private room with minimal interruptions or a quiet room 2) Tells the resident their name and title 3) Explains that the information collected will be used to provide the best care possible 4) Interviewer is sitting at resident s eye level within 3 feet of the resident (knees almost touching) 5) Amplifier if carried by the interviewer and is offered if the resident has a history of using a hearing aide, is hard of hearing or demonstrates signs of hearing issues such as inappropriate answers, eyes wandering from interviewer etc 6) Cue cards are used to assist with understanding answers 7) Interview follows MDS 3.0 directions 8 and 9) Use of good listening and IPR skills demonstrated such as: nodding head, asking for clarification, reflecting back data collected, offering support if needed 10) No cell phone or pagers went off during the interview (turned off when interview begun). If room entrance by other staff occurs, staff told to return. Interview sign could be placed on outside of door. 11) Observer codes own interview and compare answers to actual interviewer answers. Answers are within 5% of each other. 12) Appropriate exit discussion occurs Observation area 1) Private area provided 2) Interviewer introduced self to the resident 3) Interviewer explained the intent of the interview 4) Interviewer sat at resident eye level and at acceptable distance 5) Amplifier offered for those that are Correct Incorrect Comments Suggestions for correction

17 Observation area hearing impaired 6) Appropriate cue cards available to assist with consistent answers 7) Questions were asked as mandated by MDS 3.0 manual 8) Acceptance of answers were acknowledged 9) Appropriate listening and feedback skills used 10) Distractions were kept at a minimum 11) Comparison of interview answers were within 5% 12) Interviewer thanked the resident for their input when the interview was completed Correct Incorrect Comments Suggestions for correction