Often Section K on the MDS, associated CAAs, and care planning are relegated to the dietician to worry about. However, when we look at a comprehensive MDS, we can see that the information in Section K is only part of the resident’s nutritional story, and the dietitian (or any other IDT member who is coding Section K, developing the CAAs, and creating effective care plans) cannot be successful without input from multiple sources. When the data is collected from a variety of sources in the health record – including the resident or representative – the dietitian or other qualified clinician can accurately code the MDS, complete the CAA, and develop a plan of care that is resident centered and supports the resident’s health needs as well as his or her individual preferences. Because the information in section K often impacts reimbursement and quality measures, ensuring the required data is collected and captured during the correct lookback period is imperative.
Section K Breakdown
K0100 in the Resident Assessment Instrument (RAI), and the subset of data elements, examines the resident’s ability to chew and swallow safely. Sometimes the difficulties a resident experiences with chewing and swallowing are not apparent to the resident, but might be noted by the spouse or family, who can often relay the resident’s historical nutritional problems as well as their preferences and goals. Often problems in this area are first noted by the Certified Nursing Assistants and Certified Medication Aids who provide daily care and oral meds; these care givers can provide valuable insight about a resident’s status even before a qualified professional evaluation occurs. A Speech Language Pathologist’s evaluation of swallowing problems during evaluations can also be an integral part of developing an effective plan of care. All these avenues of information can provide valuable insight into problems like weight loss and delayed wound healing, as well as other health problems that might be related to nutrition.
K0200A directs us to record the resident’s most recent height since admit/entry, or re-entry into the facility. We are also instructed to obtain a new height annually. Moving to K0200B, the resident’s weight in the last 30 days is captured. From there, K0300 and K0310 require us to calculate possible significant weight loss or gain in the last 30 and 180 days. In the case of weight loss, we are to determine if the weight loss was prescribed by a provider such as physician/nurse practitioner/physician’s assistant.
The data items in K0520 capture dietary interventions that have been implemented to support the resident’s nutritional needs. These possible interventions include parenteral/IV feeding for nutrition/hydration, tube feeding, modification of texture of food/fluids, and therapeutic diets. In the case of parenteral/IV feeding for nutrition/hydration or tube feeding, we are further asked to calculate the average calorie intake and volume by these routes over the last 7 days, including the ARD in K0710.
Other Nutrition-Related MDS Sections
Other sections of the MDS provide more details about a resident’s needs for nutritional support. Section B provides insight into the resident’s hearing, speech, and vision, as well as their ability to communicate their needs and preferences. Sections C and D capture the resident’s cognition and mood, which may impact a resident’s awareness of and participation in their own health needs as well as their ability to make choices about their nutritional needs. The interview in Section F asks the resident about their preference to have snacks between meals, as well as their preference to participate in activities and be around other people; a deeper look into resident answers and preferences may uncover cultural, spiritual, and psychosocial nutritional components of a resident’s nutritional preferences.
Section GG1030A captures the resident’s ability to feed himself/herself; GG1030B captures how much assistance is needed with oral care. GG0170 captures the resident’s needs for assistance with mobility, which may include their ability to get positioned to eat or even get to/from the dining room. Section H captures constipation, which can be related to intake or have an impact on nutrition. Section I captures health diagnosis that impact the resident and could potentially require nutritional support during the look-back period as well as long-term. Section J captures problems such as pain, which may interfere with intake. Section J also captures health conditions such as terminal diagnosis and health problems that can indicate or lead to anemia and/or dehydration.
Section L looks at the resident’s dental status, including problems he or she may be experiencing with dentition and/or a dental appliance and problems such as tooth decay, sores, or masses within the oral cavity that can impact oral intake. Section M captures wounds and other skin issues that may require nutritional support to facilitate healing. Section N captures medications that can impact nutritional status in areas such as weight loss or gain, anemia/risk for bleeding, constipation/diarrhea, or kidney/liver dysfunction. Section O also captures treatments that can impact nutritional status. Section P captures alarm and restraint use, which may impact the resident’s ability or desire to participate in intake. Section Q reviews the resident’s preferences for discharge planning, which may require specialized nutritional education to facilitate a successful return to the community vs support for long term care. Many of the data points captured in these sections can impact reimbursement and quality measures.
Bringing It All Together
With the comprehensive assessment, CAAs that are triggered based on MDS responses often reflect resident’s strengths or needs that may have some impact on the resident’s nutritional status. After review of triggering data, the resident’s preferences and goals, and synthesis of the information that the CAAs bring together, the interdisciplinary team (IDT) can see how the various CAAs are often related and inter-linked for a resident, and how a resident’s strength or need for support in any area can have a unique impact on each resident’s nutritional status. From there, the IDT can develop effective care plans that support each residents’ preferences and health needs.
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- With almost every area of the MDS having or reflecting an impact on the resident’s nutritional status, it is easy to see that optimizing nutrition for every resident is an IDT project.
- Resident and representative input is needed to determine appropriate care plan goals as well as interventions to support nutrition.
- Timely and precise data collection supports accurate MDS coding, impacts quality measures, and can have a positive impact on reimbursement.
- Ensuring all information is captured timely in the health record, recorded correctly on the MDS, analyzed through the CAA process, and utilized to create an effective and appropriate plan of care for the resident is not just the dietitian’s responsibility – but that of the entire team.
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