The Perspective of a Registered Nurse Assessment Coordinator (RNAC)
by Bernadine Grist, RN, BSN
One might think that all an RNAC would have to accomplish is setting dates for required Minimum Data Set (MDS) Assessments; however, much more is required. Setting assessment dates becomes complicated when Medicare is added to the mix. There are additional assessments to track: admission 5-day, 14-day, 30-day, 60-day, 90-day and first Quarterly. Residents covered by Medicare must require 24-hour skilled nursing care or skilled rehabilitation therapy. However, therapy does not have to be involved to keep residents covered by Medicare if the person has appropriate skilled nursing needs. For residents that require long term care and do not meet the criteria for skilled services, an Admission assessment date is set, and this is followed by a Quarterly. Generally, there are three Quarterly assessments and an Annual comprehensive assessment completed in a 12-month period.
An RNAC monitors the facility’s daily reports for changes in residents’ conditions. If there are changes, the residents may
be monitored for two weeks. If the change is not resolved in that time frame, a significant change MDS is indicated. This resets the calendar of assessments for this resident. The best way to keep track of dates for each individual resident is to have a tickler file set up, which is an index card for each resident that lists the admission date, followed by Admission ARD (assessment reference date). Then the date for each Quarterly is documented, as well as a significant change assessment if that occurs. Even though most calendars are set by the computer, it is wise to keep the tickler file just in case of a computer shutdown.
The RNAC must have a good work ethic, not miss time from work, and be able to work well with others. There is a team that completes the MDS, and it includes the MDS nurse and individuals from activities, dietary, nursing, social services, and therapy. Another facet of information for the MDS completion comes from the resident and the resident’s family and must be considered in completing the MDS. Also, each team member must be kept up to date with all new MDS-related changes released by CMS. This task usually falls upon the RNAC to keep abreast of the changes and educate the team members.
Documentation by team members is a must for accurate completion of the MDS. Required documentation from the CNA includes the tasks of ADL’s, bathing, toileting, and behavior monitoring during the look-back period. Each component of the MDS requires backup documentation. This is mostly completed in Point Click Care (PCC) or another similar program that is used by the facility staff. Progress notes from nursing, the physician, and activity, dietary, social service, and therapy staff are utilized. Additionally, there are skin assessments, Braden assessments for pressure ulcer risks, and clinical, fall, and pain assessments. Lab results are reviewed, behavior assessments for documented behaviors, and use of psychotropic drugs that must be documented. Medications monitored include antidepressants, antianxiety, hypnotic, and all psychotropic drugs. Also, for consideration is a new criterion for monitoring infections, UTIs, and respiratory conditions such as pneumonia known as the McGeer criteria for Long Term Care settings. Details must be known to properly code the MDS.
Everyone working in the long-term care facility is considered part of the team, and the information obtained for the MDS must be completed within the right time frame and must be accurate. The RNAC assumes the responsibility for coordinating and completing the MDS and submission process. This goes far beyond the setting of MDS completion dates. The RNAC performs this wide range of data gathering in order to present an accurate picture of each resident for submission that drives the facility’s payment structure and the results in public reporting on Nursing Home Compare. Does the RNAC have a challenging job? From my perspective, the answer is YES.
