MDS Alert

Scenario No. 1: "Mr. P. has advanced dementia and is unable to verbally communicate. A note in his medical record documents that he has been awake during the last night crying and rubbing his elbow. When you go to his room to interview the certified nurse aide (CNA) caring for him, you observe Mr. P. grimacing and clenching his teeth. The CNA reports that he has been moaning and said 'ouch' when she tried to move his arm."

Scenario No. 2: "Mrs. M. has end-stage Parkinson's disease and is unable to verbally communicate. There is no documentation of pain in her medical record during the 5-day look-back period. The CNAs caring for her report that on some mornings she moans and winces when her arms and legs are moved during morning care. During direct observation, you note that Mrs. M. cries and attempts to pull her hand away when the CNA tries to open the contracted hand to wash it."

Scenario No. 3: "Mrs. E. has been unable to verbally communicate following a massive cerebrovascular accident (CVA) several months ago and has a Stage 3 pressure ulcer. There is no documentation of pain in her medical record. The CNA who cares for her reports that she does not seem to have any pain. You observe the resident during her pressure ulcer dressing change. During the treatment, you observe groaning, facial grimaces, and a wrinkled forehead."

Scenario No. 4: "Mr. S. is in a persistent vegetative state following a traumatic brain injury. He is unable to verbally communicate. There is no documentation of pain in his medical record during the 5-day look-back period. The CNA reports that he appears comfortable whenever she cares for him. You observe the CNA providing morning care and transferring him from bed to chair. No pain indicators are observed at any time."

RAI Manual Coding Instructions:

Scenario No. 1: "Mr. M. is an 80-year old male with advance dementia. During the 5-day look-back period, Mr. M. was noted to be grimacing and verbalizing 'ouch' over the past 2 days when his right shoulder was moved."

Scenario No. 2: "Mrs. C. is a 78-year old female with a history of CVA with expressive aphasia and dementia. During the 5-day look-back period, the resident was noted on a daily basis to be rubbing her right knee and grimacing."

Source: Excerpted verbatim from the Long-Term Care Facility Resident Assessment Instrument User's Manual MDS 3.0, V1.08 (April 2012).

Coding Quizzer Answers:

Scenario No. 1: Mr. P. has demonstrated vocal complaints of pain (ouch), nonverbal sounds (crying and moaning), facial expression of pain (grimacing and clenched teeth), and protective body movements (rubbing his elbow), so items J0800Anonverbal sounds, item J0800B facial expressions, and J0800D protective body movements or postures would be checked.

Scenario No. 2: Mrs. M. has demonstrated nonverbal sounds (crying, moaning); facial expression of pain (wince), and protective body movements (attempt to withdraw), so items J0800Anonverbal sounds, J0800C facial expressions and J0800D protective body movements or postures would be checked.

Scenario No. 3: Mrs. E. has demonstrated nonverbal sounds (groaning) and facial expression of pain (wrinkled forehead and grimacing) so items J0800Anonverbal sounds and J0800C facial expressions would be checked.

Scenario No. 4: All steps for the assessment have been followed and no pain indicators for Mr. S. have been documented, reported or directly observed, so item J0800Z none of these signs observed or documented would be checked.