MDS Alert
To Code or Not to Code E4e if a Resident Refuses Care
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The answer hinges on this key consideration. Question: Should you code E4e that a resident is resisting care if he refuses a statin prescribed for high cholesterol and becomes hostile with staff when they try to convince him to take the medication? Answer: E4e (Resists Care - Resists taking medications/injections, ADL assistance or help with eating) doesn't include a situation where the resident "has made an informed choice not to follow a course of care (that is, the, resident has exercised his or her right to refuse treatment, and reacts negatively as staff try to reinstitute treatment)," states the RAI User's Manual. Thus, you have to consider whether the resident is making an informed decision to not comply with the plan of care. "If the resident is making an informed decision, you woudn't code this item," says Jennifer Gross, RN, BSN, a healthcare specialist with PointRight Inc. in Lexington, Mass.
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