MDS Alert

Documentation Tip:

Make Sure Surveyors Can Figure Out Who's Who

Does your facility use a signature sheet for the medication administration record (MAR) where nurses sign next to their initials?
 
If so, don't forget to put the sheets in the resident's medical record when you close it out, advises Peggy Voitik, RN, LNHA, president of VP Circle of Quality Inc. in Minonk, IL. Ditto for CNA signature sheets that accompany flow sheets or other care records. "Otherwise, surveyors doing closed-record reviews won't know the identity of the nursing staff providing care," Voitik cautions.