MDS Alert

When is the right time to conduct MDS interviews? Should you conduct the resident interview on the day of the Assessment Reference Date (ARD), before the ARD, or after the ARD? The correct answer may surprise you.

 

Generally, you can conduct resident interviews within the look-back period, according to California Department of Public Health’s (CDPH) recent issue of CA MDS Nuggets. But make sure that the items captured in the MDS are included no later than 11:59 p.m. of the Assessment Reference Date (ARD) in item A2300.

 

This is commonly true for Speech, and Vision, Section C — Cognitive Patterns, Section D — Mood, Section F — Preferences for Customary Routine and Activities, Section J — Health Conditions, and Section Q — Participation in Assessment and Goal Setting. 

 

Look to These MDS Items for Specific Timing

 

Currently the only specific instructions noted in the RAI manual regarding the exact timing of any interview have to do with the PHQ-9 Mood Interview (Section D) and the pain interviews (Section J), says Joel VanEaton, BSN, RN, RAC-CT, MDS educator and director of clinical reimbursement for Care Centers Management Consulting Inc. in Johnson City, Tenn. For the PHQ-9 depression interview, the instructions on page D-4 indicate that the interviewer should: “Conduct the interview preferably the day before or day of the ARD.”

 

Similarly, regarding the pain interview, the RAI manual indicates on page J-7 that the look-back period for these items is five days, VanEaton notes. And because this item asks the resident to recall pain during the past five days, you should conduct this assessment close to the end of the five-day look-back period, preferably on the day before or the day of the ARD.

“Other than these specific instructions, the manual is silent as to the exact timing of interviews,” VanEaton states. But the RAI itself indicates that the look-back period for all items is seven days unless another timeframe is indicated. 

 

“Therefore, as to the appropriate timing of interviews, they all should be completed during the look-back period, specifically for the PHQ-9 and pain interviews preferably the day before or the day of the ARD and signed off as such in Section Z,” VanEaton instructs. 

 

Caveat: But there are certain limited circumstances in which “it may not be practicable to conduct the resident interview portions of the MDS (Sections C, D, F, J) on or prior to the ARD for a standalone unscheduled PPS assessment,” CDPH noted. “In such cases where the resident interviews (and not the staff assessment) are to be completed and the assessment is a standalone unscheduled assessment, providers may conduct the resident interview portions of that assessment up to two calendar days after the ARD.”

 

Consider Interview-Like MDS Items, Too

Also, keep in mind that aside from the obvious interviews in the MDS, such as the PHQ-9 and the Brief Interview for Mental Status (BIMS), there are many interview-type items as well, VanEaton reminds. “For example, hearing in Section B, observation for signs of delirium at the end of Section C, behaviors in Section E, balance during transitions and walking in Section G, and the oral exam in Section K.”

 

Remember that any MDS item requiring interactivity with the resident, family and/or staff “via conversation or observation should be considered an interview,” VanEaton points out. “That makes the entire RAI, in my opinion, one big interview.”