It’s called the interdisciplinary team for a reason: because everyone is on the same team.
But it doesn’t always feel that way.
Every staff member in every long-term care facility has the same primary goal in mind: providing the best possible care to each and every resident. But still, each department has its own unique tasks to complete, deadlines to meet, and processes to help its staff get there. And those daily duties don’t always perfectly align with your MDS deadlines. Before you know it, the MDS has fallen off the staff radar, and you’re pressing up against your deadlines.
Meanwhile, if anyone’s section isn’t completed, you, the NAC, are the one in the hot seat, since you are the primary owner of the MDS process. Now someone else’s task has become your responsibility, and you have to chase So-and-So down and find a way to communicate just how imperative it is that his MDS section gets completed by such-and-such date . . . all without butting heads.
There’s just too much on everyone’s plate to go adding in workplace conflict.
Which begs the question, how exactly do you go about navigating these potentially sticky situations, where you rely on others in order to get your own work done, without creating a hostile working environment?
Here are three of the most common issues you may be running into with the IDT, and solutions to help you handle them peacefully:
Problem 1: The MDS isn’t a priority for the IDT staff
The IDT has its own primary tasks that team members need to complete. And to them, those tasks very often (if not always) take precedence over the MDS.
For example, the dietary manager may be assigned to complete the dietary portions of the MDS, but she may have to cook, she may have to plan the menus, she may have to go out and talk to a new resident about his dietary preferences.
And some of those tasks may well need to be prioritized higher than the MDS. But that doesn’t mean the MDS isn’t a priority. That manager still needs to complete her MDS sections by the deadline.
But since you, the NAC, are the MDS process owner, you are still in charge of ensuring that each section is completed by its deadlines by those to whom it is delegated. Because if it’s not completed, this reflects on you more than anyone else.
Solution: Establish common goals
To solve this problem, Jessie McGill, RN, RAC-MT, and one of AANAC’s curriculum development coordinators, suggests establishing common MDS goals among the IDT members. The RAI process is not just a requirement; it also has direct value to every member of the IDT. Show team members how they benefit from this process and they’ll be more likely to prioritize it.
One example she gives is with care area assessments and care planning, which often involve multiple departments.
Let’s say you have a resident with a skin issue who also has poor dietary intake. The diet needs to be enhanced to help with the skin problems. The resident also suffers from depression, so social services staff need to become involved.
“The RAI process is intended to establish the base for the care plan. Working together as a team to work on the CAA notes and the care plan can really help to provide a better picture of the resident and more person-centered care,” says McGill. “When we work in long-term care, we're here to take care of the residents. The RAI process is a regulatory requirement, but it's also how we determine the residents' needs are being met.”
And that’s everyone’s primary goal, after all.
Problem 2: The IDT doesn’t fully understand the various deadlines involved in the RAI process
Multiple departments are usually involved with completing the MDS scripted interviews. Those interviews must be completed on or before the ARD. The different team members may also have supporting assessments, which will be used as supporting documentation for the MDS. This means that those documents also need to be completed on or before the ARD and within the look-back period.
Then there's a deadline for MDS coding. When does each department need to have its actual MDS sections coded and signed for at Z0400?
And as if that’s not enough, there's also the completion of the care area assessments, as well as a separate deadline for the completion of the care plans.
For most of the assessments, you have 14 days after your ARD to complete your MDS and CAA notes, and then another 7 days from that completion date for your care plan.
There are different completion rules when it comes to your admission assessments, significant change assessments, and significant correction assessments.
And the NAC, being responsible for ensuring completion of the entire MDS process, may have more strict timelines for the IDT.
“The NAC has to have the time to validate that everybody else's areas are done before he or she signs the completion of the MDS at Z0500,” says McGill. “Many of the IDT members know that the MDS and CAA notes do not have to be completed until day 14 after admission. However, if they push completing their sections out until day 14, it means that the NAC has a very tight deadline to actually certify the completion of the MDS and is just waiting for those team members to complete their sections, which is not an efficient workflow.”
Solution: MDS education
Provide education to the IDT about the hard-and-fast deadlines by which they need to abide. Explain to them the workflow and why it cannot be pushed to day 14 after admission. And don’t just explain each team member’s own individual deadline; go over every deadline and the entire workflow, so they can see how the deadlines correspond so that everything is completed within the required time frame.
Explain to them, too, that their MDS sections don’t need to exist in a vacuum. For instance, social services staff can use their other required assessments to assist with coding the MDS, so that these are not two separate tasks to be completed independently but rather two areas that work together in a streamlined workflow.
“The non-MDS assessments, required documentation, and MDS can be used to complement one another so that the team members don't feel like they're completing two different tasks, but truly understand how they can tie them together to make their job easier throughout that entire process,” says McGill.
As for what the education should include, there should be some basic MDS training. Each of the team members should know exactly what is in the RAI manual for the sections they are required to complete, as well as any supplemental information from other chapters or appendixes that they may also need to reference.
There also needs to be the basic education about what assessments are required for different purposes. Which residents should they expect to follow the Medicare PPS schedule and which residents will just have the regular OBRA schedule?
The education should also include an overview of the penalties of missing deadlines, so that the IDT has a better understanding of why meeting them is so crucial.
“If we are out of compliance with any of the deadlines—if we're late on interviews, if we have late MDS completion, if we're late on CAA notes, if we're late on care plans—those can all result in survey tags, especially if it's a trend,” says McGill.
Problem 3: Lack of backup systems
In any company anywhere, an individual employee cannot be the only person on staff who understands how to complete his or her required tasks. It’s impractical at best, and dangerous at worst. What if you have a sick day, or need to take a leave of absence? Someone else needs to be able to take on your duties while you’re away.
And that’s just as true for the MDS as it is for any other task.
Unfortunately, all too often, this task falls back on the NAC.
“In many facilities, the NAC is the backup to all departments. With the overwhelming workload already assigned to the NAC, this may not be an efficient backup system,” says McGill.
It's important for your facility leaders to look at all the different departments that will be completing the MDS—activities, social services, dietary, nursing, therapy, and anyone else involved in the process. Who completes the tasks when any of the IDT members are absent?
Sometimes an absence is easy to plan around, like when someone is taking a vacation with plenty of advance notice. Other times, though, it’s out of the blue. A staff member is unexpectedly hospitalized and must be out for several days. Or a staff member has a family emergency and needs to be out for a time. Or maybe no one is out, but there is an overwhelming influx of assessment caseload, and it’s too much for one person to complete everything on time.
Who's that backup person who's been trained to complete that system?
Without backup systems, a number of problems can occur: MDS sections are late because no one realizes there’s no backup system until the deadline has already been missed. Or if the NAC has to take on the task, she may not be able to properly complete her own workload.
“That can cause stress and resentment. That’s why it’s important to have that system in place so that whoever has been assigned to be backup has been trained and knows how to complete the job,” says McGill.
Communication doesn’t work like a game of Telephone, where you tell one person something and hope the message gets passed along. Because you can’t be certain that it will. Rather, there needs to be a process of communication where all team members are aware of not just their singular roles but the entire workflow—both the primary staff member in charge and whoever is assigned as backup.
“You're communicating the deadlines of the MDS, the new admissions, the discharges, the unexpected OMRA Medicare assessments. That communication has to be very strong among all team members involved. If you're not here, who's going to do your job?” says McGill. “The NAC needs to communicate to the administrator, to the team members, how are we going to get this done? How can we prioritize? How can we work together to keep the workflow on task, to keep everybody aware of what assessments are due, when the interviews need to be done, what the completion dates are for each assessment, so that process and that workflow are well communicated to the multiple team members involved?”
Bonus solution: Understand and respect people’s time
This isn’t a solution to a particular problem, but rather something to bear in mind consistently as you navigate workplace relationships.
Every staff member has a heavy workload and is often pressed for time. It’s easy to fall into social banter with your co-workers—and you should, to a degree. These are people you see every day. These are your comrades in the trenches. These are your partners in care. It’s important to establish good relationships. But it’s also important to find a balance between workplace socializing and respect for everyone’s busy schedule. So be aware, says McGill, and be good stewards of each other’s time.
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