RAI-MDS 2.0 Nutritional Care Resource Guide April 2011 - CCIM

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Sample RAPs Documentation - Essential Competencies forDietetic PracticeTriggered RAPs are generated by computer software and summarized in Section V. A summary of RAI-MDS 2.0 items (triggers) for each triggered RAP isalso available for the nutrition care team’s review to ensure coding accuracy (see reference in RAI-MDS 2.0 User’s Manual).'Non-triggered clinical problems' are identified by reviewing the completed RAI-MDS 2.0 assessment. Some examples of non-triggered clinical problems are:- intake from one of the food groups restricted - BMI over 29 or less than 19 - swallowing problem- food related allergies or intolerances - abnormal lab values - drug nutrient interactions affecting intake- physical signs of malnutrition - low body weight - unstable dysphagiaOther examples of non-triggered clinical problems related to dining are: the ability to make choices in the dining room, suitability of tablemates, diningbehaviours and positioningRAP Process Step 1Type of RAPReference to EssentialCompetencies for DieteticPracticeStep 2Nature of theproblemAdmission:17.2, 17.3, 17.4, 17.5, 17.7, 17.8Quarterly adjusted or combined:17.2, 17.5, 17.7, 17.8Step 3Key issuesandanalysisStep 4NeedforreferralStep 5Rational forcareplanningAdmission: 17.1, 17.3, 17.4, 17.5,17.6, 17.7, 17.9, 17.10, 17.11Quarterly (adjusted or combined):17.1, 17.4, 17.5, 17.6, 17.7, 17.8,17.9, 17.10, 17.11Quarterly (existing): 17.1, 17.6, 17.7,17.8, 18.11Care PlanInterventions18.1Newinterventionsare updatedin the plan ofcare asrequiredProgress Note ChartingIncidental charting of residentprogress and evaluation ofintervention effectivenessQuarterly: Evaluation of care planinterventions effectiveness inprogress noteApplication of the RAP process including RAP assessment summary documentation and the plan of care is illustrated in the following example ofMrs. K.For Information: 416.327.7625 24ltchrai@ontario.ca2424
RAPProcessLeaves25% ormore fooduneaten atmost mealsApril 30/08Step 1Type ofRAPStep 2Nature of the problemNew admission RAP. Mrs. K is alert,cooperative and friendly. She seemsto understand English, followsinstructions well, but speaks onlybroken or one word English. The nextof kin, Mrs. K’s son was contacted byphone on April 30. He visits themother most evenings after work. Heinformed writer that his motherunderstands English, but does notspeak it very well.During meal observation, it was notedthat she chews very slowly, picks ather food and has been consistentlyleaving 25% or more food uneaten ateach meal (see Food and Fluid intakerecords May 1-5th). Her denturesappear to be loose and making noisewhen she chews. Most meals, sheadds both salt and pepper to her foodand does not seem to be interested inher food. It was reported by nursingstaff that during family and friends’visits, Mrs. K ate homemade Koreanfood. She ate all of it and enjoyed herown cultural food.Weight is 49.9kg and no recent weightlosses noted by son.Step 3Key issues andanalysisStep 4Need forreferralStep 5Rational forcare planningMrs. K told her son that she does not like thefood in the home. It is too plain; she is used tospicy food with more varieties. The son issuggesting bringing in some Korean condimentsfor his mother to add to her food.The son also notices his mother’s loose dentureand is trying to set up an appointment for her tovisit the dentist. Mrs. K prefers smaller portionsize. She also likes green tea with all meals andsnacks. This is not presently available on menu.Referral to dentist will be made by son related toMrs. K’s loose denture.Care plan will be developed to improvenutritional intake.Care Plan Interventions• Label Mrs. K’scondiments and havethem available for her touse during all meals.• Monitor Mrs. K’s foodintake and record herintake for the next 7days; if improved, noaccurate intake required• Follow up with the sonregarding the dentistappointment• Have the menu availablefor the son to select withhis mother during visitand forward to nutritionmanager.• Instruct the son to recordthe homemade foodintake that the motherconsumes for the next 7days• Source appropriate greentea for meals and snacks• Instruct front line servingstaff to refer to selectedmenuProgress Note ChartingMay 12, 2008Mrs. K’s appetite seems toimprove with the newcondiments. For the past 7days, she ate most of herfood during all meals. Herson brought additionalpreserved vegetables thatare kept on the unit fridgefor Mrs. K. to use. Shegoes to the fridgeindependently and obtainsher condiments duringmealtime. She is still eatingvery slowly contributed bythe loose dentures. Theappointment is set for May31.For Information: 416.327.7625 25ltchrai@ontario.ca2525
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RAI-MDS 2.0 Nutritional Care Resour
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Table of Contents1. Chapter 1: RAI-
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Glossary of TermsADLAlgorithmAverag
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RAI-MDS 2.0 Target population:Frail
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SECTION F: PSYCHOSOCIAL WELL-BEINGI
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SECTION P: SPECIAL TREATMENTS AND P
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SECTION V - RESIDENT ASSESSMENT PRO
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OUTCOME SCALES OR MEASURES• 10 ou
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Getting Started ChecklistCompletion
Page 19 and 20:
Selected Coding Sections of RAI-MDS
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WEIGHT CHANGE CALCULATION EXAMPLE:C
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EXAMPLE:Step 1: Calculate Total Cal
Page 25 and 26: Examples include wheat-free diet to
Page 27 and 28: Overview of Assessment TimelinesOBS
Page 29 and 30: 2. QUARTERLY ASSESSMENT TIMELINEThe
Page 31 and 32: TIMELINE FOR SIGNIFICANT CHANGE IN
Page 33 and 34: RAI-MDS 2.0 Nutrition Assessment Pr
Page 35 and 36: Day 0 First Day of New Admission On
Page 37 and 38: RAI-MDS 2.0 Nutrition Quarterly, Si
Page 39 and 40: Preparing to Code ChecklistThe foll
Page 41 and 42: Recommended Tools (Optional)Admissi
Page 43 and 44: Sensory Deficit Affecting Nutrition
Page 45 and 46: Admission Nutrition Assessment Work
Page 47 and 48: Essential Nutritional Assessment Ar
Page 49 and 50: Nutrition/Hydration Risk Identifica
Page 51 and 52: Assessing Nutrition / Hydration Ris
Page 53 and 54: CHAPTER 3: Resident Assessment Prot
Page 55 and 56: TRIGGERED RAPS IN THE RAI-MDS 2.0 R
Page 57 and 58: TRIGGERED RAP OR NON-TRIGGERED CLIN
Page 59 and 60: What have you read to support evide
Page 61 and 62: NO EXISTING RAP TRIGGEREDIf existin
Page 63 and 64: RAP IMPLEMENTATION STRATEGIES Compl
Page 65 and 66: NEW ADMISSION RAP AND CARE PLAN TIM
Page 67 and 68: M axim um 7 days M aximum 7 days Ma
Page 69 and 70: RAPS and Care Planning Software Ori
Page 71 and 72: The College of Dietitians of Ontari
Page 73 and 74: 8 Documentation by the dietitian in
Page 75: 17.10 Draws relevant conclusions fr
Page 79 and 80: RAP Process Step 1Type of RAPLeaves
Page 81 and 82: Dietitian ReferralDietitian Referra
Page 83 and 84: 13. Dental Care14. Pressure UlcersD
Page 85 and 86: New triggered RAPs affecting nutrit
Page 87 and 88: Criteria to Review4. Evidence of RA
Page 89 and 90: OverviewOVERVIEW• Getting started
Page 91 and 92: MoodWorsened mood - symptoms of dep
Page 93 and 94: 15. Prevalence of depression withou
Page 95 and 96: • E1l - Sad, pained worried facia
Page 97 and 98: AGGRESSIVE BEHAVIOUR SCALE (ABS)•
Page 99 and 100: • Hemiplegia, pneumonia, septicem
Page 101 and 102: Preparing for RAI-MDS 2.0 Outputs a
Page 103 and 104: Application of RAI-MDS 2.0 Reports
Page 105 and 106: Case Study ApplicationThe Quality I
Page 107 and 108: Domain # Quality Indicators - Unit
Page 109 and 110: Domain # Quality Indicators - Unit
Page 111 and 112: 4-35Domain # Quality Indicators - U
Page 113 and 114: InterRAI RAI-MDS 2.0 Quality Indica
Page 115 and 116: For Information: 416.327.7625 28ltc
Page 121 and 122: Strategies for Achieving RAI-MDS 2.
Page 123 and 124: RAI-MDS 2.0 Quality Improvement Too
Page 125 and 126: Comments:Part C: Use of Data for De
Page 127:
Literature: Recommended Articles1.
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RAI-MDS 2.0 Nutritional Care Resource Guide April 2011 - CCIM

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