As part of the interviews for MDS 3.0 Section F, the Activities or Social Services department will be asking residents "How important is it to you to have snacks available between meals?"  Check with the Dietary Manager to make sure there is a system in place to communicate this resident feedback to the dietary department.email or call the office 916-364-5300.  

  

 

There will be a global focus on resident interviews for data collection which will also impact the dietary Section K portion of the MDS. Dietary Managers and RDs will need to be familiar with the revised Section K, instructions for completion, coding changes and interview/observation requirements. Training seminars, webinars, in-services and in-depth disciplinary staff training has been ongoing all summer long. A brief overview of Section K changes and requirements are discussed here.
 
The initial/annual/Change of Condition now called Significant Change in Status (SCSA) and quarterly Section K of the MDS is now the same form. There is a new discharge MDS required which is abbreviated. There are 5 dietary data collection areas:
 
K0100 Swallow Disorder: The Dietary Manager will interview resident, family, caregivers, physician, and other disciplines as well as observe residents during food/fluid intake to determine if there are any of these signs/symptoms:

If there are interventions in place to address the problem such as thickened liquids, chin tuck, etc. and none of the symptoms are exhibited, then none of the above would be checked.
 
K0200 Height and Weight: Rounding is used to record height in inches and weight in pounds by rounding up if measurement is .5 or more, and rounding down if .4 or less.
 
K0300 Weight Loss: This area remains the same for 5% loss in one month or 10% loss in 6 months. It no longer includes weight gain, and has differentiated between weight loss on a physician prescribed weight loss regimen or not. The physician must document that the diet or other intervention such as exercise or diuretics to promote diuresis is intended for weight loss. Instructions for data collection include interviewing the resident, family, or significant other about weight loss over the past 30 and 180 days, consulting the physician and hospital transfer documentation and comparing with admission weight.
 
K0500 Nutritional Approaches: The nutritional problems section such as leaves 25% or more of meals uneaten on the previous MDS has been eliminated, and the nutritional approaches section has been reduced to only 4 areas: 

IV fluids given as a part of a procedure such as blood transfusion, outpatient surgery, dialysis, chemotherapy, diagnostic procedures or flushing purposes are not coded here.

Tube feedings are not coded as mechanically altered diets, but will be coded as therapeutic diets if the formula is used to treat a medical condition such as diabetes, COPD, kidney or liver failure, and wound healing. Enteral feeding formulas such as Glytrol, Pulmocare, Nepro, and Impact would be coded as therapeutic diets. Nutritional supplements served with meals are also considered therapeutic diets.
 
K0700 Percent Intake by Artificial Route:  This area continues to be in 2 parts to identify calorie and fluid intake. The RD's help will often be needed to calculate calorie and fluid intake for this section, especially when a resident is on both p.o. diet and tube feeding or parenteral feeding.
 
A. Proportion of total calories the resident received through parenteral or tube feeding:
   1. 25% or less
   2. 26-50%
   3. 51% or more
B. Average fluid intake per day by IV or tube feeding: to be coded only if resident uses it for nutrition or hydration, not IV medications and IV flush. Include all tube feeding formula volume and tube feeding water flush in these calculations.
1. 500 cc/day or less
2. 501cc/day or more

Consult with the Speech Therapist at your facilities and request in-services with the Dietary Manager to help identify the signs/symptoms of swallowing problems. Ask the Speech Therapist if you and the Dietary Manager could observe a treatment with a resident, or observe a resident at a meal with the Speech Therapist. Help the Dietary Manager practice calculating weight changes to be able to correctly code for significant weight loss. Ask the MDS Coordinator if you can review the RAI (Resident Assessment Instrument) Manual for Section K, and make sure the Dietary Manager has a copy of this section of the manual for reference. Review the MDS in the resident's charts when you are documenting to check for accuracy of calculations and coding and assist the facility with completion or corrections as needed.