D0500I1: PHQ Staff Mood Interview - Thoughts Better Off Dead: Presence, Step-by-Step

Step-by-Step Coding Guide for D0500I1: PHQ Staff Mood Interview – "Thoughts Better Off Dead: Presence"

1. Review of Medical Records

Objective: Identify if the staff has observed or reported that the resident has expressed thoughts about being better off dead or has made statements about self-harm during the past two weeks.

Actions:

• Conduct interviews with staff across all shifts who interact with the resident.
• Review documented observations in the medical records or notes regarding the resident’s mood, particularly any mention of suicidal ideation or statements reflecting a desire to harm oneself.

2. Understanding Definitions

D0500I1: Thoughts Better Off Dead – Presence assesses whether staff have observed or reported that the resident has expressed thoughts that life isn’t worth living, wishes for death, or has attempted to harm themselves in some way.

Example Scenario:

• Resident A: A staff member reports that the resident has said, "I just wish God would take me already." This would be coded as 1: Yes.

3. Coding Instructions

Step-by-Step:

• Step 1: Ask staff if the resident has expressed thoughts that life isn’t worth living or has made statements related to self-harm.
• Step 2: Based on the staff's report, select the appropriate code:
  • 0: No – No such thoughts or expressions were reported by the staff.
  • 1: Yes – The resident has expressed such thoughts or statements.
• Step 3: For a "Yes" response, proceed to ask about the frequency of these thoughts (D0500I2).

4. Coding Tips

• Clear Documentation: Ensure that staff observations are clearly documented, and statements from the resident are directly quoted when possible.
• No Assumptions: Base the coding on staff reports rather than assumptions or unverified information.

5. Documentation

Objective: Accurately document the presence of thoughts related to being better off dead or self-harm as observed by staff, to ensure proper follow-up and intervention if necessary.

Actions:

• Document the exact statements made by the resident and reported by the staff.
• Ensure this information is communicated to the interdisciplinary team for appropriate care planning and intervention.

6. Common Errors to Avoid

• Overlooking Reports: Ensure that staff are interviewed from all shifts to capture any observations related to the resident’s mental state.
• Incomplete Documentation: Failing to document specific instances or statements can lead to underreporting of critical mental health issues.

7. Practical Application

Example 1:
A staff member reports hearing the resident say, "I don’t want to live like this anymore." This should be coded as 1: Yes for D0500I1.

Example 2:
Staff from all shifts report that the resident has not expressed any statements about self-harm or wishing for death. This should be coded as 0: No.

Please note that the information provided in this guide for MDS 3.0 Item set D0500I1 was originally based on the CMS's RAI Version 3.0 Manual, October 2023 edition. Every effort will be made to update it to the most current version. The MDS 3.0 Manual is typically updated every October. If there are no changes to the Item Set, there will be no changes to this guide. This guidance is intended to assist healthcare professionals, particularly new nurses or MDS coordinators, in understanding and applying the correct coding procedures for this specific item within MDS 3.0.  

The guide is not a substitute for professional judgment or the facility’s policies. It is crucial to stay updated with any changes or updates in the MDS 3.0 manual or relevant CMS regulations. The guide does not cover all potential scenarios and should not be used as a sole resource for MDS 3.0 coding.  

Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice. Users are responsible for ensuring compliance with all applicable laws and regulations in their respective practices.