D0500I2: PHQ Staff Assessment - Thoughts Better Off Dead: Frequency, Step-by-Step

Step-by-Step Coding Guide for D0500I2: PHQ Staff Interview – "Thoughts Better Off Dead: Frequency"

1. Review of Medical Records

Objective: Assess how often the staff observed or reported that the resident expressed thoughts of being better off dead or self-harm over the past two weeks. This is part of the Staff Assessment of Mood (PHQ-9-OV©).

Actions:

• Review the resident’s medical records and care notes for mentions of mood disturbances or expressions of self-harm.
• Conduct interviews with staff who have had regular contact with the resident across all shifts.
• Document the frequency of these thoughts based on staff observations during the 14-day look-back period.

2. Understanding Definitions

D0500I2: Thoughts Better Off Dead - Frequency assesses how frequently the resident expressed or implied feelings of being better off dead or hurting themselves.

Example Scenario:

• Resident A: Staff note that the resident mentioned “I would be better off dead” on 10 days during the look-back period. This would be coded as 2: 7-11 days.

3. Coding Instructions

Step-by-Step:

• Step 1: Ask staff members if, over the past two weeks, the resident expressed thoughts that life is not worth living or thoughts of self-harm.
• Step 2: Code the frequency based on staff feedback:
  • 0: Never or 1 day – If the resident expressed these thoughts never or only once in the past 14 days.
  • 1: 2-6 days (several days) – If the resident expressed these thoughts for 2-6 days in the last two weeks.
  • 2: 7-11 days (half or more of the days) – If the resident expressed these thoughts on 7-11 days.
  • 3: 12-14 days (nearly every day) – If the resident expressed these thoughts almost daily over the two weeks.
  • 9: No response – If no information is available or staff cannot determine a frequency.

4. Coding Tips

• Higher Frequency: If staff reports conflicting observations, code for the higher frequency of occurrence.
• Cross-Shift Collaboration: Interview staff from all shifts to ensure an accurate assessment of mood changes throughout the day.

5. Documentation

Objective: Accurately document the resident’s mood based on staff observations, ensuring that any expressions of self-harm are properly addressed.

Actions:

• Record the frequency of staff-reported thoughts of being better off dead, and ensure it is included in the care plan for monitoring.
• Follow up with appropriate mental health interventions if frequent occurrences are reported.

6. Common Errors to Avoid

• Underreporting: Ensure all staff are included in the interview process to avoid missing critical observations.
• Assumptions: Do not assume mood trends based on one staff member’s observation. Always gather information across shifts.

7. Practical Application

Example 1:
Staff report the resident expressed thoughts of self-harm on 12 days during the past two weeks. This should be coded as 3: 12-14 days.

Example 2:
A resident mentioned feeling better off dead only once in the past two weeks. This would be coded as 0: Never or 1 day.

Please note that the information provided in this guide for MDS 3.0 Item set D0500I2 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.