E0600: Impact on Others

Item Rationale

Health-related Quality of Life

• Behaviors identified in item E0200 put others at risk for significant injury, intrude on their privacy or activities and/or disrupt their care or living environments. The impact on others is coded here in item E0600.

Planning for Care

• Identification of the behaviors noted in E0200 that have an impact on others may require treatment planning and intervention.

• Subsequent assessments and documentation can be compared with a baseline to identify changes in the resident’s behavior, including response to interventions.

Steps for Assessment

1. Consider the previous review of the clinical record, staff interviews across all shifts and disciplines, interviews with others who had close interactions with the resident and previous observations of the behaviors identified in E0200 for the 7-day look-back period.

2. To code E0600, determine if the behaviors identified put others at significant risk of physical illness or injury, intruded on their privacy or activities, and/or interfered with their care or living environments.

Coding Instructions for E0600A. Did Any of the Identified Symptom(s)

Put Others at Significant Risk for Physical Injury?

• Code 0, no: if none of the identified behavioral symptom(s) placed staff, visitors, or other residents at significant risk for physical injury.

• Code 1, yes: if any of the identified behavioral symptom(s) placed staff, visitors, or other residents at significant risk for physical injury.

Coding Instructions for E0600B. Did Any of the Identified Symptom(s)

Significantly Intrude on the Privacy or Activity of Others?

• Code 0, no: if none of the identified behavioral symptom(s) significantly intruded on the privacy or activity of others.

• Code 1, yes: if any of the identified behavioral symptom(s) kept other residents from enjoying privacy or engaging in informal activities (not organized or run by staff). Includes coming in uninvited, invading, or forcing oneself on others’ private activities.

Coding Instructions for E0600C. Did Any of the Identified Symptom(s)

Significantly Disrupt Care or the Living Environment?

• Code 0, no: if none of the identified behavioral symptom(s) significantly disrupteddelivery of care or the living environment.

• Code 1, yes: if any of the identified behavioral symptom(s) created a climate of excessive noise or interfered with the receipt of care or participation in organized activities by other residents.

Coding Tips and Special Populations

• For E0600A, code based on whether the behavior placed others at significant risk for physical injury. Physical injury is trauma that results in pain or other distressing physical symptoms, impaired organ function, physical disability or other adverse consequences, regardless of the need for medical, surgical, nursing, or rehabilitative intervention.

• For E0600B, code based on whether the behavior violates other residents’ privacy or interrupts other residents’ performance of activities of daily living or limits engagement in or enjoyment of informal social or recreational activities to such an extent that it causes the other residents to experience distress (e.g., displeasure or annoyance) or inconvenience, whether or not the other residents complain.

• For E0600C, code based on whether the behavior interferes with staff ability to deliver care or conduct organized activities, interrupts receipt of care or participation in organized activities by other residents, and/or causes other residents to experience distress or adverse consequences.

Examples

1. A resident appears to intentionally stick their cane out when another resident walks by.

Coding: E0600A would be coded 1, yes; E0600B and E0600C would be coded 0, no.

Rationale: The behavior put the other resident at risk for falling and physical injury. You may also need to consider coding B and C depending on the specific situation in the environment or care setting.

2. A resident, when sitting in the hallway outside the community activity room, continually yells, repeating the same phrase. The yelling can be heard by other residents in hallways and activity/recreational areas but not in their private rooms.

Coding: E0600A would be coded 0, no; E0600B and E0600C would be coded 1, yes.

Rationale: The behavior does not put others at risk for significant injury. The behavior does create a climate of excessive noise, disrupting the living environment and the activity of others.

3. A resident repeatedly enters the rooms of other residents and rummages through their personal belongings. The other residents do not express annoyance.

Coding: E0600A and E0600C would be coded 0, no; E0600B would be coded 1, yes.

Rationale: This is an intrusion and violates other residents’ privacy regardless of whether they complain or communicate their distress.

4. When eating in the dining room, a resident frequently grabs food off the plates of other residents. Although the other resident’s food is replaced, and the behavior does not compromise their nutrition, other residents become anxious in anticipation of this recurring behavior.

Coding: E0600A would be coded 0, no; E0600B and E0600C would be coded 1, yes.

Rationale: This behavior violates other residents’ privacy as it is an intrusion on the personal space and property (food tray). In addition, the behavior is pervasive and disrupts the staff’s ability to deliver nutritious meals in dining room (an organized activity).

5. A resident tries to seize the telephone out of the hand of another resident who is attempting to complete a private conversation. Despite being asked to stop, the resident persists in grabbing the telephone and insisting that they want to use it.

Coding: E0600A and E0600C would be coded 0, no; E0600B would be coded 1, yes.

Rationale: This behavior is an intrusion on another resident’s private telephone conversation.

6. A resident begins taunting two residents who are playing an informal card game, yelling that they will “burn in hell” if they don’t stop “gambling.”

Coding: E0600A and E0600C would be coded 0, no; E0600B would be coded 1, yes.

Rationale: The behavior is intruding on the other residents’ game. The game is not an organized facility event and does not involve care. It is an activity in which the two residents wanted to engage.

7. A resident yells continuously during an exercise group, diverting staff attention so that others cannot participate in and enjoy the activity.

Coding: E0600A and E0600B would be coded 0, no; E0600C would be coded 1, yes.

Rationale: This behavior disrupts the delivery of physical care (exercise) to the group participants and creates an environment of excessive noise.

8. A resident becomes verbally threatening in a group discussion activity, frightening other residents. In response to this disruption, staff terminate the discussion group early to avoid eliciting the behavioral symptom.

Coding: E0600A and E0600B would be coded 0, no; E0600C would be coded 1, yes.

Rationale: This behavior does not put other residents at risk for significant injury. However, the behavior restricts full participation in the organized activity, and limits the enjoyment of other residents. It also causes fear, thereby disrupting the living environment.