Step-by-Step Coding Guide for Item Set E0900: Wandering - Presence & Frequency

1. Review of Medical Records

Start by thoroughly reviewing the resident's medical records, focusing on physician orders, nursing notes, incident reports, and behavioral observations that document instances or patterns of wandering behavior within the 7-day look-back period.

2. Understanding Definitions

Wandering is described as moving about aimlessly or unsafely, without a clear destination, which can pose safety risks. This can include a variety of behaviors, such as walking into others' rooms, moving to different areas without purpose, or attempting to leave the facility.

3. Coding Instructions

• Code 0, Not Exhibited: No episodes of wandering.
• Code 1, 1 to 3 Days: Wandering was observed on 1 to 3 days of the 7-day look-back period.
• Code 2, 4 to 6 Days: Wandering was observed on 4 to 6 days of the 7-day look-back period.
• Code 3, Occurred Daily: Wandering occurred daily during the 7-day look-back period​​.

4. Coding Tips

• Consider all available information, including staff observations and family reports.
• Distinguish wandering from goal-directed movement (e.g., a resident moving towards a common area for an activity).
• Observe the resident at different times and settings to accurately capture wandering behavior.

5. Documentation

Document specific instances of wandering, including time, location, potential triggers, and how the situation was addressed. This information is crucial for care planning and ensuring resident safety.

6. Common Errors to Avoid

• Overlooking infrequent wandering: Even if wandering happens once, it should be coded accurately.
• Confusing wandering with other behaviors: Ensure the behavior meets the definition of wandering.
• Inadequate observation: Failing to observe the resident at various times can lead to inaccurate coding.

7. Practical Application

Scenario: Mrs. Smith has been observed wandering into other residents' rooms four times in the past week, twice attempting to exit the facility. Staff intervened safely each time.

• Review of Medical Records: Check Mrs. Smith's records for documented instances of wandering.
• Understanding Definitions: Confirm that Mrs. Smith's behavior aligns with the definition of wandering.
• Coding Instructions: Since Mrs. Smith wandered on more than three days, she is coded as 2, 4 to 6 Days.
• Documentation: Document each wandering episode, noting the time, place, and intervention.
• Common Errors to Avoid: Ensure that Mrs. Smith's walking with purpose towards a specific destination isn't mistakenly coded as wandering.

The Step-by-Step Coding Guide for item E0900 in MDS 3.0 Section E is based on the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.18.11, dated October 2023. Healthcare guidelines, policies, and regulations can undergo frequent updates. Therefore, healthcare professionals must ensure they are referencing the most current version of the MDS 3.0 manual. This guide aims to assist with understanding and applying the coding procedures as outlined in the referenced manual version. However, in cases where there are updates or changes to the manual after the mentioned date, users should refer to the latest version of the manual for the most accurate and up-to-date information. The guide should not substitute for professional judgment and the consultation of the latest regulatory guidelines in the healthcare field.