E1000. Wandering - Impact

Step-by-Step Coding Guide for E1000. Wandering - Impact

1. Review of Medical Records

Start by thoroughly reviewing the resident's medical records, including physician's notes, nursing notes, therapy reports, and any relevant behavioral assessments. Look for documented evidence of wandering behavior, including any instances where the resident's wandering has impacted their care, safety, or interactions with others.

2. Understanding Definitions

Wandering is defined as moving about aimlessly or unsafely, often without a clear destination or purpose, which may lead to safety concerns or interfere with needed care. This can include wandering within the facility or attempting to leave the facility.

3. Coding Instructions

• 0 - Behavior not exhibited. Select this code if the resident did not display any wandering behavior during the look-back period.
• 1 - Behavior of this type occurred 1 to 3 days. Select this if wandering occurred on a minimal basis.
• 2 - Behavior of this type occurred 4 to 6 days, but less than daily. Use this for more frequent occurrences that do not happen every day.
• 3 - Behavior occurred daily. This code is for residents who exhibit wandering behavior every day.

4. Coding Tips

• Always use the 7-day look-back period for observation and documentation.
• Collaborate with interdisciplinary team members who may have observed wandering behaviors not noted in the medical record.
• Consider environmental and situational triggers that might influence wandering.

5. Documentation

Document all observed instances of wandering in the resident's care plan, including frequency, time of day, triggers, and any interventions that were attempted or considered. This documentation should support the coding choice made on the MDS.

6. Common Errors to Avoid

• Failing to review all sources of information.
• Overlooking wandering behaviors because they did not result in harm.
• Not updating the MDS to reflect changes in the resident's behavior during the look-back period.

7. Practical Application

Scenario: A resident has been observed wandering aimlessly around the facility on multiple occasions, both during the day and at night. The wandering has resulted in the resident entering other residents' rooms, which has caused distress.

• Based on observations, staff discussions, and documentation, determine the frequency of wandering.
• Code E1000 accordingly, considering the impact of wandering on the resident's safety and well-being.
• Update the care plan to include strategies for managing wandering, such as increased supervision at high-risk times, use of a wearable device for location tracking, and environmental modifications to redirect the resident from exits.

The Step-by-Step Coding Guide for item E1000 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.