E0600. Impact on Others

Step-by-Step Coding Guide for E0600. Impact on Others

1. Review of Medical Records

• Objective: To gather information on resident behaviors that impact others. Start by reviewing medical records, including nurse's notes, behavioral reports, and any incident reports involving interactions with other residents or staff.

2. Understanding Definitions

• Impact on Others (E0600): Refers to behaviors exhibited by the resident that negatively affect the well-being or routines of other residents or staff. This includes verbal abuse, physical abuse, other disruptive behaviors, and rejection of care.

3. Coding Instructions

• E0600A (Verbal abuse): Code only if the resident directed verbal gestures or statements to others that were considered abusive.
• E0600B (Physical abuse): Code if the resident was involved in physical actions against others considered abusive.
• E0600C (Other disruptive behaviors): Code for behaviors not classified as verbal or physical abuse but disrupt the facility's routine.
• E0600D (Rejection of care): Code if the resident's behavior involved rejection of assistance that affected the caregiver's ability to provide care or impacted other residents' care.

4. Coding Tips

• Observation Period: Focus on the 7-day look-back period.
• Interdisciplinary Input: Consider input from various staff members who interact with the resident.
• Specificity: Be specific in identifying behaviors; distinguish between isolated incidents and patterns.

5. Documentation

• Clearly document specific instances of behaviors impacting others, including date, time, individuals involved, and actions taken.
• Record any interventions attempted and their outcomes.

6. Common Errors to Avoid

• Overlooking Behaviors: Not all behaviors are overtly aggressive; some may be subtle yet impactful.
• Confusion with Other Sections: Ensure behaviors are coded in E0600 when they impact others, not when they are self-directed.
• Inconsistency: Ensure all staff use the same criteria for what constitutes impact on others.

7. Practical Application

• Case Study: A resident frequently shouts at staff and other residents during meal times, causing distress. After reviewing the records and consulting with the care team, code E0600A as present.
• Action Plan: Develop an intervention plan that might include behavioral therapy, adjusting the resident's mealtime routine, or staff training on managing challenging behaviors.

The Step-by-Step Coding Guide for item E0600 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.