MDS 3.0 Item E0200A: Physical Behavioral Symptoms Directed Toward Others

Introduction

Purpose: Physical behavioral symptoms directed toward others can indicate underlying emotional distress, cognitive impairment, or frustration in long-term care residents. MDS Item E0200A focuses on identifying whether a resident has exhibited aggressive or harmful physical behaviors, such as hitting, kicking, or pushing others, over the past seven days. Accurate coding of this item is essential for developing a care plan that addresses the causes of aggression and ensures the safety of both residents and staff.

What is MDS Item E0200A?

Explanation: MDS Item E0200A is part of Section E: Behavioral Symptoms. This item assesses whether the resident has exhibited physical behaviors directed toward others during the past seven days. Such behaviors can include hitting, pushing, grabbing, or striking other residents or staff members. Recognizing and documenting these behaviors is essential for assessing the resident’s mental health and implementing appropriate interventions, such as behavioral management strategies or environmental modifications to reduce the triggers of aggressive behavior.

Guidelines for Coding MDS Item E0200A

Coding Instructions: To code MDS Item E0200A, staff must observe and record whether the resident has demonstrated any physical behavioral symptoms directed toward others in the past seven days. These behaviors include physically aggressive actions such as:

• Hitting
• Kicking
• Pushing
• Grabbing
• Striking others

The coding options for this item are:

• 0 - Behavior not exhibited: The resident has not shown any physical behavioral symptoms directed toward others in the past seven days.
• 1 - Behavior of this type occurred 1 to 3 days: The resident has exhibited physical behavioral symptoms toward others on 1 to 3 days during the past seven days.
• 2 - Behavior of this type occurred 4 to 6 days: The resident has exhibited these behaviors on 4 to 6 days during the past seven days.
• 3 - Behavior of this type occurred daily: The resident has exhibited these behaviors every day during the past seven days.

Example Scenario: If a resident has struck or pushed staff members or other residents twice over the past seven days, you would code E0200A as 1 - Behavior of this type occurred 1 to 3 days. If the resident exhibited such behaviors on four or more days during the assessment period, you would code 2 or 3 depending on the frequency.

Best Practices for Accurate Coding

Observation: Staff should carefully monitor the resident’s interactions with others during the seven-day observation period. Look for signs of frustration or agitation that may lead to aggressive actions, and note any patterns in behavior, such as whether the aggression occurs at specific times of the day or in response to certain situations.

Documentation: Record specific instances of physical behavior directed toward others, including the time, context, and any possible triggers for the behavior. This documentation is essential for developing care plans that address the root causes of aggression and implement strategies to prevent future incidents.

Communication: Share observations of physical behavioral symptoms with the interdisciplinary care team. Understanding the context in which these behaviors occur can help in identifying underlying causes, such as pain, fear, or cognitive decline, and allow for appropriate interventions such as behavioral therapy, medication adjustments, or changes to the resident’s environment.

Training: Provide regular training for staff on managing physical aggression in residents. This training should include techniques for de-escalation, understanding the triggers of aggressive behavior, and strategies for keeping both residents and staff safe during behavioral episodes.

Conclusion

Summary: MDS Item E0200A is critical for assessing physical behavioral symptoms directed toward others in long-term care residents. Accurate coding based on staff observations ensures that these behaviors are identified and addressed early, allowing for the development of effective care plans that improve the resident’s safety and well-being, as well as the safety of others.

Reference

This guide is based on the CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024, Page E-6.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item E0200A: "Physical Behavioral Symptoms Directed Toward Others" was originally based on the CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024. 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. Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice.