MDS 3.0 Item E0900: Wandering - Presence and Frequency

Introduction

Purpose: Wandering behavior in long-term care residents can pose significant risks, including injury, confusion, and elopement (leaving the facility without supervision). MDS Item E0900 assesses the presence and frequency of wandering over the past seven days. Identifying and managing wandering behavior is essential to ensure the resident’s safety and prevent harmful incidents.

What is MDS Item E0900?

Explanation: MDS Item E0900 is part of Section E: Behavioral Symptoms. This item evaluates whether the resident has engaged in wandering behavior during the past seven days, and if so, how frequently it occurred. Wandering is defined as moving around the facility without purpose, often leading to entry into unsafe areas or other residents' rooms. Tracking the frequency of wandering helps care teams implement appropriate interventions to protect the resident and others.

Guidelines for Coding MDS Item E0900

Coding Instructions: To code MDS Item E0900, staff must observe whether the resident has exhibited wandering behavior and how often it occurred over the past seven days. Wandering is defined as:

• Moving from one place to another without purpose
• Entering unsafe areas or other residents’ rooms
• Walking aimlessly, potentially causing safety concerns

The coding options for this item are:

• 0 - No: The resident has not exhibited wandering behavior.
• 1 - Wandering occurred 1 to 3 days: The resident exhibited wandering behavior on 1 to 3 days during the past seven days.
• 2 - Wandering occurred 4 to 6 days: The resident exhibited wandering behavior on 4 to 6 days during the past seven days.
• 3 - Wandering occurred daily: The resident exhibited wandering behavior every day during the past seven days.

Example Scenario: If a resident wandered around the facility aimlessly on two occasions during the past week, you would code E0900 as 1 - Wandering occurred 1 to 3 days. If the resident wandered daily, you would code 3 - Wandering occurred daily.

Best Practices for Accurate Coding

Observation: Staff should carefully observe the resident’s movements within the facility over the seven-day period, noting any instances of wandering, such as aimless walking or entering other residents' rooms. Staff should distinguish wandering from purposeful walking, such as going to an activity or meal.

Documentation: Record specific examples of wandering behavior, including where and when it occurred, the frequency, and any factors that may have triggered the behavior. Accurate documentation ensures appropriate interventions are implemented to reduce the risk of harm.

Communication: Share observations with the interdisciplinary care team to address wandering behavior. This may involve exploring possible causes, such as cognitive decline, boredom, or disorientation, and implementing strategies such as increased supervision, environmental modifications, or participation in structured activities.

Training: Provide regular training for staff on how to manage wandering behaviors in residents. Training should include understanding the causes of wandering, safety protocols to prevent elopement, and strategies to keep residents engaged and safe.

Conclusion

Summary: MDS Item E0900 is crucial for identifying the presence and frequency of wandering behavior in long-term care residents. Accurate coding of this item ensures that wandering is recognized and addressed early, allowing care teams to implement safety measures and interventions that prevent harm and improve the resident’s quality of life.

Click here to see a detailed Step-by-Step on how to complete this item set.

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-10.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item E0900: "Wandering - Presence and Frequency" 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 item within MDS 3.0. Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice.