Understanding and Coding MDS 3.0 Item D0150I2: PHQ Response - Frequency of Thoughts of Being Better Off Dead

Understanding and Coding MDS 3.0 Item D0150I2: PHQ Response - Frequency of Thoughts of Being Better Off Dead

Introduction

Purpose: Monitoring the frequency of suicidal thoughts or thoughts of self-harm is critical in long-term care settings to ensure the safety and mental health of residents. MDS Item D0150I2 focuses on how often the resident has had thoughts that they would be better off dead or of hurting themselves in some way over the past two weeks. Accurate coding of this item is essential for assessing the severity of these thoughts and for ensuring that residents receive the immediate and appropriate care they need.

What is MDS Item D0150I2?

Explanation: MDS Item D0150I2 is part of the Patient Health Questionnaire (PHQ-9) interview in Section D: Mood. This item specifically assesses the frequency with which a resident has had thoughts of being better off dead or thoughts of self-harm over the past two weeks. Understanding how often these thoughts occur is crucial for determining the level of risk and for implementing timely interventions to protect the resident’s well-being.

Guidelines for Coding MDS Item D0150I2

Coding Instructions: To code MDS Item D0150I2, the interviewer asks the resident how often they have had thoughts that they would be better off dead or of hurting themselves in some way over the past two weeks. The coding is based on the resident’s response and is categorized as follows:

• 0 - Not at all: The resident has not had these thoughts.
• 1 - Several days: The resident has had these thoughts on several days.
• 2 - More than half the days: The resident has had these thoughts on more than half of the days.
• 3 - Nearly every day: The resident has had these thoughts nearly every day.

Example Scenario: If a resident reports having thoughts of being better off dead or hurting themselves on five out of the last fourteen days, you would code D0150I2 as 1 - Several days. If these thoughts have been present nearly every day, the appropriate code would be 3 - Nearly every day.

Best Practices for Accurate Coding

Documentation: Document the resident’s responses carefully and accurately, especially if they indicate that they have had these thoughts frequently. This documentation is crucial for ensuring that appropriate follow-up actions and interventions are taken to protect the resident’s safety.

Communication: Immediately communicate any positive response to this item to the interdisciplinary team, including mental health professionals, to ensure that the resident receives the necessary support and that a safety plan is implemented.

Training: Regular training for staff on how to conduct the PHQ-9 interview is essential, particularly for discussing sensitive topics like suicidal thoughts. Staff should be trained to respond appropriately and ensure that residents feel supported and understood during these discussions.

Conclusion

Summary: MDS Item D0150I2 is critical for assessing the frequency of suicidal thoughts or thoughts of self-harm in long-term care residents. By accurately coding this item, healthcare providers can ensure that residents who are at risk receive the immediate and appropriate care necessary to protect their safety and well-being.

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 D-12.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item D0150I2: "PHQ Response - Frequency of Thoughts of Being Better Off Dead" 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. The guide is not a substitute for professional judgment or the facility’s policies. It is crucial to stay updated with any changes or updates in the MDS 3.0 manual or relevant CMS regulations. The guide does not cover all potential scenarios and should not be used as a sole resource for MDS 3.0 coding. Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice. Users are responsible for ensuring compliance with all applicable laws and regulations in their respective practices.