Understanding and Coding MDS 3.0 Item D0500I2: PHQ Staff Assessment - Frequency of Thoughts of Being Better Off Dead

Understanding and Coding MDS 3.0 Item D0500I2: PHQ Staff Assessment - Frequency of Thoughts of Being Better Off Dead

Introduction

Purpose: Monitoring the frequency of suicidal thoughts or thoughts of self-harm is essential in providing proper mental health care for long-term care residents. MDS Item D0500I2 focuses on how often staff have observed that the resident has expressed thoughts of being better off dead or of hurting themselves over the past two weeks. Accurately coding this item helps assess the severity of these thoughts and ensures timely interventions to safeguard the resident’s well-being.

What is MDS Item D0500I2?

Explanation: MDS Item D0500I2 is part of the staff assessment for mood under Section D: Mood. This item asks staff to evaluate how frequently they have observed or heard the resident express thoughts of being better off dead or thoughts of self-harm during the past two weeks. It is used when the resident cannot or does not complete the PHQ-9 interview, and staff observations are documented. Recognizing how often these thoughts occur is critical for evaluating the resident’s mental state and implementing necessary safety measures.

Guidelines for Coding MDS Item D0500I2

Coding Instructions: To code MDS Item D0500I2, the staff member assesses how often the resident has expressed thoughts of being better off dead or thoughts of self-harm over the past two weeks. The coding is based on the frequency of these observations:

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

Example Scenario: If a staff member notices that a resident has expressed feelings of being better off dead on five out of the last fourteen days, you would code D0500I2 as 1 - Several days. If the resident has expressed these thoughts nearly every day, the appropriate code would be 3 - Nearly every day.

Best Practices for Accurate Coding

Observation and Listening: Staff should carefully monitor and document any comments or behaviors that suggest thoughts of self-harm or suicidal ideation. Even indirect statements such as "I feel like I don’t belong here anymore" or "I wish I could just disappear" should be considered.

Documentation: Thorough documentation is essential. Record the exact words or behaviors of the resident that indicate these thoughts, as well as how often they occur. This documentation ensures accurate coding and helps guide interventions.

Communication: Share any positive observations immediately with the interdisciplinary care team, including mental health professionals. Residents expressing these thoughts may need urgent mental health support and a safety plan, including closer supervision or a referral to a mental health specialist.

Training: Regular training is vital for staff to recognize and respond appropriately to signs of suicidal thoughts. Training should include guidance on how to approach sensitive conversations with residents and how to escalate concerns for appropriate intervention.

Conclusion

Summary: MDS Item D0500I2 is crucial for determining the frequency of suicidal thoughts or self-harm ideation in long-term care residents. Accurate coding of this item ensures that the severity of these thoughts is assessed and that appropriate mental health interventions are implemented to protect the resident’s safety.

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-23.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item D0500I2: "PHQ Staff Assessment - 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. Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice.