Understanding and Coding MDS 3.0 Item E1000A: Wandering - Risk of Getting to Dangerous Place

MDS 3.0 Item E1000A: Wandering - Risk of Getting to Dangerous Place

Introduction

Purpose: Wandering in long-term care residents, especially those with cognitive impairments such as dementia, can pose a significant safety risk. MDS Item E1000A focuses on assessing whether a resident's wandering behavior increases the risk of reaching a dangerous location, such as an unsupervised exit, stairwell, or other hazardous areas. Identifying this risk allows care teams to implement safety measures that protect residents from injury or elopement.

What is MDS Item E1000A?

Explanation: MDS Item E1000A is part of Section E: Behavioral Symptoms. It evaluates whether the resident's wandering behavior places them at risk of accessing dangerous places within or outside the facility. These areas may include staircases, kitchens, storage rooms with chemicals, or outside exits leading to roads or other hazardous environments. Monitoring and managing wandering behavior are essential to prevent harm and ensure the resident’s safety.

Guidelines for Coding MDS Item E1000A

Coding Instructions: To code MDS Item E1000A, staff must assess whether the resident’s wandering behavior over the past seven days has put them at risk of reaching dangerous places. Dangerous areas may include:

• Exits that lead outside unsupervised (potential for elopement)
• Stairs or steps that pose a fall risk
• Rooms with hazardous materials (e.g., kitchens, storage areas)
• Outdoor areas that are unsafe or unsecured

The coding options are:

• 0 - No: The resident’s wandering does not place them at risk of getting to dangerous places.
• 1 - Yes: The resident’s wandering places them at risk of getting to dangerous places.

Example Scenario: If a resident has wandered near exit doors or into areas such as stairwells or maintenance rooms, putting themselves at risk of injury, you would code E1000A as 1 - Yes. If the resident’s wandering has not led to dangerous places, code 0 - No.

Best Practices for Accurate Coding

Observation: Staff should carefully observe the resident’s movements throughout the facility. Pay attention to whether the resident is attempting to access exits, stairwells, or other unsafe areas. Be mindful of the potential risks posed by the environment, such as access to unsecured doors or unsupervised spaces.

Documentation: Record specific instances where the resident’s wandering behavior led them to, or near, dangerous places. Include details on how often this behavior occurred and the potential risks it posed. Accurate documentation helps in developing safety plans that prevent the resident from reaching hazardous areas.

Communication: Share observations with the interdisciplinary care team to ensure that safety interventions are implemented. This may involve installing alarms on doors, securing hazardous areas, increasing supervision, or modifying the environment to reduce risks.

Training: Provide regular training for staff on how to monitor and manage wandering behavior, including strategies for preventing residents from accessing unsafe areas. Staff should also be trained in elopement prevention and how to respond quickly if a resident is found in a dangerous location.

Conclusion

Summary: MDS Item E1000A is critical for assessing whether a resident’s wandering behavior puts them at risk of reaching dangerous places. Accurate coding based on staff observations ensures that wandering is recognized and addressed early, allowing for the implementation of interventions that safeguard the resident from harm.

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-11.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item E1000A: "Wandering - Risk of Getting to Dangerous Place" 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.