Understanding and Coding MDS Item D0500D2: PHQ Staff Assessment - Feeling Tired/Little Energy (Frequency)

MDS 3.0 Item D0500D2: PHQ Staff Assessment - Frequency of Feeling Tired or Having Little Energy

Introduction

Purpose: Assessing how often a resident experiences fatigue or low energy is essential for identifying the severity of potential health issues, including depression. MDS Item D0500D2 focuses on how frequently staff have observed that the resident has been feeling tired or has had little energy over the past two weeks. Accurate coding of this item helps to determine the extent of these symptoms and guides the development of appropriate care plans.

What is MDS Item D0500D2?

Explanation: MDS Item D0500D2 is part of the staff assessment for mood under Section D: Mood. This item asks staff to evaluate how often they have observed the resident showing signs of fatigue or low energy during the past two weeks. It is used when the resident cannot or does not complete the mood interview (PHQ-9), and staff observations are recorded instead. Understanding the frequency of these symptoms is crucial for assessing the resident’s overall health and for implementing necessary interventions.

Guidelines for Coding MDS Item D0500D2

Coding Instructions: To code MDS Item D0500D2, the staff member assesses how often they have observed that the resident has been feeling tired or has had little energy over the past two weeks. The coding is based on the frequency of these observations:

• 0 - Not at all: The resident has not shown signs of feeling tired or having little energy.
• 1 - Several days: The resident has shown signs of feeling tired or having little energy on several days.
• 2 - More than half the days: The resident has shown signs of feeling tired or having little energy on more than half of the days.
• 3 - Nearly every day: The resident has shown signs of feeling tired or having little energy nearly every day.

Example Scenario: If a staff member observes that a resident has been lethargic, avoiding activities, or frequently expressing feelings of tiredness on five out of the last fourteen days, you would code D0500D2 as 1 - Several days. If these symptoms have been present nearly every day, the appropriate code would be 3 - Nearly every day.

Best Practices for Accurate Coding

Observation: Staff should carefully monitor the resident’s behavior and energy levels over the two-week period, noting any signs of lethargy, reduced participation in activities, or expressions of tiredness. Accurate and consistent observation is key to capturing the frequency of these symptoms.

Documentation: Thorough documentation of the resident's behavior is essential. Staff should record specific examples of fatigue or low energy, noting how often these symptoms occur. This documentation supports the coding decision and informs the care plan.

Communication: Share observations regarding the resident’s energy levels with the interdisciplinary team to ensure that any underlying issues are addressed comprehensively. This may involve exploring potential causes of fatigue, such as medication side effects, sleep disturbances, or underlying medical conditions.

Training: Provide regular training for staff on recognizing and documenting signs of fatigue or low energy in residents. Training should emphasize the importance of accurately identifying and recording the frequency of these symptoms to ensure proper coding and care planning.

Conclusion

Summary: MDS Item D0500D2 is essential for assessing the frequency of fatigue or low energy in long-term care residents. By accurately coding this item based on staff observations, healthcare providers can better understand the severity of these symptoms and implement appropriate interventions to support the resident’s overall health and well-being.

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-19.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item D0500D2: "PHQ Staff Assessment - Frequency of Feeling Tired or Having Little Energy" 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.