Understanding and Coding MDS Item D0500H1: PHQ Staff Assessment - Presence of Being Slow, Fidgety, or Restless

MDS 3.0 Item D0500H1: PHQ Staff Assessment - Presence of Being Slow, Fidgety, or Restless

Introduction

Purpose: Changes in motor activity, such as moving more slowly than usual or being unusually fidgety or restless, are often linked to mental health conditions like depression or anxiety. MDS Item D0500H1 focuses on whether staff have observed that the resident has been moving or speaking more slowly than usual or has appeared fidgety or restless over the past two weeks. Accurate coding of this item is essential for identifying potential mood disturbances and ensuring the resident receives appropriate care.

What is MDS Item D0500H1?

Explanation: MDS Item D0500H1 is part of the staff assessment for mood under Section D: Mood. This item asks whether staff have observed that the resident has been slow, fidgety, or restless 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. Identifying the presence of these motor activity changes is crucial for assessing the resident’s mental health and for guiding care interventions.

Guidelines for Coding MDS Item D0500H1

Coding Instructions: To code MDS Item D0500H1, the staff member assesses whether they have observed that the resident has been moving or speaking noticeably slower than usual or has appeared fidgety or restless over the past two weeks. The coding is binary:

• 0 - No: The resident has not shown signs of being slow, fidgety, or restless.
• 1 - Yes: The resident has shown signs of being slow, fidgety, or restless.

Example Scenario: If a staff member observes that a resident has been moving or speaking more slowly than usual, or if the resident appears unusually fidgety or restless during the past two weeks, you would code D0500H1 as 1 - Yes. If there have been no such observations, the coding would be 0 - No.

Best Practices for Accurate Coding

Observation: Staff should consistently monitor the resident’s motor activity over the two-week period, noting any signs of slowness, restlessness, or fidgetiness. These observations should be based on patterns rather than isolated incidents.

Documentation: Record specific examples of changes in motor activity, such as moving slowly while walking, appearing fidgety during meals, or pacing. Thorough documentation supports the coding decision and helps guide care planning.

Communication: Share observations of motor activity changes with the interdisciplinary team to ensure that any mental health or neurological issues are addressed. This may include further assessments or adjustments to the resident’s care plan.

Training: Provide ongoing training for staff on identifying and documenting changes in motor activity, as subtle shifts may indicate underlying mental health concerns. Proper training ensures accurate coding and improved care outcomes.

Conclusion

Summary: MDS Item D0500H1 is essential for identifying residents who may be experiencing changes in motor activity, such as being slow, fidgety, or restless, which are often linked to depression or anxiety. Accurate coding based on staff observations ensures that these signs are recognized early and that appropriate interventions are put in place.

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-22.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item D0500H1: "PHQ Staff Assessment - Presence of Being Slow, Fidgety, or Restless" 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. 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. Users are responsible for ensuring compliance with all applicable laws and regulations.