Understanding and Coding MDS Item D0500H2: PHQ Staff Assessment - Frequency of Being Slow, Fidgety, or Restless

MDS 3.0 Item D0500H2: PHQ Staff Assessment - Frequency of Being Slow, Fidgety, or Restless

Introduction

Purpose: Evaluating the frequency of motor activity changes, such as slow movement, fidgetiness, or restlessness, is important for understanding a resident’s mental and physical health. MDS Item D0500H2 focuses on how often staff have observed that a 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 helps assess the severity of these symptoms and guides appropriate interventions.

What is MDS Item D0500H2?

Explanation: MDS Item D0500H2 is part of the staff assessment for mood under Section D: Mood. This item asks staff to assess the frequency with which the resident has shown signs of moving or speaking more slowly than usual or being unusually fidgety or restless over 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. Understanding how often these symptoms occur is crucial for evaluating the resident’s overall well-being and mental state.

Guidelines for Coding MDS Item D0500H2

Coding Instructions: To code MDS Item D0500H2, staff must determine how frequently they have observed the resident exhibiting signs of slowness, fidgetiness, or restlessness 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 slow movement, fidgetiness, or restlessness.
• 1 - Several days: The resident has shown signs of slow movement, fidgetiness, or restlessness on several days.
• 2 - More than half the days: The resident has shown signs of these behaviors on more than half the days.
• 3 - Nearly every day: The resident has shown signs of these behaviors nearly every day.

Example Scenario: If a staff member observes that a resident has been speaking more slowly or pacing frequently on four out of the last fourteen days, you would code D0500H2 as 1 - Several days. If these symptoms are present almost daily, the appropriate code would be 3 - Nearly every day.

Best Practices for Accurate Coding

Observation: Staff should carefully monitor and document the resident’s motor activity, including walking speed, speaking patterns, or any signs of fidgetiness or restlessness, over the two-week period. Accurate observation helps in identifying the frequency of these symptoms.

Documentation: Record specific instances of slow movement or fidgety behavior, including how often these behaviors occur. This documentation supports the coding decision and informs the resident’s care plan.

Communication: Share observations with the interdisciplinary care team to ensure that any motor activity changes are addressed. This may involve further assessments to explore underlying causes such as depression, anxiety, or neurological conditions.

Training: Regular staff training is essential to ensure consistent and accurate observation of motor activity changes. This will help in recognizing subtle patterns and recording them properly for better care outcomes.

Conclusion

Summary: MDS Item D0500H2 is critical for assessing the frequency of changes in motor activity, such as slow movement or restlessness, in long-term care residents. By accurately coding this item, healthcare providers can better understand the severity of these symptoms and develop appropriate care plans to improve the resident’s overall 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-22.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item D0500H2: "PHQ Staff Assessment - Frequency 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.