Understanding and Coding MDS 3.0 Item D0500I1: PHQ Staff Assessment - Presence of Thoughts of Being Better Off Dead

Introduction

Purpose: Assessing the presence of suicidal thoughts or thoughts of self-harm is critical in long-term care settings. MDS Item D0500I1 focuses on whether staff have observed that the resident has expressed thoughts that they would be better off dead or thoughts of hurting themselves in some way over the past two weeks. Accurate coding of this item is crucial for identifying residents at risk and ensuring that immediate mental health interventions are provided to protect the resident’s well-being.

What is MDS Item D0500I1?

Explanation: MDS Item D0500I1 is part of the staff assessment for mood under Section D: Mood. This item is used when the resident cannot or does not complete the PHQ-9 interview, and staff observations are recorded. It asks whether staff have observed or heard the resident express thoughts about being better off dead or thoughts of self-harm during the past two weeks. Identifying the presence of these thoughts is essential for assessing the risk of suicide or self-harm and for taking necessary safety measures.

Guidelines for Coding MDS Item D0500I1

Coding Instructions: To code MDS Item D0500I1, the staff member assesses whether they have observed or heard the resident express thoughts that they would be better off dead or of harming themselves over the past two weeks. The coding is binary:

• 0 - No: The resident has not expressed such thoughts.
• 1 - Yes: The resident has expressed such thoughts.

Example Scenario: If a staff member notices that a resident has made statements about feeling worthless, being better off dead, or has expressed any intent or desire to harm themselves during the past two weeks, you would code D0500I1 as 1 - Yes. If the resident has not made any such statements, the appropriate code is 0 - No.

Best Practices for Accurate Coding

Observation and Listening: Staff should carefully observe and listen to the resident during interactions. Subtle comments or expressions that indicate self-harm or suicidal ideation, even if not explicit, should be noted. Residents may express these thoughts directly or in more vague terms, such as "I wish I weren’t here."

Documentation: Thorough documentation is essential. Staff should record specific examples of the resident’s statements or behaviors that suggest thoughts of self-harm or feeling better off dead. This documentation supports the coding decision and ensures that appropriate interventions are taken.

Communication: Immediately share any positive response to this item with the interdisciplinary team, including mental health professionals. Residents who express such thoughts need to be assessed for risk and provided with immediate support. Safety measures, such as one-on-one monitoring or a referral to a mental health specialist, should be implemented.

Training: Ensure that staff are regularly trained on recognizing and responding to signs of suicidal thoughts or self-harm. Staff should be equipped to handle these conversations sensitively and to escalate concerns appropriately to protect the resident’s safety.

Conclusion

Summary: MDS Item D0500I1 is critical for identifying residents who may be experiencing suicidal thoughts or thoughts of self-harm. Accurate coding of this item based on staff observations ensures that at-risk residents receive immediate mental health support and safety interventions.

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 D0500I1: "PHQ Staff Assessment - Presence 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.