Understanding and Coding MDS 3.0 Item C1310B: Signs of Delirium - Inattention

Introduction

Purpose:
MDS 3.0 Item C1310B is a critical part of the cognitive assessment process, focusing specifically on identifying signs of delirium, with an emphasis on inattention. Delirium is a serious and often reversible condition that can have significant impacts on a resident’s health and quality of life. Accurately identifying and coding inattention as a sign of delirium allows for timely interventions that can prevent further complications and promote recovery.

What is MDS Item C1310B?

Explanation:
MDS Item C1310B, "Signs of Delirium: Inattention," is part of Section C, which addresses cognitive patterns. This item evaluates whether the resident shows signs of inattention, a key symptom of delirium. Inattention refers to the resident’s difficulty in focusing, sustaining, or shifting attention. It is one of the core criteria for diagnosing delirium and can manifest as an inability to stay focused on a conversation, easily being distracted, or difficulty following instructions.

The identification of inattention is crucial for distinguishing delirium from other cognitive conditions like dementia, which typically have a more gradual onset. Delirium often develops quickly and can fluctuate in severity, making prompt detection essential for effective management.

Guidelines for Coding C1310B

Coding Instructions:
Item C1310B should be coded based on observed signs of inattention in the resident during the assessment period.

1. Code 0 - Behavior not present: The resident does not exhibit signs of inattention. They can focus, follow conversations, and complete tasks without noticeable difficulty maintaining attention.

2. Code 1 - Behavior continuously present, does not fluctuate: The resident consistently shows signs of inattention throughout the day, with no significant periods where their attention improves.

3. Code 2 - Behavior present, fluctuates: The resident exhibits signs of inattention, but these signs fluctuate throughout the day. There may be times when the resident is attentive, followed by periods of noticeable inattention.

Example Scenario:
Mrs. Thompson, who usually participates actively in group activities, has recently been observed to lose track of conversations frequently. She seems easily distracted and struggles to follow simple instructions during meals, but her attention improves in the evening. In this case, Item C1310B should be coded as "2 - Behavior present, fluctuates," indicating that Mrs. Thompson shows signs of inattention that vary throughout the day.

Conversely, if Mr. Lee shows no signs of inattention, consistently focusing during interactions and tasks, Item C1310B should be coded as "0 - Behavior not present."

Best Practices for Accurate Coding

Documentation:

• Detailed Observations: Document specific instances where the resident exhibits or does not exhibit signs of inattention. Note the times of day and the context in which these behaviors occur to support accurate coding, particularly for fluctuating behaviors.
• Consistency: Assess the resident’s attention levels over a period of time to determine whether inattention is present and whether it fluctuates or remains consistent.
• Objective Evidence: Use observations from multiple staff members and interactions across different settings (e.g., during meals, activities, and personal care) to ensure a comprehensive assessment.

Communication:

• Interdisciplinary Team: Share observations of inattention with the interdisciplinary care team to ensure prompt evaluation and intervention. This is crucial for addressing potential delirium and mitigating associated risks.
• Family Involvement: Discuss any changes in the resident’s attention with their family, as they may notice similar issues during visits and can provide additional context about the resident’s cognitive status.

Training:

• Staff Education: Train staff to recognize signs of inattention and other symptoms of delirium, emphasizing the importance of distinguishing these from chronic cognitive impairments like dementia.
• Assessment Techniques: Provide training on effective observation techniques and documentation practices to ensure that inattention is accurately identified and reported.
• Updates and Refresher Courses: Regularly update staff on best practices for identifying and coding signs of delirium, including inattention, to maintain high standards in cognitive assessment and care.

Conclusion

Summary:
Accurately coding MDS Item C1310B is essential for identifying signs of inattention, a key indicator of delirium. This assessment is crucial for early detection and intervention, which can prevent further complications and improve the resident’s overall health outcomes. By following the coding guidelines and best practices, healthcare professionals can ensure that signs of delirium are promptly identified, leading to better care and support for residents in long-term care settings.

Click here to see a detailed Step-by-Step on how to complete this item set.

Reference

Please refer to CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024, specifically Chapter 3, Page C-12, for detailed instructions on coding Item C1310B.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item C1310B: Signs of Delirium - Inattention 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.