Understanding and Coding MDS 3.0 Item C1310C: Signs of Delirium - Disorganized Thinking

Introduction

Purpose:
MDS 3.0 Item C1310C is an essential component in the assessment of cognitive function, focusing on identifying disorganized thinking as a sign of delirium. Delirium is a serious condition that can significantly impact a resident’s health and requires prompt attention. Identifying disorganized thinking is crucial for early detection of delirium, allowing for timely intervention and management to prevent further complications.

What is MDS Item C1310C?

Explanation:
MDS Item C1310C, "Signs of Delirium: Disorganized Thinking," is part of Section C, which addresses cognitive patterns. This item specifically evaluates whether the resident exhibits disorganized thinking, a key symptom of delirium. Disorganized thinking can manifest as confusion, incoherent speech, illogical thought processes, or difficulty staying on topic during conversations. It is one of the hallmark signs of delirium and indicates a disruption in cognitive function.

Disorganized thinking is often characterized by an inability to follow a conversation logically, jumping from one idea to another without clear connections, or providing answers that are unrelated to the questions asked. Recognizing this symptom is vital for distinguishing delirium from other cognitive disorders such as dementia, which typically have a more gradual onset.

Guidelines for Coding C1310C

Coding Instructions:
Item C1310C should be coded based on observations of the resident’s thought processes during the assessment period.

1. Code 0 - Behavior not present: The resident does not exhibit disorganized thinking. Their thoughts and speech are coherent, logical, and stay on topic during conversations.

2. Code 1 - Behavior continuously present, does not fluctuate: The resident consistently shows signs of disorganized thinking throughout the day, with no periods of improvement.

3. Code 2 - Behavior present, fluctuates: The resident exhibits disorganized thinking, but these signs fluctuate throughout the day. There may be times when the resident is able to think and speak coherently, followed by periods of disorganized thinking.

Example Scenario:
Mrs. Miller, usually able to have coherent conversations, has recently been observed giving answers that do not match the questions asked, such as responding with unrelated topics or jumping from one subject to another without making clear connections. Her ability to stay on topic varies throughout the day. In this case, Item C1310C should be coded as "2 - Behavior present, fluctuates," indicating that her disorganized thinking varies.

Conversely, if Mr. Adams consistently provides logical and relevant responses during interactions with staff, Item C1310C should be coded as "0 - Behavior not present."

Best Practices for Accurate Coding

Documentation:

• Detailed Observations: Record specific examples of disorganized thinking, including the context of conversations and the resident’s ability (or inability) to stay on topic. Note the times and situations where disorganized thinking occurs.
• Consistency: Observe the resident over different times of day and in various settings to determine whether disorganized thinking is continuous or fluctuates.
• Objective Evidence: Support the coding decision with documented instances of disorganized thinking observed by multiple staff members across different interactions.

Communication:

• Interdisciplinary Team: Share observations of disorganized thinking with the interdisciplinary care team to ensure prompt evaluation and intervention. This is crucial for addressing potential delirium and mitigating associated risks.
• Family Involvement: Engage the resident’s family in discussions about the resident’s cognitive status, particularly if there have been noticeable changes in thought processes or behavior.

Training:

• Staff Education: Train staff to recognize signs of disorganized thinking 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 disorganized thinking is accurately identified and reported.
• Updates and Refresher Courses: Regularly update staff on best practices for identifying and coding signs of delirium, including disorganized thinking, to maintain high standards in cognitive assessment and care.

Conclusion

Summary:
Accurately coding MDS Item C1310C is essential for identifying disorganized thinking as a sign 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.

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 C1310C.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item C1310C: Signs of Delirium - Disorganized Thinking 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.