Understanding and Coding MDS Item D0500D1: PHQ Staff Assessment - Feeling Tired/Little Energy (Presence)

MDS 3.0 Item D0500D1: PHQ Staff Assessment - Presence of Feeling Tired or Having Little Energy

Introduction

Purpose: Fatigue or low energy levels in long-term care residents can be indicative of underlying health issues, including depression. MDS Item D0500D1 focuses on whether staff have observed that the resident has been feeling tired or has had little energy over the past two weeks. Accurate coding of this item is essential for identifying potential health concerns and for ensuring that the resident receives appropriate care.

What is MDS Item D0500D1?

Explanation: MDS Item D0500D1 is part of the staff assessment for mood under Section D: Mood. This item asks whether staff have observed that the resident has been feeling tired or has had little energy 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 instead. Identifying the presence of fatigue or low energy is important for assessing the resident’s overall health and for guiding appropriate care interventions.

Guidelines for Coding MDS Item D0500D1

Coding Instructions: To code MDS Item D0500D1, the staff member assesses whether they have observed that the resident has been feeling tired or has had little energy over the past two weeks. The coding is binary, based on the staff's observations:

• 0 - No: The resident has not shown signs of feeling tired or having little energy.
• 1 - Yes: The resident has shown signs of feeling tired or having little energy.

Example Scenario: If a staff member notices that a resident has been lethargic, avoiding activities, or has frequently expressed feeling tired during the past two weeks, you would code D0500D1 as 1 - Yes. If there have been no observable signs of fatigue or low energy, you would code 0 - No.

Best Practices for Accurate Coding

Observation: Staff should carefully monitor the resident’s behavior, particularly any signs of lethargy or reduced energy levels, over the two-week period. Consistent observation is crucial for accurately identifying these symptoms.

Documentation: Thorough documentation of the resident's behavior is essential. Staff should record specific examples of fatigue or low energy, such as frequent naps, difficulty completing tasks, or verbal expressions of tiredness. This documentation supports the coding decision and informs the care plan.

Communication: Share observations regarding the resident’s energy levels with the interdisciplinary team to ensure that any underlying issues are addressed comprehensively. This may involve exploring potential causes of fatigue, such as medication side effects, sleep disturbances, or underlying medical conditions.

Training: Provide regular training for staff on recognizing and documenting signs of fatigue or low energy in residents. Training should emphasize the importance of accurately identifying and recording these symptoms to ensure proper coding and care planning.

Conclusion

Summary: MDS Item D0500D1 is essential for identifying residents who may be experiencing fatigue or low energy, which can be significant indicators of underlying health issues. Accurate coding of this item based on staff observations ensures that these symptoms are detected and addressed promptly, leading to better health outcomes for residents.

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-19.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item D0500D1: "PHQ Staff Assessment - Presence of Feeling Tired or Having Little Energy" 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.