Prepare for MDS Audit: How Do Dietitians Complete MDS?

If you are a dietitian, the first thing you should understand is how to complete the MDS when working in a long-term care facility. The main idea is to stay with us to learn about a brief guide that will help you throughout the process.

Minimum Set Data or MDS is the essential requirement for State Audits that must meet Provincial Standards. Everything should be up to date, while Dietitians oversee Sections V and K. The first thing you should do is to ask from the beginning about your requirements when it comes to MDS.

We recommend you ask the Director or Administrator of a nursing home to learn about each step along the way. You must handle them quarterly, while being as specific as possible, meaning you should go through each resident and individual care plan you implement.

It covers everything from their bath, hearing aids, and things they consume and dislike when it comes to diet. It is important to check here to understand everything about data set.

The main idea is to allow everyone to check out residents’ care plans and know how to care for them even if they have not met them. During audits, the professionals will go through the residential care plans and determine whether everything is up-to-date and accurate.

Similarly, as with any other facility, when you are a dietitian, you should keep up with Sections V and K, which are MDS quarterly care plans. When you get a new resident, you will have two weeks after admission to complete your MDS. However, with quarterly assessments, you should ask Director or Educator to provide you with due dates.

Of course, at quarterly assessment, you do not have to implement complete nutritional information from scratch as the first time. The main goal is to review the nutrition state and ensure you update the relevant info.

Terms to Remember

The assessment Reference Date is the time frame in which you must evaluate the resident. In most cases, you will assess the resident after the date passes. The main goal is to ensure to learn about the date, which will help you prepare for completion and gather relevant info.

A nurse should sign off an MDS and close it afterward, meaning you cannot handle the section when the deadline passes. That is the main reason you should complete it on time unless you wish to cause severe problems to your nursing home.

If a patient or resident gains five percent in weight after a month or ten percent in six months, you should implement the Significant Weight Change aspect. Visit this link: to learn about MDS.

At the same time, if the diet texture gets different than the standard or regular one you implemented at first, you should add it to Mechanically Altered Diet. Therefore, if the resident is on Pureed or Minced from the start, then you should avoid it,

Although a therapeutic diet is becoming rare nowadays, you should implement it within the process in case it creates an exception to the regular or standard diet you implemented. We are talking about vegetarians, controlled carbs, and many more.

Things Dietitians Should Handle in the MDS

1.   Mealtime Observation

You must assess whether you must change the nutrition care plan throughout the process. Therefore, you should observe mealtime to understand and address the challenges, assistance levels, intake, and potential swallowing and chewing issues.

2.   Height and Weight

You should measure patients’ height annually. That way, you can record everything and compare from the moment they entered long-term home care. At the same time, you can change the initial nutrition assessment in case you notice visible changes throughout the process. Therefore, an MDS audit will go as smoothly as possible.

One of the most important and contentious topics in long-term care facilities is weight. The main goal is to achieve the recent weight from the patient without severe changes. However, if you do not have that, we recommend you talk with the people in charge.

Everything depends on the individual requirements of each patient, meaning the dietitian will create specific assessments. When a facility asks you to use a previous weight, that should make you concerned, because it is not an honest practice. You should be as honest as possible about your preferences, but it must stay reasonable throughout the process.

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