August 24, 2017
Preparation for MDSC in Emergency Status
To All MDSC;
This is to inform you of some steps that should be taken in preparation for the possibility of evacuations and emergency weather events.  The possibility of power outages, internet loss and evacuations can all seriously impair your ability to complete and transmit required MDS data.  The following are some steps you can take now to prepare for those possibilities.  
If your facility must evacuate:
  1. You must send a current copy of the MDS and Care Plan for each resident transferring to another location.  This is to ensure continuity of care for each resident.  If your facility is prone to evacuation, you should start making copies well in advance of the storm. 
  2. If you are evacuating to a sister facility, talk to your Corporate Director about giving the sister facility electronic access to your records for the duration of the evacuation.  This will keep you from having to print an MDS and care plan for each resident.
  3. Back up your MDS data to ensure that it is stored and updated.  Any updates should be made now and saved to your back up files.
  4. Be mindful of the need for discharge assessments.  If you document exactly where and when each resident was evacuated, you will be able to complete the records when the situation is more stable.

Facilities in the path of the storm:
  1. If you have any assessment with an ARD within the next 14 days, open these assessments in your software system with the appropriate ARD.  It is also encouraged to copy this information on a paper MDS with the same ARD.  (These can be transported to a safe place in the event of an evacuation.)  By opening these assessments it will protect you if there is an extended power outage and you will be able to prove that the assessment was opened timely.
  2. If you have files ready to transmit, go ahead and get them sent to QIES.  
  3. Assessments that have an ARD over the next 7 days, evaluate if you can safely move the ARD to an earlier date so that they can be completed and transmitted prior to the arrival of the storms.  (Again, to protect you in the event of evacuations or extended power outages.)  If moving the ARD to an earlier date changes your RUG value, remember you can always complete a new MDS after any danger has passed to capture the new RUG.
  4. Consider printing out a Kardex or copies of your care plans in the event you have a power outage and staff is unable to access computer systems.  This will allow you to continue care and follow the Care Plan.  
  5. Evaluate your facilities back up documentation plan in the event of power outages.  Will your facility user paper based documentation?  ADL flow sheets?  If so, you may have some staff that have never used paper based documentation and might need a short training session to ensure that you get the documentation you need to complete your assessments.
  6. Coordinate with your therapy staff to determine upcoming COT check-points.  Again, to be prepared you might consider opening COT or EOT assessments on paper to protect in the event of power outages.  

Receiving Evacuated Residents from Other Facilities
  1. If you are receiving residents from other facilities, get them admitted into your system as quickly as possible.  
  2. Even if the evacuating facility has just completed an MDS you will open an Entry tracking record and admission assessment for your facility. 
  3. In the past CMS issued guidance that all evacuated residents could be counted as Skilled Residents. They didn't issue this guidance until Mandatory evacuations had started. If you start by charting each resident as if they are skilled, when that guidance does come, you will be prepared.  But, do not transmit MDS as skilled unless CMS issues that guidance, (unless skilled at prior facility.)
  4. Encourage your staff to chart on the residents as if they were Skilled Residents.  Each resident will be coded as a new admission with anentry and admission MDS and care plan. 
  5. If the resident coming to you was already skilled at the evacuating facility you will go forward with skilled assessments but you will treat the date of admission as day one and move forward with your skilled assessments. (Regardless of where the skilled assessments were at evacuating facility, this is just like any other skilled admission.)
  6. When initiating interim Care Plans, don't forget to address the implications of the evacuation. This is potentially traumatic for that resident and this should be addressed.

Please stay safe and if you need assistance or have questions please don't hesitate to contact myself or Brian Johnson.
Shelly Nanney, RN, RAC-CT
MDS Clinical Coordinator, Texas

Brian Johnson
MDS Automation Coordinator, Texas