Q:
We have a lot of residents on Scheduled Toileting. I’m worried we won’t get credit for them during our next CMI validation. What will I need to show our review nurse to receive credit?
A:
The RAI Manual MDS item H0200C, ‘Current Toileting Program’ (page H-6), outlines specific requirements that must be met in addition to having documentation of the program in place during the 7-day lookback period:
- Implementation of an individualized, resident-specific toileting program based on an assessment of the resident’s unique voiding pattern.
- Communication of the individualized program to staff and the resident (as appropriate) through verbal explanation and inclusion in care plans, flow records, and written reports.
- Documentation of the resident’s response to the toileting program and subsequent evaluations, as needed.
For each item:
Item #1 – Prior to implementing the program, staff should observe and document the resident’s toileting pattern for at least 3 days to determine if the resident could benefit from a toileting program. Documentation should include the approximate time and whether the resident was continent or incontinent. After collecting the data, a scheduled toileting plan should be developed based on the 3 days of data and the desired goal/outcome.
Item #2 – Progress notes, Bladder/Continence assessments, Care Plan Conference notes, etc., can be used to document communication of the plan with the resident or resident’s responsible party. Communication to staff can be documented in progress notes, care plans, Kardex, and staff memos.
Item #3 – The resident’s response to the program should be routinely documented per facility policy or state-specific Medicaid requirements. If any changes are noted (improvement or decline), then a reevaluation may be indicated.
Angie Hamer, RN, RAC-CT
Clinical Consultant
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