306

Part III Standards for Compliance

The MDS is not considered a comprehensive assess- ment; rather, it identifies potential problem areas, strengths, and preferences that need further assessment. These areas are known as “triggered care areas” or care area triggers (CATs), which signify the resident may be at risk. In the CAA process, these areas are further assessed with input from the resident, the resident’s family, the IDT, and the physician. A decision is made whether or not to develop a care plan once an addi- tional assessment is completed. There are 20 CATs that reflect conditions, symp- toms, and other areas that are common in nursing facil- ity residents and are frequently identified in the MDS findings. The RDN needs to be aware of all 20 areas since any of them could have an impact on a resident’s nutritional health. In particular, the CAT areas the RDN may be asked to further assess are Nutritional Status, Feeding Tube, Dehydration/Fluid Maintenance, Dental Care, and Pressure Ulcers. However, such things as cognitive loss, a decline in activities of daily living, pain, or the use of psychotropic medications may have a huge impact on a resident’s nutritional health (8). Table 21.5 identifies the 20 care area assessments requiring a more extensive review.

The federal or state government does not mandate a specific tool for the completion of the CAAs.

However, facilities must identify and use tools that are current and reflect appropriate standards of practice. The MDS user’s manual does contain a section of CAA resources for each CAT area for facilities that wish to use this resource.

The documentation for the CAA should demon- strate how the IDT made their decision related to a triggered area and explain the basis for the care plan. It should include:

● ● causes and contributing factors;

the exact issue and why it is a problem for this resident;

● ● risk factors;

factors to be considered in the development of the care plan;

●

the need for additional assessments from other professionals;

● ●

the resource used for decision-making; and conclusions from performing the CAA.

This documentation may appear anywhere in the res- ident’s record. In many cases, the location of this information will be listed within the CAA rather than rewriting it again. The RDN can use the Nutrition

TABLE 21.5 Care Area Assessments in the Resident Assessment Instrument, Version 3.0 1. Delirium

3. Visual Function

5. Activity of Daily Living (ADL) Functional/ Rehabilitation Potential

7. Psychosocial Well-Being 9. Behavioral Symptoms 11. Falls

13. Feeding Tubes 15. Dental Care

17. Psychotropic Medication Use 19. Pain

2. Cognitive Loss/Dementia 4. Communication

6. Urinary Incontinence and Indwelling Catheter

8. Mood State 10. Activities

12. Nutritional Status

14. Dehydration/Fluid Maintenance 16. Pressure Ulcer

18. Physical Restraints 20. Return to Community Referral

Source: Centers for Medicare & Medicaid Services. MDS 3.0 RAI Manual v1.13:4-3. www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html. Accessed October 14, 2015.