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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
‐ ‐
for use with
MDS 3.0 Resident Interview
Pocket Guide
April 2012
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
‐3‐
BRIEF INTERVIEW FOR MENTAL STATUS (BIMS)
IMPORTANT NOTE
Cue Cards for Section C should only be used if the
resident’s primary method of communication is in
written format. Otherwise, the interview should
be conducted without cue cards.
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
‐5‐
I would like to ask you some questions, which I will show you in a moment.
We ask everyone these same questions.
This will help us provide you with better care.
Some of the questions may seem very easy, while others may be more difficult. We ask these questions so that we can make sure that our care will meet your needs.
C
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
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I have written 3 words for you to remember.
Please read them.
Then, I will remove the card and ask you to re‐peat or write down the words as you remember them.
C
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
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C
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
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C
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
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C
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
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C
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
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C
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
‐19‐ C
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
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C
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
‐23‐ C
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
‐25‐ C
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
‐27‐
RESIDENT MOOD INTERVIEW (PHQ‐9©)
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
‐29‐
Never or 1 Day
2—6 Days (several days)
7—11 Days (half or more of the days)
12—14 Days (nearly every day)
D
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
‐31‐
INTERVIEW FOR DAILY PREFERENCES AND ACTIVITY PREFERENCES
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
‐33‐
Very important
Somewhat important
Not very important
Not important at all
Important, but can’t do, or no choice
F
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
‐35‐
PAIN ASSESSMENT INTERVIEW
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
‐37‐
J
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
‐39‐
No Pain
Worst Pain You Can Imagine
J
10
9
8
7
6
5
4
3
2
1
0
Numeric Rating Scale
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
‐41‐
J
Verbal Descriptor Scale
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Source: MDS 3.0 RAI User’s Manual, April 2012, Centers for Medicare & Medicaid Services Compiled by: Quality Improvement & Evaluation Service, Oklahoma State Department of Health
‐43‐
QIES HELP DESK
(405) 271-5278
The Oklahoma State Department of Health is an equal op‐
portunity employer.
This publication, printed by Docutech is issued by the Okla‐
homa State Department of Health, as authorized by Terry
Cline, Ph.D., Commissioner of Health. 600 copies have been
prepared and distributed at a cost of $2418.00. Copies are
also available for download from the Oklahoma State De‐
partment of Health website at www.health.ok.gov.
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