Decision Making on the MDS

"We recently had our EDS audit and got dinged pretty bad on decision making. (So much of it was a judgment call i.e. wearing slacks under a skirt was not a bad decision in the eyes of the auditors.)

"Does anyone have a good test or good questions to ask a resident that would show impaired decision making?"

A great answer comes from Lori Smith, Administrator at Pilgrim Manor:

"In the past we had trouble with decision making; however, I think we finally understand.

"The way we look at it, because that is how EDS looks at it, is what is the consequence of that decision. Before you can count poor decision making, there has to be a poor consequence or the potential for a poor consequence. Example:

"It is not a poor decision not to change your clothes or wear them again the next day, it is a poor decision if it has been demonstrated that they will not change their clothes to the point of having offensive body odor.

"Keeping in mind there has to be a consequence or a large potential for a consequence, here are some examples that we have used for poor decision making:

- Will start walking without walker and is at risk for falls according to the falls risk assessment
- Will try to go outside in the winter without a coat
- Will try to get out of bed and go to the bathroom without assistance and she is very unstead on her feet, fall risk
- Puts dirty underwear back in drawer and trys to wear them again
- Has a UTI and will not drink fluids after educating about fluids and UTI's.
- Tries to get out of her recliner chair, she is not able to walk or transfer self

"Here are some that EDS would not accept:

- Will put her dirty clothes back in her closet
- Walks around with just her nightgown on
- family/POA makes decisions for her for major things
- refuses to take medications. EDS said that that is not a poor decision unless there is a consequence such as refused insulin and blood sugar was 400.
- spits medications out
- refuses to shower

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