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
‐ ‐
RESIDENT CUE CARDS
for use with
MDS 3.0 Resident Interview
Pocket Guide
April 2012
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
‐2‐
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‐
SECTION C BRIEF INTERVIEW FOR MENTAL STATUS (BIMS)
IMPORTANT NOTE
Cue Cards for Section C can only be used if the resident’s primary method of communication is in written format. Otherwise, the interview should be conducted without cue cards.
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
‐4‐
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
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
‐6‐
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
‐7‐
I have written 3 words for you to remember. Please read them. Then, I will remove the card and ask you to repeat or write down the words as you remember them.
C
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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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
‐9‐
SOCK
BLUE
BED
C
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
‐10‐
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
‐11‐
SOCK, something to wear
BLUE, a color
BED, a piece of
furniture
C
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
‐12‐
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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Please tell me
what year it is
right now.
C
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
‐14‐
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
‐15‐
What month
are we in
right now?
C
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
‐16‐
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
‐17‐
What day of
the week is
today?
C
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
‐18‐
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‐
Let’s go back to an
earlier question.
What were those
three words that I
asked you to
repeat? C
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
‐20‐
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
‐21‐
Something
to wear
C
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
‐22‐
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‐
A color
C
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
‐24‐
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‐
A piece of
furniture
C
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
‐26‐
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‐
SECTION D RESIDENT MOOD INTERVIEW (PHQ‐9©)
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
‐28‐
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
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
‐30‐
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‐
SECTION F INTERVIEW FOR DAILY PREFERENCES AND ACTIVITY PREFERENCES
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
‐32‐
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
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
‐34‐
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‐
SECTION J PAIN ASSESSMENT INTERVIEW
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
‐36‐
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‐
Almost constantly
Frequently
Occasionally
Rarely J
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
‐38‐
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
(Numeric Rating Scale)
10
9
8
7
6
5
4
3
2
1
0
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
‐40‐
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‐
Mild
Moderate
Severe
Very severe, horrible
J
(Verbal Descriptor Scale)
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
‐42‐
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
opportunity employer.
This publication is issued by the Oklahoma State Depart‐
ment of Health, as authorized Terry Cline, Ph.D., Com‐
missioner of Health. Copies have not been printed but
are available on the Oklahoma State Department of
Health website at www.health.ok.gov.