Skilled Nursing Facilities

Section V - RAPs Worksheet

If your facility uses the New RAP Worksheet format for working RAPs, you can complete RAPS triggered by the RAI-MDS 2.0 assessment using this worksheet. The New RAP Worksheet is a structured form that guides you through working the RAP.

  1. From the resident chart, click the MDS tab.

  2. Click Edit to go into the MDS.

  3. Edit Section V.

  4. Edit the RAP you want to work. The RAP pop-up appears and shows the following information for each RAP triggered:

    • A Problem Definition link is accessible through the top right corner of the RAP window. The problem definition outlines health and wellness issues related to aging that would require intervention by staff to assist the resident to maintain or restore health. The problem definition is the basis for determining if the problem is related to the resident’s current health (Actual) or poses a risk (potential).

    • Resident Name, Description of the RAI-MDS 2.0 reason for assessment type and ARD

    • RAP triggered by indicates which response on the MDS assessment triggered this RAP. These triggers follow the matrix for determining which RAPS be worked as per the CIHI guidelines.

    • Is this problem/need - Click Actual or Potential. If you are unsure, click the Problem Definition link in the right corner of the popup to review the RAI definition.

    • Nature of the problem/condition - Describe what you see going on with your resident. Enter both subjective and objective information.

    • Factors and problems that may be associated with the RAP - This section highlights many different responses in this RAI-MDS 2.0 assessment and shows them to you. 

    • Management cues - These are other actions that should be considered to assist you when making the decision of how to treat your resident or what should be documented in your plan of care.

    • Will _RAP Name_ be addressed in the care plan? - Indicate through Yes or No options whether or not you are proceeding to care plan around the triggered RAP.

    • If care planning for this problem, what is the overall objective? - Select as many options as are appropriate. These should assist you with your goal setting in the residents' plan of care. If you are not going to care plan on the item, do not check off any of these boxes.

    • Describe impact of this problem/need on the resident and your rationale for care plan decision (Include complications and risk factors and the need for referral to other health professionals). This box is not to be used to describe items that appea in the care plan intervention. It is to be used to support your decision making for care planning or not and to describe the overall impact on the resident.

    • Referrals - This option only appears if this feature is turned on in configuration. This text box is for recording referrals to other disciplines as applicable to the RAP.

  5. Save saves the information added to the RAP. Save and Close saves the information added to the RAP and closes the RAP pop-up window, 

  6. Sign each of the triggered RAPS listed in green after documentation is completed. Click the sign link next to each triggered RAP.

  7. Location of RAP documentation. You are required to select at least one but can select multiple:

    1. If you used the PointClickCare provided RAP worksheet, select the first check box.

    2. If you used a progress note to document your RAPs process, check the second check box and note your position and the date of the progress note written to address the RAP.

    3. If your database is configured to Allow users to combine RAPs, then you see an option to select which RAPS that were combined with/contains the documentation.

    4. If you used another means of RAPs documentation, select the last check box and type the location of your documentation in the text box.

  8. After the RAPs are signed, under the column Location and Date of RAP Assessment Documentation are marked with the location and date information entered and the edit link changes to a view link and a reopen link appears in the event a user needs to make changes to that RAP.

  • 4 questions to ask yourself when completing the Nature of the problem/condition text box:

    1. What is the problem?

    2. What have you observed to support evidence of this problem?

    3. What have you heard to support evidence of this problem? (Interviews with resident, family and staff)

    4. What have you read to support evidence of this problem? (Consultations, interdisciplinary notes, lab reports, vital signs, weights, intake & output records, care records)

  • In many cases for Factors and problems that may be associated with the RAP, you see it reference an RAI-MDS 2.0 question in brackets. When these items are responded to on the MDS, the system pushes the response to the RAPs worksheet. On some occasions, there are questions which are not asked in the RAI-MDS 2.0. Youcan select those boxes individually if you believe this is an issue that could be impacting your resident.

  • In the Describe impact of this problem/need on the resident and your rationale for care plan decision. Include complications and risk factors and the need for referral to other health professionals. Address the following:

    • What is the cause of the problem?

    • Are there any complications or changes as a result of this problem?

    • How is this RAP or non-triggered clinical problem affecting day-to-day functioning or wellbeing of the resident?

    • What interventions have you tried?

    • Are they effective?

  • The last 2 items (4 and 5) are looking at evaluating a current care plan in addressing and whether any alterations need to be made to the care plan. You also may want to include any outcome measures/scales to provide objective data for evidenced based decision making.

  • The RAPS Worksheet includes an H (history) link next to the following sections: Nature of the Problem/Condition, Care Plan Decision, Impact Statement and Referrals (if in use). You can view and copy the previously used text directly into the current RAPS Worksheet. Security privileges control whether or not the user can use the copy functionality.

  • If the New RAPs Worksheets are being used and if configured to Require users to sign off on non-triggered RAPS then a sign link appears next to all RAPs that are worked, not just triggered (appearing in green) RAPs.

  • After the RAPs are completed and signed, you can record their care plan decisions by clicking the Care Plan Decisions button in the blue bar if the decision was not made in the RAP. Select Yes or No for each RAP triggered then click Save to record your care plan decisions. If using the New RAP Worksheets, you can select Care Plan decisions from within the worksheet. After this is completed, column (b) Addressed in CP? is marked with Y or N according to your selections.

  • From the MDS Portal, the in progress tab, you can see all MDS in progress. Here you can edit the MDS to work your RAPS, you don’t go to the MDS tab of each resident chart.

  • The New RAPS worksheet is enabled with the appropriate security permissions through Clinical > Setup > MDS Configuration.

  • You must have appropriate security permissions to carry this action out when editing an MDS that contain RAPS

  • You must have appropriate security permissions to see the MDS Portal