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Q: On the MDS, item J1c, dehydration, states that this condition is defined as output exceeds input. Is that the only sign needed for checking dehydration?

Julia's PPS Chat, October 13, 2004

Welcome again to PPS chat!

When you are completing the MDS, do you just go by what is printed on the MDS form, or are you reading the revised Resident Assessment Instrument (RAI) User's Manual for further clarification? Read on to find out the answer to this question-

Q: On the MDS, item J1c, dehydration, states that this condition is defined as output exceeds input. Is that the only sign needed for checking dehydration?

A: The dehydration item on the MDS is an excellent example of the importance of referring to the revised Resident Assessment Instrument (RAI) User's Manual when completing an MDS.

By just reading the MDS form itself, you could infer that all residents whose inputs are less than their outputs are dehydrated. However, this would be incorrect.

Let's review the definition of dehydration according to the revised RAI User's Manual. On p. 3-138, it states that you should check dehydration only if the resident has two or more of the following indicators:

  • Takes in less than the recommended 1,500 ml of fluids daily (water or liquids in beverages, and water in food)
  • Has clinical signs of dehydration
  • Fluid loss exceeds the amount of fluids he or she takes in (e.g., loss from vomiting, fever, diarrhea that exceeds fluid replacement)

At least two of these three criteria need to be present before you mark dehydration. Also, these two criteria must be present during your seven-day assessment period. If the resident experienced dehydration, and it was resolved more than seven days prior to the assessment reference date, do not check dehydration on the MDS.

Accurately coding this item is extremely critical because dehydration is one of the sentinel events in the quality indicators. Be sure to follow the exact definition as written in the revised RAI User's Manual when coding item J1c on the MDS.

You probably knew that the answer would be to consult the manual. Many MDS coordinators refer to it as their "MDS Bible." It's an important book-be sure to refer to it consistently.

Until we chat again about transmitting the MDS-