Resident Assessment Instrument Overview

The Resident Assessment Instrument (RAI) is designed to help care providers
assess resident strengths, needs, and preferences using a holistic perspective and
interdisciplinary input. Nursing facilities are the homes of residents. It is very important
to identify what care goals are most important to the resident and/or family and to
identify resident strengths that would support meeting those goals.
The RAI process parallels the problem solving processes used by many
disciplines and involves; assessment using the Minimum Data Set (MDS) and Resident
Assessment Protocols (RAPs); care planning using interdisciplinary input, care plan
implementation, care plan evaluation, and care plan revision.
Problem Solving Process Resident Assessment Instrument
Assessment Assessment (MDS/others)
Planning Decision Making (RAPs/others)
Care Plan Development
Implementation Care Plan Implementation
Evaluation (reassessment) Evaluation (reassessment)
Revision of Care Plan Revision of Care Plan
The MDS is a core set of screening and assessment variables designed to assist
care providers to assess for resident specific information that will ultimately direct the
provision of care to residents. The MDS is the first step in the two step assessment
process. The second step in the assessment process is the RAPs. There are 18 RAPs
covering key problem areas that present often for resident in long term care. The RAPs
are a brief synopsis of current standards of care for these key areas. It would take a
clinician many hours to reference in textbooks and current journal articles the information
contained in the RAPs. Certain scoring of items on the MDS trigger resident evaluation
using the RAPs. As the RAPs are worked, questions are asked that drive the teams
thinking about other assessments or interventions that may be appropriate for the
individual residents. Care plan interventions, designed from working RAPs, will achieve
the overall goals of maintaining residents functioning at the highest practical level,
improving functioning where possible and preventing decline where possible. The
overall goal of the RAI process is to improve resident outcomes. Quality
Indicators/Quality Measures derived from MDS data are an example of outcome
measures.
Resident Assessment Protocols (RAPs)

1. Delirium 10. Activities
2. Cognitive Loss/Dementia 11. Falls
3. Visual Function 12. Nutritional Status
4. Communication 13. Feeding Tubes
5. ADL Functional/Rehabilitation Potential 14. Dehydration/Fluid Maintenance
6. Urinary Incontinence and Indwelling Catheter 15. Dental Care
7. Psychosocial Well-Being 16. Pressure Ulcers
8. Mood State 17. Psychotropic Drug Use
9. Behavioral Symptoms 18. Physical Restraints
   QIPMO: University of Missouri Sinclair School of Nursing 2
   This is not a complete comprehensive list for all care issues that need to be potentially
   addressed by the care plan team. Examples of areas that are not covered with the RAP’s
   are pain, constipation, etc.
   Resident Assessment Instrument Overview
   The end product of the RAI Process is the resident’s individualized care plan.

Care plans are very important tools to communicate the resident’s care needs to the team.
Without the care plan, resident care becomes fragmented and interventions may only be
as consistent as the staff who works that day. The care plan is a living, breathing
document that exists to be changed as the resident’s care needs change. Not every change
in the resident’s condition will require a new RAI. However, changes in the resident’s
care needs will require that the care plan and chart documentation reflect what is
currently happening with that individual resident. Care plan goals should be revised as
they are achieved and interventions should accurately reflect the care needs of residents.
The Resident Assessment Process is designed to assist long term care facilities to
comprehensively assess residents and to develop individualized plans of care. It is
important for each nursing facility to assess their current care delivery system and to
determine how to implement the RAI process in such a way that all staff share the
responsibility. Registered nurses by virtue of their education and license must direct and
take part in assessment and care planning for residents. Those activities cannot be
delegated in their entirety to other licensed or non-professional staff.
QIPMO: University of Missouri Sinclair School of Nursing 3
Section I
Resident Assessment Protocols
Self-Study Modules Introduction
The purpose of the study guide is to assist members of the interdisciplinary team
to learn the content of the Resident Assessment Protocols (RAPs) before applying them
to a particular resident. Once the content of the protocols has been learned planning care
should become more directed and meaningful. The MDS is designed to be used as a
preliminary scoring instrument to identify potential resident problems, strengths, and
preferences for care. The second step in the assessment process is the RAPs. RAPs are
problem-oriented frameworks that provide additional in-dept assessment of the resident
condition. Information obtained from this second step should be used to describe resident
problems or needs and to aide facility staff in the development of goals and interventions
in the plan of care.