[laurenbella24]

Hey ya'll, I am hoping an experienced nurse/manager/whoever can give me their input. Here's the deal...I am actually in social services at a long-term care facility. I have about 15 months experience under my belt at a facility and started working at this new facility this week to gain experience. Wow, has it been an eye opener. Found out my part time person quit and last day is in less than a week and there's late MDSs and resident assessments that guess who-ME has to do. All with no orientation, granted I have some experience, but add a new facility/coworkers/residents and it makes everything take sooooo much longer. Anyhow....When doing my social history assessment/MDS/care plan for a resident and I notice there are no-yes, not ONE care plan in all the residents charts I looked at. I hope this is an oversight on my part and maybe it's in another binder or something!!! But I honestly wouldn't be surprised if no one does them. And one other question....
In regards to care conferences...correct me if I'm wrong....but isn't it a REGULATION that regardless of if a family member/resident attends the interdisciplinary team must STILL meet and discuss the plan of care within 21(?) days of admission, quarterly thereafter, and when there's a significant change? I noticed that while about 15 residents were due for a care conference this week, only 4 were noted on the schedule. When asked about this, the social services person that has been doing them said "oh those are the ones that are going to come". I explained that they all need to be reviewed by the team regardless to be in compliance and she looked at me like I was talking swahilian. At my old place, I sent the care conference letters to families with a designated time slot (30 min apart) and asked they phone me if they CANT attend. I guess their current system is call to set up an appointment if you want to be a part of it. If no one calls, it doesn't get reviewed. And I think they are calling 3-4 days beforehand. In my experience, I was told families must have at least 1 week notice. There's a form for every person due for care conference that is supposed to be passed around and signed, but frankly, there names weren't so much as brought up nor their plan of care, so am I wrong in saying I refuse to sign them?

Please give me some input on this and if I'm in compliance here. I think they are as time consuming as the next person, but it's necessary and apparently the last survey this facility had was BAD. So it seems even more important to do things in line with regs. Please reply! Thanks and keep up all of your hard and dedicated work.
_Frustrated
*Oh yes, one more thing...I also observed at the care conference no one thought it was necessary to bring the resident's chart or care plans (if they exist) to the care conferences! Is it me, or is that a little odd? They just all sort of just showed up.

[Rizpah]

From what you've described, it sounds like you've walked into a nightmare. You sound like you know your stuff. Yes, there are regulations that require timely assessments, plans of care, interdisciplinary approach, etc. Do you have access to a regulation book? You could look up the specific regulations related to care plans and conferences and present this info to your administrator along with your concerns. Is he/she even aware of what's happening out on the floor? (one would think that the adm. would know there is SOME kind of problem if the surveys are bad). I would have to question if the administration end of patient care is as messed up as you are describing, how is the actual patient care? staffing? environment?
Regarding CP in the pt. charts - we don't keep ours in each individual chart, they are kept in a separate binder for easy access and the CNAs get a flow sheet copy of the care plan for their documentation. We also have "care plan face sheets" behind each closet door for "point of contact information". We do everything on computer so we also have access to the CP via computer - could that be where yours are (if they are done of course )
You have your work cut out for you! Keep us updated on how things are going!

Oh, and by the way - WELCOME to AllNurses!

[Daytonite]

In one LTC facility I worked there was a daily (Monday-Friday) multi-disciplinary care team conference at 9am that lasted at least a half hour to an hour. Attendance was mandatory and expected. We nurses took turns being called for and spending 5 or 10 minutes to discuss what was going on with our patients. I worked the Medicare hall so I had to be there. However, social services, activities, PT, dietary, the MDS nurse, admission/Medicare nurse, the DON and several people from administration were also at these meetings.

Care plans were kept by the MDS nurse but she expected our input. The permanent care plans were kept in huge 4 inch three-ring binders at the nurses stations, however, as I recall, the nurse in charge of them didn't want anyone altering them and most nurses were happy to oblige her on that point. I think I can say with confidence that most of the nursing staff never looked at them.

[Summer69]

OH GOOD GRIEF!!! You are correct about care conferences. You have really stepped into a mess. Is it the administration who feels care conferences are not necessary or did things just get dropped? I did work one place where the DNS was the care plan coordinator( a small facility) and she had just dropped that part of the MDS process and everyone got into a rut so when new DNS started she had to basically start from scratch on care conferences. Good Luck

[CapeCodMermaid]

The care plans have to be updated on a quarterly basis ...at least. And the team should sign off that they have reviewed the plan. Every place is different. I like keeping the care plans in the patient's chart. It is EVERYONE'S responsibility to keep care plans updated.

[lpnbecky123]

What has worked for me is first thing I review the daily report, gather up telephone orders & check the charts for MED-A & managed care. I also look for incident reports. then I update care plans with 1 or 2 lines. some need a bit more research and take a bit more time. the staff nurses will not touch the care plan, the response i get is "I'll screw it up & the state will get up". You do what you can do.