[CapeCodMermaid]

Hi. How do you all make sure your summaries are done in a timely manner? I have nurses in the building who say they can't possibly get their summaries done and want to come in on their day off (with pay) to finish the summaries. One nurse said she just didn't have time...she has 15 patients...no sick people, no IVs, one gtube...15 ! and she wanted to come in on her day off to do her summaries!!?!?!? Is it me or what?
We have all the summaries assigned and they arrive on the floor usually by the 20th of the month. They are supposed to be done between the 30th and the 5th of the month.

[noc4senuf]

Hi CapeCod, Since there is the requirement of weekly documentation in the chart. We do not do monthly summaries but, have weeklies that mimic the questions asked on the MDS. My nurse managers complete these weekly, not the floor nurses.

[CapeCodMermaid]

We have DAILY documentation on at least 3/4 of our residents and we STILL have to do monthly summaries. Massachusetts is still one of the only states which uses the MMQ to determine medicaid payment rates.

[noc4senuf]

If a resident is ill or has to be observed for some other reason, then we do daily charting on them. Otherwise, it is only the residents on our TCU that are on their Med A stay that has daily charting.

[CapeCodMermaid]

We have an insurance- Senior Whole Health- which is like a managed medicaid/medicare. We have to chart on these residents every day even if they have had no change in condition. And of course we have to chart on the Med A patients as well.

[noc4senuf]

Have you tried a checklist flow sheet? Or do you use narrative charting? The flowsheet we use, covers all needed areas and a narrative note is only needed when something like labs, appt or something out of the ordinary is needed.

[CapeCodMermaid]

We do a check off of the basics...vital signs, pain, lung sounds and the like AND a narrative. Before I got there they were charting q shift( ! ) on stable people just to make sure they got one note daily.

[HannasMom]

I hate monthly summaries! I work the night shift in LTC. I pass meds (lots of meds) to 48 patients on the 7 pm med pass it takes from 7 pm until almost 11 pm to pass these meds, do accuchecks and insulin on a good night. Then I have to do the night shift assignment sheet for my night CNA's, the meal and BM daily tracking for all 48 patients, record the evening vitals, calculate the I& O's for patients on IV's and /or foleys.

I also have treatments, straight caths on patients who need a UA done, plus nightshift changes the foleys that need to be changed. We also do the accucheck machine checks, check the refrigerator temps on the two refrigerators. Also we do 72 hour charting on those on Alert charting. PLUS monthly summaries, because the nurse manager feels that nightshift nurses don't have enought to keep them busy!!! Also I give out pain meds prn, pass several 12 am meds, then also have accuchecks, insulin and another large med pass beginning at 5 am. Oh I forgot skin checks also and documentation on that. They also now want nightshift to do a total physcial assessments on all skin checks.

I hat how nightshift gets criticized all the time, my CNA's work hard!

See nightshift nurses just sit around eating bonbons and reading love stories. Sorry, I'm kinda frustarted with my job lately.

[HannasMom]

P.S. I envy the nurse with only 15 patients. How lucky can one person get??!! That would be a piece of cake!

[noc4senuf]

The flowsheet i mentioned is a two sided checklist. IT follows the MDS an few extras. Transfers, bed mob,eating, ROM, pain, skin, behavior, amb, the works. It has taken me approx 1-2 min to fill each out. IF need there is room for comments. So, the only narrative is something out of the ordinary.