[Rexie68]

From Medicare Title 42:


§ 405.2137 Condition: Patient longterm
program and patient care
plan.

Each facility maintains for each patient
a written long-term program and
a written patient care plan to ensure
that each patient receives the appropriate
modality of care and the appropriate
care within that modality. The
patient, or where appropriate, parent
or legal guardian is involved with the
health team in the planning of care. A
copy of the current program and plan
accompany the patient on interfacility
transfer.
(a)

Standard: patient long-term program.

There is a written long-term program
representing the selection of a
suitable treatment modality (i.e., dialysis
or transplantation) and dialysis
setting (e.g., home, self-care) for each
patient.
(1) The program is developed by a
professional team which includes but is
not limited to the physician director of
the dialysis facility or center where
the patient is currently being treated,
a physician director of a center or facility
which offers self-care dialysis
training (if not available at the location
where the patient is being treated),
a transplant surgeon, a qualified
nurse responsible for nursing services,
a qualified dietitian and a qualified social
worker.

Well gosh, that doesn't really qualify it to RN for LTC, but some could take it that way. I guess our surveyors consider me qualified to write the darned care plans. Guess I'll have to keep doing them!

[LanaBanana]

In my hospital we are to do daily goals sheets for each pt, which is essentially a care plan. My dilema is that forming a care plan is not within my scope of practice as a LPN. So here I am with my own team of pt's and I'm supposed to write the goals and then have a RN sign them all. I finally said this week that I'm not going to write them out if I can't sign them. This means that now my charge nurse has to do all of mine. I think it's kind of ridiculous because the goals for most pt's is "no falls", "no skin breakdown", and getting whatever labs that are out of whack WNL. There are others that are more specific, but how hard is it to see what needs to happen to keep a pt safe and get them home/well?

[kizzykatlove]

i am a RN and i just plug them into a computer when i do the admit assesment. i do the first care plans and the LPN's can just add a daily notation.

[Daytonite]

Originally Posted by Rexie68

Are you sure, Daytonite? I've been doing it for 3+ years and the surveyors are OK with it. I do the MDS' (an RN signs off on the MDS, but I sign section V where it says RAPS were care planned) and the care plans...I also did the care plan meetings and sign the ICC sheets and notes...many times an RN never signs them.

You are nursing home. That is Section 483 of Title 42 and may be OK. That is not true for acute hospitals.

Title 42, Section 482 CONDITIONS OF PARTICIPATION FOR HOSPITALS, Sec. 482.23 Condition of participation: Nursing services. The hospital must have an organized nursing service that provides 24-hour nursing services. The nursing services must be furnished or supervised by a registered nurse. (b) Standard: Staffing and delivery of care. The nursing service must have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed. There must be supervisory and staff personnel for each department or nursing unit to ensure, when needed, the immediate availability of a registered nurse for bedside care of any patient. (4) The hospital must ensure that the nursing staff develops, and keeps current, a nursing care plan for each patient.

[txspadequeen921]

Well that is just great... If we could just pass this wonderful information to the many nursing homes that I work in as a agency nurse then my load will be lightened. My personal opinion is that this may work in the hospital but wont float in LTC. Many times there is one RN in the whole building (DON) and you know she ain't sitting and doing care plans...There has to be a loophole for this . I know every LTC in Texas does not have a RN doing there doing their care plans.

Originally Posted by CyndieRN2007

As I stated before, in the state of Texas, an LVN cannot initiate a careplan.