A really boring question!

[ComicRN]

OK....so this isn't a really exciting topic but I need help!!!

I'm the clinical coordinator of a 46 bed LTC unit (in a 414 bed facility). We (and the majority of the other floors) are having a hard time getting compliance with the CNA's and nurses filling out I & O sheets at the end of the their shifts (or even during the shift).

Does anyone have any words of wisdom as to how you do it in your facility? We can't put the sheets on the outside of the resident's doors because that's a dignity/privacy issue. The majority of our residents eat in the dining room on the floor, so hanging the sheets on the inside of their doors would probably cause everyone to forget to fill them out also. At any given time we only have 5-8 residents on I&O, so you wouldn't think it would be that hard, but it is!! Often, the CNA clearing away the tray is not the primary aide for that resident and may not know that he/she is on I&O.

ANYWAY......anyone have any good ideas? We have out state survey coming up pretty soon and the administration is getting pretty uptight about this!! (And you know what rolls downhill!!)

Thanks in advance!

Jan

[KlareRN]

Jan-

Maybe this will help. We use our food consumption records that the aides fill out after meals. There is a place for each meal for liquids to be recorded. The aides document liquids on everyone-not just those on I&O. (Those on I&O also have a different colored consumption sheet to help remind the aides that outputs need recorded for this person also. But-outputs are not documented on this sheet.)

Outputs are recorded on the CNA assignment sheet. (A sheet that lists each of the res. the aide is responsible for with a brief description of care highlights including toileting programs, type of diet, etc)

The MARs have a place for the nurse to document on those that are on I&O (No seperate form). The nurse is responsible to check the consumption book for intakes and the CNA assignment sheet for outputs. (This also makes them more aware of consumption.) I also think the nurse should remind the aide that he/she needs that documentation. The nurses seem to complete the actual MAR better than seperate flow sheets. Less holes!

If you would like to see a copy of the consumption forms or the CNA assignment sheet- E-Mail me and give me a fax #. I will send you one.

PS- Also use a different colored consumption sheet for insulin dependant diabetics for carbohydrate replacement. Has worked great!

Hope this helps-

Klare

[Vicki30CNA, CNA, LPN]

At our facility we have a book that all meals are charted in directly after the last persons tray is off the cart. All residents names are in it in alphabetical order and if they are on I&O an I&O sheet is right before their name so you can calculate straight off their tray.

[bandaidexpert, BSN, RN]

ComicRN: I don't know if New York is the same as Florida, but we don't have to keep I & O's without an MD order. This went into effect about a year ago. But I share in your frustration with the incomplete forms, I am constantly getting Bowel & Bladder retraining forms returned incomplete. Good Luck

[tex]

At our facility, we had a terrible problem with getting the CNA's to not only document on the residents they were responsible for, but a few were suspended for filling out the sheets prior to delivering care. So our DON, created a new nursing form that all 3 shifts qd have to document on, it is a check or inital system. That way the nurse has to communicate with their CNA's and there is actual communication for the most part. It will never be 100%. The only book that the CNA's document on is our B/B program, and only the first and second shift have to do this, since the program is done daily between 8a to 10p, whether the resident is prompted or scheduled. The night shift, documents on the same form the other shifts do, but what they have to do, is take a problem stated in the care plan and address it. Just one problem, unless there is more the nurse wants to do, which is not likely.............Tex

[kcherryrn]

Our facility uses the diet sheet to help capture I&O. The nurse will highlight which Resident needs to have I&O recorded at the beginning of each shift. When the CNA is documenting the meal intake (while picking up trays) they see the highlighted name and know that they need to record the fluid intake. (we don't record I&O on all of our Residents.) Works well for us.

kcherryrn

[unknown99, BSN, RN]

I do not work in LTC now, but we had that same problem when I did. One place I worked had the dietary aides do it when they collected the trays. Worked wonderful.

[leslieanne]

At the hospital where I've had clinicals, we had a simple system.

The form is bright yellow and folds in half, like a little brochure.

all food items are listed along with number of calories, grams of protein etc.

After the pt. has eaten and before you clear away the tray, you write how many portions of x was served, how much was eaten. this happens at every meal and snacks are recorded as well.

night shift adds it all up.

no problem.

there's my two bits. Les

[leslieanne]

In reference to previous message.

Forms are kept on bedside table, which I guess doesn't work if everyone trots off to the cafeteria for lunch.

I would think that whoever brings the trays to and from would have to do the forms.

Assign x number of pt.s to each tray bringer.