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This is a discussion on ? re-med "a" in Geriatric Nurses / LTC Nursing, part of Nursing Specialties ... We've been told we must do anything we can to keep our beds full-we accept admissions at any hour...by ktwlpn Sep 29, '10We've been told we must do anything we can to keep our beds full-we accept admissions at any hour of the day (or night) and day of the week.Our admissions staff are aggressively recruiting (sounds like the NFL,doesn't it? ) short term skilled rehab and respite care residents. The social worker told us today that our Medicare "A" people should be self administering meds. Anyone ever heard of this? All of the residents have the right to do so but we can't MAKE them can we? We never did it before with Med A people-is this something" new and improved" like MDS 3.0?
PS-we heard thru the grapevine that our facility is also trying to bring in a dialysis company-in the old cafeteria-LOL! Sounds like a can of worms to me -unless it was completely dissassociated from us.
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- Sep 29, '10 by Copper4If they are capable of giving out their own meds, then why do they need rehab-- I am still in the learning phase about the new MDS twists, but complex medical patients are important, and I think ADL needs are going to be weighted at higher rates. i too am not sure who are the best to take these days when there are actually choices ...sometimes there are so many empty beds, anybody looks good.
- Sep 29, '10 by ktwlpnquote>>>anybody looks good>>>quote Ain't it the truth? We recently admitted a resident whose family had taken her out of THREE local nursing facilities because they were not happy with the care in any of them- THREE! And now the DON wonders why the administrator and she are getting nasty phone calls and letters from the daughter. Boggles the mind,don't it? Didn't they expect that her behavior would continue in our facility or did the DON really believe we have magic water or something? It's tough enough to keep up with the regs,our new p and p ( which are popping up like stink bugs) I'm tired....Thankfully it's my drinking night.
- Sep 30, '10 by pielęgniarkaI haven't heard that self administration of medications is a requirement for Med A folks. However they tend to be the majority of A&O residents so it would make sense that they at least would be more likely to self administer, at least after nursing set up.
MDS 3.0 is all about resident interviews and choices, I've looked through the RAI manual over the past couple months and didn't see anything about self administration of meds in there so I don't know where the social worker's statement would come from.
I also just want to say you are not alone!!! We are also accepting all kinds of train wrecks into the facility, just to fill beds. The hospitals are dumping their worst patients on us with just a few hours notice. What gets me is that most of the patients are kept in the hospital for 2 days "admitted" and 1 or more day(s) "observation" so when them come to the skilled nursing facility, Medicare won't pay due to no 3 day admission. So then on top of very ill patients we have stressed families trying to figure out how to pay, helping them to appeal or apply to MA.... It has been a difficult year....
- Sep 30, '10 by debRN0417Residents have the right to self-administer medications ONLY if they have been assessed by the interdisciplinary team as SAFE to do so. If they are assessed as safe then they may CHOOSE whether they desire to self-administer or not. Then they must be care planned and there has to be some type of safety measures put into place to safeguard any medications that are left at the bedside.
- Sep 30, '10 by CapeCodMermaidAs far as I know, and I've been doing this longer than many of you have been alive, there is no reg. that residents MUST administer their own meds. Certainly, as the previous poster said, they have the RIGHT to, if they are assessed and understand what they are taking and why they are taking it. Med teaching has always been an important part of what we do in SNFs and MDS 3.0 has not changed that.
- Sep 30, '10 by ktwlpnQuote from debRN0417That's what I thought-We have had a few residents preparing for discharge self -admin meds.We don't leave anything at the bedside.They are responible for presenting themselves to the nurse at the appropriate times and we then hand them their vials of meds on a tray and observe them. This social worker seem to use it as a weapon.Both of the residnts she is pushing to self medicate are people that we don't feel are cognitively capable of doing so.She often says "we are NOT in the business of discharging people" so maybe having them try and fail is her goal. The former has support in the home and the latter is looking into the waiver program and has a supportive family whom set her meds up in the "days of the week " boxes -something she says we "are not allowed to do" They must know exactly what to take and when with no prompting from us. So tired of fighting against people-we should be fighting together for the benefit of the residents. Thisparticular social worker also hates hospice-we have had a few heated discussions about it.Never in my years there have I ever had the support of a social worker during a difficult time on any unit.They are"too busy" to come and offer support during an end of life situation-Measuring residents for new bras or shoes or browbearting someone for "misbehaving"Residents have the right to self-administer medications ONLY if they have been assessed by the interdisciplinary team as SAFE to do so. If they are assessed as safe then they may CHOOSE whether they desire to self-administer or not. Then they must be care planned and there has to be some type of safety measures put into place to safeguard any medications that are left at the bedside.
- Sep 30, '10 by ktwlpnQuote from CapeCodMermaidHEY! I look and sound younger then I am-you crone.Ya think I fell of the haywagon yesterday? You would think MDS 3.0 is the end of the world to hear our social worker tell it.It's "just going to be awful"As far as I know, and I've been doing this longer than many of you have been alive, there is no reg. that residents MUST administer their own meds. Certainly, as the previous poster said, they have the RIGHT to, if they are assessed and understand what they are taking and why they are taking it. Med teaching has always been an important part of what we do in SNFs and MDS 3.0 has not changed that.
- Sep 30, '10 by CapeCodMermaidWe ARE in the business of discharging people. Not every one needs to live in a facility for life. We get them to be as good as they can...we hope at least better than when they came in and we send them home. I don't like your social worker and I've never met her!
- Sep 30, '10 by Nascar nurseQuote from CapeCodMermaidI second that. Who put your social service in charge of the facility? I can bully a bully right back & I nearly always win! (evil smile)I don't like your social worker and I've never met her!
Our discussion at work today
We currently have a resident that would seem to be completely cognitive & is insisting that he be allowed to keep meds at bedside and self administer. States if we don't allow him to do this he has a whole list of stuff he is going to tell state at next visit (a common threat to get us to give into his demands). Problem is even tho he would probably pass a self administration assessment, he has had to be readmitted to us twice in the past due to "messing up" his medications at home and getting into trouble. Both times coming back to us much sicker then we discharged him just weeks before.
I say we should just careplan this history and the probability that he is unsafe as well as the manipulative behaviors and let it be. Agree?? Opinions