? RE: Starting A Restorative Nursing Program

Consult with the physical therapy department. Also read up on the regs for the State Health Department/Medicare/Medicaid survey guidelines. Physical therapy is over our Restorative nursing department---in conjunction with nursing, but they do the screens and periodic evals to maintain appropriateness and evaluate progress. We have restorative for ambulation, toileting, grooming, and feeding. It is very busy, and they accomplish wonderful things to keep folks functioning as best as they can. We have CNA's who are specifically trained for this. They do a great job! GOod luck with your program.

As a PT working in long term care, i'm excited to see a facility implementing a formal Restorative nursing program. PT is great, but it's up to the CNAs to carry out our recommendations otherwise the patients decline (inevitably if they aren't ambulated) and get bounced right back to PT because "the patient isnt able to walk anymore". We also recommend active,passive and active assistive range of motion to prevent contractures. The CNAs are so busy as are the Nurse supervisors, that often these recommendations do not get carried out. I have been pushing for a rehab nurse since i started but of course the problem comes down to money. So hooray for you (and your facility) for starting a program!
If you have any specific questions about rehab feel free to contact me.

Hello,
I have been working as a Restorative Nurse Coordinator for 6 years in Mississippi. As mentioned earlier, referring to your MDS will help some, but there is alot more info needed to begin this type program. I am not familar with any published info out there, but I am sure there are some available. Working with your therapy department is essential. Residents are usually referred to Restorative by therapy, but nursing can refer patients too, if there is a need.
All patients beginning a restorative program must be initially evaluated (with a form) of course, and then monthly by a liscened nurse. A restorative plan of care must be formulated and followed, indicating individualized, specific goals for each resident.
The RCNA's document daily on the treatment.
Your RCNA needs to be a leader who who can work well with little supervision.
It is essential that your RCNA be able to document well. The specific goals must be included on the RCNA's daily documentation sheet.
Restorative treatment must be done no less than 5 times weekly for atleast 15 minutes, and have 2 different treatments in order for reimburstment. Example: ambulation and bed mobility x's 15 minutes each. AROM and PROM are considered only 1, so if they only have these 2 treatments, you will not be reimbursed.
On the CNA's daily documentation, the following must be indicated: their INITIAL, how the Resident TOLERATED the treatment, any PROGRESS, how much ASSISTANCE they required, and the # of MINUTES spent with them. If ambulation is the treatment, you also need to include the DISTANCE they walked, and how many REST STOPS they required.
The nurses monthly summary should provide an overview of the residents progress for that month. According to how well the resident did, your plan of care should be updated. Example: residents goal for ambulation is 400ft with 2 min assist. Review of the RCNA's daily documentation indicates that the Resident ambulated 4ooft with 2 assist. You would need to change the goal and care plan to increase ambulation to 450ft with 2 min assist.
Restorative is a wonderful program. It is used to Maintain, prevent, or "restore" a function.
example: currently at our facility a man required restraints in his w/c due to a fx leg from a fall. With approx. 7 months of restorative, this man is no longer restrained and is ambulating 700ft 2x's daily with the RCNA's. His agitation and behaviors have improved. He is obese and a diabetic. His blood sugars have improved, and he has therapeutically lost some weight with exercising. He also is noted as going from being incontinent daily to a few times a week.
I hope any of this helps. I have lots of info, and will gladly share with you if you would like. Just let me know of any questions.
kcherryrn

Hello,
I have been working as a Restorative Nurse Coordinator for 6 years in Mississippi. As mentioned earlier, referring to your MDS will help some, but there is alot more info needed to begin this type program. I am not familar with any published info out there, but I am sure there are some available. Working with your therapy department is essential. Residents are usually referred to Restorative by therapy, but nursing can refer patients too, if there is a need.
All patients beginning a restorative program must be initially evaluated (with a form) of course, and then monthly by a liscened nurse. A restorative plan of care must be formulated and followed, indicating individualized, specific goals for each resident.
The RCNA's document daily on the treatment.
Your RCNA needs to be a leader who who can work well with little supervision.
It is essential that your RCNA be able to document well. The specific goals must be included on the RCNA's daily documentation sheet.
Restorative treatment must be done no less than 5 times weekly for atleast 15 minutes, and have 2 different treatments in order for reimburstment. Example: ambulation and bed mobility x's 15 minutes each. AROM and PROM are considered only 1, so if they only have these 2 treatments, you will not be reimbursed.
On the CNA's daily documentation, the following must be indicated: their INITIAL, how the Resident TOLERATED the treatment, any PROGRESS, how much ASSISTANCE they required, and the # of MINUTES spent with them. If ambulation is the treatment, you also need to include the DISTANCE they walked, and how many REST STOPS they required.
The nurses monthly summary should provide an overview of the residents progress for that month. According to how well the resident did, your plan of care should be updated. Example: residents goal for ambulation is 400ft with 2 min assist. Review of the RCNA's daily documentation indicates that the Resident ambulated 4ooft with 2 assist. You would need to change the goal and care plan to increase ambulation to 450ft with 2 min assist.
Restorative is a wonderful program. It is used to Maintain, prevent, or "restore" a function.
example: currently at our facility a man required restraints in his w/c due to a fx leg from a fall. With approx. 7 months of restorative, this man is no longer restrained and is ambulating 700ft 2x's daily with the RCNA's. His agitation and behaviors have improved. He is obese and a diabetic. His blood sugars have improved, and he has therapeutically lost some weight with exercising. He also was noted as being incontinent daily to now only a few times a week.
I hope any of this helps. I have lots of info, and will gladly share with you if you would like. Just let me know of any questions.
kcherryrn

Sorry, I hit the submit button twice!!!
kcherryrn

Hi julie1014;
I also have been given the opportunity to start a RNP in my facility. How has yours been coming along?

Julie
You had asked for some of the forms we utilize at our facility......Sorry it has been so long I have not had "computer time" if you know what I mean....
Do you have a fax number so that i could send you some samples?
Hope all is going well.
KCherryRN

we have a good program at our facility. so if you need anything, please email me. i am also in pa. i may be able to help you.

HI!
WE ARE TRYING TO REVAMP OUR RESTORATIVE NURSING PROGRAM. I HAVE BEEN IN LONG-TERM CARE FOR OVER 25 YEARS. STARTING AS A C.N.A. 25 YEARS AGO AND HAVE BEEN A NURSE FOR MANY YEARS. NOW I AM A NEW ADMINISTRATOR OF 1 YEAR. I THINK IT IS VERY IMPORTANT TO HAVE AN EFFECTIVE RESTORATIVE PROGRAM.
SO MANY TIMES I HAVE SEEN THE RNA PULLED TO THE FLOOR WHEN THEY ARE SHORT. WHICH TAKES AWAY FROM THE INDIVIDUALIZED PROGRAM SET UP FOR EACH RESIDENT. THIS IS A BIG NO-NO IN MY BOOK EXCEPT AS A LAST RESORT

IF ANYONE HAS ANY FORMS OR INFORMATION TO SHARE. IT WOULD BE GREATLY APPRECIATED