State Survey

leslie :-D · May 23, 2004

one thing i used to do is prioritize.... any interventions i applied, from a conversation i had with mds, nps, don re: pt. issues, i documented. that was key for me. monthly summaries were low on my priority list, even w/the quarterly turnaround. and i was literally bullied by my higher ups but i gave only what i could give, period. so no, we cannot do it all. just prioritize and do those things that directly impact pt. care 1st.

leslie

NursesRmofun, ASN, RN · May 23, 2004

Perhaps if you didn't put in 55 hrs. and things weren't perfect then the state inspected theywould see the reality of what we do, along with the great need for mandatory safe staffing levels. As long as we all run around like chickens with our heads cut off before these inspections making things look perfect only to return to the norm when they leave, the state will never get a accurate picture and mandate or legislate for changes. Perhaps of the hospitals got huge fines because of the errors that are covered up during inspections then we would see changes.

Well, it wasn't anywhere *near* perfect even with my 55 hrs. in! Too much to do like someone else said. I can't be 25 places at once and can't do 25 things at once. It was far from a perfect or good score.

NursesRmofun, ASN, RN · May 23, 2004

one thing i used to do is prioritize.... any interventions i applied, from a conversation i had with mds, nps, don re: pt. issues, i documented. that was key for me. monthly summaries were low on my priority list, even w/the quarterly turnaround. and i was literally bullied by my higher ups but i gave only what i could give, period. so no, we cannot do it all. just prioritize and do those things that directly impact pt. care 1st.
leslie

You are so right! Those are the priorities. And I have learned a lot from this experience, even if I don't stay in this position.

NursesRmofun, ASN, RN · May 23, 2004

I agree that documentation is crucial, in my facility however, there is soooo much work to do, so many medications, so many needy residents, needy families, so much everything! There just isn't enough time in an 8 hour shift to get everything done. If we aren't punched out by 3 pm, we get a note of reprimand in our paychecks about " unauthorized overtime"! If we ask for authorization, the administration says " no"! What's a nurse to do? As for me, I haven't taken a break in 15 yrs, only my 1/2 hr lunch. I give till I can't give anymore! Any ideas?

I agree 100%! It just can't all be done with the staffing we have! Not even supernurses can get it all done without putting in extra hrs. and not even then! Even staffing that is not the worst just doesn't cut it. You have to have a certain ratio to get it done right.

BHolliRNMS · May 23, 2004

I agree the med nurses and the cnas are the busiest people in the home. Documentation takes a team effort. A few ideas to help be sure you have needed documentation are:

Have the RD review all residents with pressure ulcers monthly.

Have the treatment nurse or Charge Nurse write a weekly progress note on a flowsheet to show the progress or lack of ----ours is just measurements, descrip draingage, etc. real easy to complete...no narrative unless there is a major change and they update the careplan at this time.

Have the treatment/charge nurse review orders weekly to be sure you are treating with vitamins, supplements, pressure relief devices, etc and that you have labs as CBC and prealbumin levels.

The MDS nurses are given a report weekly on which residents have pressure ulcers. It is their responsibility to check the careplans and to determine if a siginificant change MDS needs to be done.

Our weight committee meets weekly and they also review all pressure ulcers and update the careplans and recommend new interventions. All our residents with pressure ulcers receive a weekly weight.

NursesRmofun, ASN, RN · May 23, 2004

I agree the med nurses and the cnas are the busiest people in the home. Documentation takes a team effort. A few ideas to help be sure you have needed documentation are:
Have the RD review all residents with pressure ulcers monthly.
Have the treatment nurse or Charge Nurse write a weekly progress note on a flowsheet to show the progress or lack of ----ours is just measurements, descrip draingage, etc. real easy to complete...no narrative unless there is a major change and they update the careplan at this time.
Have the treatment/charge nurse review orders weekly to be sure you are treating with vitamins, supplements, pressure relief devices, etc and that you have labs as CBC and prealbumin levels.
The MDS nurses are given a report weekly on which residents have pressure ulcers. It is their responsibility to check the careplans and to determine if a siginificant change MDS needs to be done.
Our weight committee meets weekly and they also review all pressure ulcers and update the careplans and recommend new interventions. All our residents with pressure ulcers receive a weekly weight.

Thanks for your thoughts. Much of what you said, we do regularly too. We had a combo of last minute things that happened or were missed in the week or two before the survey began....last minute misses...and the other thing was something you always mean to check but never have the time, and then they came unexpectedly, and it bit us in the butt. Then paperwork was somewhat unfinished or misplaced and all things added up.

BHolliRNMS · May 24, 2004

DebbieMig, there is way too much for nurses to do in ltc! My focus this year has been to try to help the docs remember that we are LTC, not a hospital. Our local hospital has a nurse:pt ratio of 1:8. Ours is 1:30. So, we have taken a close look at how often we are doing FSBS, how many residents are on I/O, how many with daily vs etc. and have tried to cut back on some of this when safe to do so for patients who are not on the skilled unit. I also review all meds of residents on 9or more meds at least quarterly and work with the doc to get some dc. Am trying to teach the staff nurses to do this also. ex....vitamins can be d/c once a decub has healed, some residents on two bp meds and bp always on the low side.etc.

donmomofnine · May 30, 2004

I think my state survey will start on Tuesday. Only have been a DON for six months, so I am scared. Always worked 3-11 and the surveyors were always gone when I came in, or shortly after!

debbiemig · May 30, 2004

The one thing I can recomend is, don't elaborate on any answers. The surveyors love it when you talk too much! Just answer in exacts. Wash hands, wash hands! Think of it as a learning experience!

I think my state survey will start on Tuesday. Only have been a DON for six months, so I am scared. Always worked 3-11 and the surveyors were always gone when I came in, or shortly after!

leslie :-D · May 30, 2004

The one thing I can recomend is, don't elaborate on any answers. The surveyors love it when you talk too much! Just answer in exacts. Wash hands, wash hands! Think of it as a learning experience!

aaarrrgghhhhh!!! i remember the 1st year i was employed, i had to do the walkthrough with the surveyor, giving a brief hx of each patient. i just rambled on and on and on........i was never asked again after that. :rolleyes:

leslie

NursesRmofun, ASN, RN · May 30, 2004

I think my state survey will start on Tuesday. Only have been a DON for six months, so I am scared. Always worked 3-11 and the surveyors were always gone when I came in, or shortly after!

Good luck! Our surveyors seemed to be looking for the appropriate interventions and preventative measures being in place! Check on those!

donmomofnine · May 30, 2004

Good luck! Our surveyors seemed to be looking for the appropriate interventions and preventative measures being in place! Check on those!

That's what I am counting on! I have put in place a new fall prevention and intervention team, reducing psychotropics and new policies for that, reduced to only one restraint, a best practices pain management protocol. Saw many problems and started on many action plans. I hope this helps. Also, my administrator/COO will be in PERU! Geez! :uhoh3: