I am a new ADON in an LTC center and am the unit manager for the Skilled/Rehab unit. In the month I have been there, I have found that serious care issues are falling through the cracks and changes in condition are being missed.
In an effort to stay on top of these changes and improve the quality of care, I have been working with my assistant nurse coordinator in developing a plan to implement DAILY NURSING ROUNDS. He and I plan to review 8-10 patients each day from 0900-1000 on Monday-Friday. This way each patient would be reviewed once by the end of the week (full house is 42 patients).
We plan to review nurse notes, weights, nursing assistant documentation, compare the MARs with the orders, the treatment records, changes in continence, mental status, labs, pain, and general appearance of the patient's room. Unfortunately, this allows only 6-7 minutes per patient if we are hoping to round in one hour or less. Daily rounds on each patient would be ideal but that's just not realistic.
Does anyone have any suggestions on either improving this system or implementing another system that would address the same problem but possibly in a different way? Thanks for your assistance!
Apr 11, '09
How about having your nurses put a copy of all new orders, and admissions in a basket solely for you and your assistant. You and your assistant can review these during the day as things occur, and flex your time to come in early to review the orders/24 hour report and new patients before your morning meeting. I have seen that if you come in earlier and flex your time, you can concentrate and focus your attention on the patients and what need to be done. Once the regular work day starts, it is a rollercoaster and a race you have to pace yourself to stay on top of things.
Apr 12, '09
Thanks for the input! Unfortunately, we are already doing that. It works well but the things that are falling through the cracks are the things that aren't being addressed or aren't being brought to the doctor's attention (i.e. progressive mental status change leading to decreased oral intake and before you know it they are hypotensive and then that is brought to the doctor and she starts an IV).
What we are trying to do is find a way we can pick up on the subtle changes or smaller issues so that we can address them before they become big issues.
Apr 15, '09
At the last place I worked, each department head, unit nurse managers and others met every am for a short time to discuss residents. The 24 hr report was used and others' observations about the residents was discussed. For example, the activities people often picked up changes and important observations in the residents and reported these in the meeting.
May 15, '09
it is so refreshing to hear that you are all about patient care !! most of the Administrators in LTC only care about cutting costs !!
May 16, '09
keep a log of all problems encountered and have a weekly meeting of unit heads to discuss them and come to conclusions how to prevent further mistakes and problems...