What clinical servcies does your LTC facility provide

We are developing a CHF protocol. I am currently writing policies on IV Lasix and IV Solumedrol. We have implemented INTERACT II to try to keep everyone in the building. We do not do TPN because the reimbursement isn't worth the work involved, but I have sent 2 of my RNs to class for PICC and MIDline insertions.

I think working toward policies for keeping residents in the facility is wise. Where I work, residents are shipped to the ER at the drop of a hat. We don't even do IV fluids for dehydration. It's a huge expense and it's very traumatic for the poor, elderly residents.

BUT..... I question how a LTC facility can have nurses administer IV push lasix for acute CHF episodes. How can a nurse who has 40 other residents possibly monitor such a sick pt? Aren't you setting her up to fail?

Brandon...it's a process. I am in favor of IM lasix since it works almost as quickly with fewer chances for a castastrophe AND you don't need to have a line established. Our local hospitals are pushing this so the admissions team is too. I just hired a 3-11 supervisor who will be able to spend the time with a really sick resident.

My facility does IV Lasix, IV Solumedrol, TPN, maintenance weight based Dobutamine infusions, and maintenance weight based milrinone drips. I know it seems scary, but really it's not as bad as you would think. We take LVADs and Life Vests too. We treat acute CHF episodes all the time. Usually, the person gets a foley temporarily to monitor output while on the IV Lasix. We monitor pulse ox, lung sounds and vital signs while acute. For TPN, I require that the hospital have the complete TPN orders to be by 11 am the day they are coming. They also have to supply me with the confirmation of PICC placement at the same time. We also write a prn order for D10 at the same rate as the TPN in case something happens that the TPN can't run. You have to keep it in house stock. We do labs twice weekly, and if the MD prefers, the pharmacy will adjust the TPN formula based on the lab results. For the Dobutamine and milrinone, we call the weight in to the pharmacy each day to get the daily infusion rate. When we started taking these things into the building, my pharmacy provided me with the drug protocols, so I would suggest talking to them when thinking of doing these things. I review each of these referrals carefully to ensure we can provide the care before they come in. Actually, the Life Vest is the thing that hangs me up the most when considering taking the referral. Life Vest does a good job of selling their product, and even though it says in their literature that the candidate should be alert and oriented and able to care for the vest independently, that is not always the case. I ended up with an extremely confused Life Vest resident once, was walking down the hall and heard the alarm that signals a shock and got to the room in the nick of time to stop the shock. The resident had the pads wrapped around his head. We use the Interact II and care paths.