Latest Comments by CoffeeRTC - page 2

CoffeeRTC, BSN 17,002 Views

Joined Jan 22, '03. CoffeeRTC is a RN LTC. Posts: 3,635 (24% Liked) Likes: 1,667

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    Do you have any CNAs or pcts? or are the nurses doing total care?

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    Mysilver1 likes this.

    Do you mean sub-acute? When you say acute care, I'm thinking hospital/ med-surg unit. Staffing for acute care is different than sub acute snf, skilled care or LTC. The regulations are very different too.
    If they are truly acute care/ hospital patients...that staffing ratio is insane and you need to check with your state to see if it is even legal.

    In LTC/ skilled or sub-acute, the ratios you gave are pretty much the norm.

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    We got rid of chux (paper and cloth) years ago. The folded draw sheet works just a well. I've seen not change in our pressure ulcer rates with or without them. What is the reasoning behind not letting residents lay on their backs? Are they taking into account the time that they spend sitting upright for meals? are there wounds on that area??

    Our acuity varies in my LTC but it normally is very high in the one unit. Lots of total care, sick residents. The residents that are incontinent wear briefs. No chux = more frequent changing = less wounds due to incontinence.

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    poppycat and VivaLasViejas like this.

    Wowsa! As an agency nurse, I would make sure you know where the AED is in every facility. I give offer that info to all agency staff I tour/ orientate to our facility. I would think that not being able to call out to 911 or overhead page has to be some type of citation...delay of care, quality of life, etc..

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    Gericare25 likes this.

    Quote from Tenebrae
    whats the rationale behind splitting the bottle into two?

    To me thats really dodgy, and puts everyone involved at very high risk of ending up with a narc discrepancy

    Not trying to have a go, just curious
    I see the reasoning. Morphine SL at .25-1ml will go a long way. I'm guessing they have two bottles of it on hand so it is there in case two different people need an after hours dose.

    I have one more question....is the bottle in a box? Our Roxinal comes in a 30 ml bottle with a dropper. It is normally in a box. If it isn't opened and sealed from the manufacturer, I never open it. I would give it a shake.

    I work in a smaller facility so our emergency narcs some in a metal box that has tag locks with numbers on it. It is locked in our med room in a drawer. We do not count it unless we open it for a med. Green tag means it is unopened. When it is opened, we verify the number with the sheet inside. Count the meds against the sheet. After we sign out the meds, a red tag goes on it and the box is locked back up. The only time it is recounted is when we go back in to take out another med.

    I would think that the RN supervisors that have been counting your meds each shift would be the ones they would look at.

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    Paws2people likes this.

    We try to toilet residents every two hours. Same for the incontinent residents...check and change every two hours. Does this always happen? Sad, but no. Staffing is the biggest barrier we encounter. Two CNAs to take care of 24-48 patients?

    Incontinence care is more than just changing a soiled brief. Making sure proper peri-care is provided is important. Hydration in also key. Lots of elders do not drink enough fluids. Private duty care would be awesome

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    AnOldsterRN likes this.

    and I was thinking about taking a sdc/ Risk Manager job

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    Hopefulpsych likes this.

    Why can't the DON just rewrite it?

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    I realize that we would need my mother in law to proceed. She was POA and the next of kin. She is a very reasonable woman and has relied on her faith to get her through this period and I think, for the most part, we are all dealing with this. I think I will always have those moments where I wonder "what really happened?" and I understand that those questions will go unanswered. She did ask the doctor and he sugar coated a lot. He is her doctor too and my husband also went to him. My husband is switching from his practice. (he had to beg for an EKG when he was having chest pain, dizziness headaches, fatigue.)
    At this point, the questions to ask would be what benefit would it have to ask questions? What would it solve/ prove? We didn't have an autopsy done. We don't have a lawyer. I was just wondering what the process would have been.

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    As the title stated, I had a family member die in the hospital. Not recently, it was about 2 months ago. I still have so many questions. Questions the rest of the family do not want to ask. It was my father in law...and I'm just the daughter in law.

    FIL had been sick with a cold for about a week and a half. At 76 he was doing well, had his diabetes under control with diet and lantus insulin (good HGA1C #s), no issues with his cardiac status (he had a cabgx3 about 4 years ago), went to the gym 3 days a week and walked for over an hour, cut his grass...etc. MIL and FIL went to the dr for the cold and she got antibiotics, he got Mucinex..his chest xray was negative.

    1.5 days later, he was cranky, slightly confused and still was coughing. He made MIL take him to the ER in the evening...they admit with bronchitis for antibiotics, steroids, neb tx and o2. Spent 9 hrs in the ER on telemetry waiting for a bed. Gets to the floor and it took another 2.5 hrs until he was seen by a nurse.
    Next day husband visits (I was going to pop my head in the next day) until 9pm, dad was feeling better, mentally clear, feeling better. I would have never thought to come in or even stay overnight.
    We get a call in the AM from a friend (yeah, hippa break) to come in...dad is in the ICU. We get a brief report that he was belligerent and confused around 1am, nurse got an order for Ativan that was given around that time. Next time he was seen was 5:30 am and he was cold, blue, pulseless. Full code...cpr started. He was down waaaay to long.
    The only time I've ever seen him confused was when his blood sugar was super low. I would expect if he was admitted with bronchitis, hypoxia could have also caused this change. He's never taken sedatives before (aside from the surgeries he has had). After two days of the hypothermia treatment, we pulled life support when he had no brain function.

    So...yeah, I know I have issues dealing with a lot of this. Should we have really been told that "they are soo short staffed and the hospital is full" ? That just makes my head spin. This is way after the fact, but what would have been the proper way to ask questions? Who do you approach first? This is a community hospital and at the time, he was being followed by his family practice MD. Does your hospital have a way of helping families deal with this?

    I'm not asking for medical or legal advice, just wondering how situations like this are managed.

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    amoLucia likes this.

    What are you giving at 1 am?? I would kick someone if they woke me up for meds.

    We have 50. I might start at 5:30 am and be done at 7. This would be accu checks, synthroids, prilosec, iv meds and g tube feeds....probably for about 25 or so getting meds.

    12 am pass was very light, but I would also change tubing, g tube dressings, IV meds, neb treatments....and probably be done 1 am -130.

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    Yes, med error for you and the nurse taking off the order. if you don't know what a particular med is, then look it up.

    The nurses following made the error, but they wouldn't have know the med was dc'd unless they got it in report.

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    read the Terms of Service....we cannot give you medical advice.

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    Kitiger, poppycat, and Sour Lemon like this.

    For the most part, we do not wake the residents just to check them. Sometimes there is not need to wake them to check on them. Unless they are on vital signs q shift or more frequent, there is no need. If they have a treatment or iv med timed then that would be a good time for a mini assessment. I do visuals every 1-2 hours when I work 11-7. I'm normally down the hall helping the cnas or giving a prn anyway.

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    NFuser and PierreB like this.

    Your pharmacy should have a policy in place.

    I work LTC. We get meds delivered from an off site pharmacy. The case comes in and has an inventory sheet. We are supposed to verify that we get is on the sheet (blister packs etc) We get a copy, the delivery driver gets a copy. We also sign the hand held computer and a paper sheet for them.


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