CoffeeRTC, BSN 15,863 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,578 (23% Liked)
I have to agree, he is probably weaker in the evenings and requires more assistance.
How is he being taken care of when he is OOB all day?
I think the MAR is appropriate place to have it noted and boxed off. I think it should probably be more specific too "Call/ notify MD with an update on recent behaviors or xyz"
I also place a note in our appointment book so that the desk nurse aka charge nurse is aware that a follow up needs done.
Ask the MD what their reasoning is for refusing to manage the pain?
In LTC we have a medical director we can go to for issues like this.
Get the family involved?
Pop the pills out of the bubble while checking against the MAR. Initial MAR, walk in room to give to patient. If they take all of them...good. If not, we circle initial and not on the back of the MAR why it wasn't given.
Doesn't everyone love a change of shift admit? LOL.
3-11 is the best shift for admissions...1 okay, 2 is iffy and when we get 3 or more...forget about it! Prioritize what needs to get done...initial meet and greet, orders verified and meds ordered. Nursing assessment and then skin check. Other assessments can be done after those are finished. Sometimes those get pushed to the other shifts. That is just life.
Don't sign what you didn't do. Either make a note on the assessment what and when you did it or redo it completely.
Well, you have us all confused with the little details. I'm going to try and guess at a few things.
MDS nurse....so you work in LTC? Was it false documentation from another nurse? Did they use your name on documentation?
I'm not sure what would make you leave so abruptly and abandon you position. I've been pulled into some deep situations but still have to scratch my head on what would make you up and leave? Did you give report to another nurse that was qualified to accept your duties? Did you call you malpractice insurance provider right after you left?
Yep. I press #1 for provider if it will skip the wait time. I work in a LTC and we are the ones who call things in for the MD.
Never had a problem.
Could you or should you? You can do anything you put your heart into, but should you....probably not.
Reports of abuse must be dealt with by the director. I would absolutely follow up on that report.
In my 20 years of LTC, I've never had EMS refuse a transport to the hospital.
We call 911 for emergencies and all others we call a local transport agency that is staffed with both EMTs and Paramedics. If they only have an EMT crew available and the situation warrants a paramedic or if they cannot give us an ETA, we are often told to call the local 911.
When you call for a transport, you should be giving a mini report: Why does this patient require transport to the ER?
If it is not a 911 full code/ cpr in progress/ circle the drain type of event....I call the family, make mini chart copies (one for ems and one for ER), call the ER for report etc. If things are going down fast...it is a 911 call and after they get in and assume care, then i make the calls.
Treat all EMS with respect. When they come into your facility greet them with report, go to the room and go over your assessment and why the MD ordered a transfer to the ER...give them the baseline of the resident and most of all...make sure the resident is ready (not soiled)
I've been considering getting my certification for school nurse. In some areas it is a very difficult position to get. (Pittsburgh area)
Many school districts pay along the lines of teachers salary.
We still use paper charting in our facility.
We have a separate order in the MAR that says Check PT/ INR before administering coumadin. It is timed for the 3-11 shift.
The 11-7 nurse redlines all of the charts nightly too. This would have caught the error if you had wrote an order for it but didn't take it off.
We also have a binder where we schedule the labs. When the lab comes back we are supposed to check it off and not if the MD was called and we got new orders.
Since this is LTC, most nurses get to know the resident. Why didn't anyone realize they weren't getting coumadin? It's easy to see on the paper MAR. All the old orders are there and marked off.
Wow...stick with that place if you get the 40 days. That is very generous! There are many threads on this subject in this section..browse thru them to get a little more.
I would make a time line to plan the shift.
7a- 730 Report/ get cart ready
730-8 check for appointments/ therapy schedule..do a quick round to check residents/ treatments
8am -1030/ 11 am Med pass and treatments
11:30 start noon meds and accu checks
12 help with lunch
charting/ follow up calls etc until the end of the shift.
In the morning..residents might be going for therapy or dr appts..try and get them first.
What sad is that some of these things are still common in a good bit of LTC facilities and the VA systems.
Hmmm...is the money good? Do you have any team members that are supportive or on board with the changes? If the answer is no....i'd use my running shoes!
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