CoffeeRTC, BSN 15,479 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,556 (23% Liked)
If the CNAs refused to adhear to the turning and repositioning what is being done about that?? The nurses need to be making sure it is getting done.
Who is in charge?
Just wandering..what did you do for the chest pain?
Getting back to the order.....my advice..get over it. You will have docs that love to write crazy orders like that. "Brush res teeth after meals" "soak dentures at hs" "extra blankets when cold" I've seen my share and just laugh.
I would make sure the DON knew of the order.
How does a LTC get away with carpet in the res rooms? We need an infection control policy for fall mats beside a bed...is there one for carpet cleaning?
As far as this resident...I would def be making sure she stays on a toileting plan. Even if she refuses..you have to try it.
Febreeze is your friend. Since it is in the carpet, you would need the stuff for fabric freshening. I'm sure they have an industrial deoderizer like febreeze to use. Housekeeping should be in that room alot.
We are not permitted to use air fresheners, but I keep a bottle of febreeze spray for touch ups. I don't care what you do..there will still be odors on occasion..we all have them at home. I let the CNAs use it in the rooms if they are semi privates and need to freshen the air during changes.
They might be hanging out with all of the IV poles.
As far as pillow use in LTC centers....where dothey go? Its not like we are a hospital with multiple floors and people coming an going. This is a mystery to me.
As fas as cutting down on the need/ use for postioning....we have started ordering different positioners that really work much better than pillows. Blue foam pieces that are sturdier for floating heals and wedges for side positioners. Instead of needing 2 or 3 pillows to elevate heels and one between the knees and 3 more behind the back..
Deep breath....First off..congrats for staying alive in LTC. I've been doing LTC for more years than I like to admit. It is very demanding and just being able to think straight after some shift is a win.
Before you go into the meeting..think about how it happened and what could have been and should be done differently next time. When I get an order to hold a med, we turn the cards around in the drawer and right hold on the MAR nice and big.
The ativan...that isn't really an error. Has anyone looked in the narc drawer of LTC med cart??? Horrible...some people have mulitple cards for the same meds but could be at differnt times or one is prn and one is straight....it is a night mare.
What I do to organize mine or make it easier to find what I need is to turn the cards that are DC's around, turn the cards that are standing orders around after I use them or when I give a prn and can't give it again...it eliminates a lot of looking thru cards when trying to find the meds. I try to remember to turn them around when we count at the end of the shift so I don't get weird looks...hey..its my system and it works!
None of our admits are even scheduled to be on 7-3...never ever. I understand the hospital is a busy place and they wait for docs to round to DC but most of these residents are expected and planned discharges from the hospital and admit to the nursing centers. Why can't it happen.
When we do get them they come in at 2:30 (change of shift) or then they are expected at 5pm (dinner) but son't come until 7-8 or 9pm!!!
We do not have pharmacy in chouse...they are 1hr away for a STAT STAT( not a slow STAT or a ha ha..you want that STAT) and of course they are day 2 or 3 post op hips or knees and need the pain meds etc.
I'm sorry...I thought it was funny/ cute. They probably had a great time doing it and I would gather they are a great bunch to work with...looks like they have fun getting their jobs done and work as a team.
Yes...you still need an order. Why didn't you just write one after you talked to the doc in the am?
"Hey Dr so and so...I just sent Mr X to the hospital for xyz...he was a full code and going bad fast. Can I write that order to transfer to the hospital now?"
There is no way in heck that I'm going to wait for a order to send someone to the ER in an emergent situation. I've worked many a shift where this was the case...never got in trouble for it ever. Just write the order after the fact put a note in the chart indicating such.
I don't mind that the times have changed and the acutiy is different. I actually enjoy it. What I do mind is that the staffing or regs haven't changed. 10 years ago, when we had more LTC residents with dementia and bed sores and no one was discharged unless it was to a funeral home....the staffing was just about the same. Yes, more total cares then but with the sicker, younger residents and the "customer" service requests (not nursing care requests) the staffing needs to change.
I honestly thought is was really only my place that gets the poorly arranged admits on 3-11 shift. LOL. I don't know why we can't get the process to go better always seems like some info is missing or they are coming so late that it is a cluster getting things from pharmacy.
Yes..we get the late night admits and transfer assessments need to be done. Thanks heavens most will just tell us how they've been doing in the hospital and we go from there. Sometimes you can find good info in the hospital PT records or the info you get with the referal from the hospital.
Could she have been an RN? Is that a separate search? Did you try and look at the CNA registry too?
Are the patient/ parent complaints being passed on to the practice manager?
New employee will figure it out.
Do it all the time..but I worl LTC and the docs only come in once a week or so.
Its all in your approach. Ask and ask the rational behind it...not all docs are idiots and there many that would be willing to go along with what is suggested and offer a rational for not being in agreement.
Again....all in your approach.
Sounds like you are in LTC with that many patients. Go over to the LTC fourm and you will see tons of advice for this.
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