CoffeeRTC, BSN 16,209 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,612 (23% Liked)
Wow, it has been years since I have see this! We used Polysporin and Santyl.
Google it and you will find a bunch of links. Collagenase SANTYL(R) Ointment | The Continuous, Active Micro-debrider
after cleaning the wound, we would sprinkle the powder and apply the santyl.
Most of us, especially after working in healthcare, have MRSA in our groins and arm pits etc. It's a community bacteria. We did a test when I was at university and swabbed each other. A good 60% of us had it in our nose, groins, armpits. It's susceptible patients that are at risk and it's just unfortunate. It doesn't mean you have to not work.
OP....come back and explain yourself! Why is this so important to you?
When the DR is out, does care suffer? Do other Drs pick up the slack or is there a huge delay of care?
As far as worrying about the paramedic, their base would be sending out calls if they needed them back asap? EMS crews work in pairs in my parts, where is the other one while this is happening? If anyone should be concerned, it would be his partner.
We have very little standing orders in LTC except with our diabetics Totally different world than acute care, but often times we get new admits that are newly diagnosed.
A critical reading is retested via finger stick (stat labs take at least 3 hours) and then treated via standing orders. No wait time. (5 minutes tops to access the needed meds)
GI bug is hitting our ltc bad. Good thing I haven't been working for a while. Bad thing..3 of my kids have been down with it.
Rarely to I get sick. I had it a month ago. Not sure if it is the noro.
Is this in addition to an event/ incident report? Why is is so long? Is is all about the falls or is there other material on the form that doesn't really apply?
I've filled in for our risk manager and I have a new appreciation for what they go through when investigating events. Since I am also working on the unit, I have a good idea of what the resident is like. Someone that doesn't work the floor, won't have this picture of the resident or unit. I really don't like the forms we use for events. They are way to broad and leave it up to the nurse or witnesses to fill out a narrative of the event. Things get missed and not noted. That being said, I can see how things need to be streamlined.
We have bed/ chair alarms, but I'm not sure if it really does cut down on the falls. The alarms are only effective if 1. they are actually turned on and 2. you have the staff to respond to the alarm. As far as interventions.. start from the top and work your way down.
When does the fall occur? is there a pattern? toileting issue, pain, hunger etc. Are they trying to get up to leave for work? (we had a dementia resident that was trying to get up to get ready for work around 4:30 am...solution was to get them up and dressed, out of bed and get an early breakfast)
Where does it occur? Are they being left in the dinning room unattended after dinner?
Look at positioning....are they trying to stand up because they haven't had a position change and are getting sore?
Are the W/C or bed wheels locked?
Are they bored? Is activities involved?
We don't use restraints either. We have 1 or 2 residents in a geri chair for comfort/ request and on occasion use a merrywalker (resident can get in and out of it on their own) so it can be tricky to prevent falls.
Yikes. I need to recheck our policy. We do accept meds from home, but it normally for our respite patients that are only there for a week. I don't recall using narcs from home except with a hospice patient. I understand the position you might have been in. Often times we get admits on the weekend, pharmacy is taking forever to even answer the phone, doc is taking forever to call in scripts (if they didn't come with them from the hospital), you have the order for them, the resident is clearly in pain and has a need for them, it is easy to look the other way while they pull one from their purse or family might bring them in from home. BUT....I also see how this can go wrong, and it not being legal etc.
Don't stop caring and remembering why you are there. It is so easy to focus on the daily tasks and responsibilities and get over whelmed.
...and I'm the nurse that gets those patients admitted to my SNF for rehab....minus the Ativan, minus the Ambien, minus the Dilaudid/ Percocet/ Vicodin.
Yep, they were on all of those in the morning and might have even got their prns that morning. Now it is 7pm and I'm in the middle of doing their admission. Try getting an order for any of those.
Do it!!! I've been an RN in LTC for ever, so I see where you are coming from. If you are worried about the less pay...you can probably pick up hours prn at your current facility or any other.
Sigh, yet another post blaming the LTC facility. Granted not all LTC's provide stellar care, but not all hospitals do either. I don't think it matters what the care setting is some places are great and others, well not so much. Not to mention that there are instances when that pressure ulcer is just about unavoidable due to a variety of reasons such as patient noncompliance and natural disease process.
Case in point is Christopher Reeves. This was a relatively young man with the money and means to acquire the best care possible and yet he still developed a pressure ulcer, it was pretty widely reported at this time of death that complications related to this contributed to his death.
Another case in point that I have first hand knowledge of is an elderly gentleman in my SNF. He is known to be noncompliant and suffers from dementia along with his multiple physical ailments. His noncompliance with cares involves striking and kicking at staff. He was hospitalized a few days. While we don't ever restrain a resident in our SNF the local hospital has no such restrictions and this gentleman had his feet and hands restrained during cares. When he returned he had a pressure ulcer on his heel that subsequently required surgical debridement and multiple rounds of ABX. Amazingly, with the good care we were able to provide this hospital acquired pressure ulcer eventually healed. It took months, but heal it we did.
So rant over. I guess my point is that not all pressure ulcers can or should be blamed on a LTC facility. They can develop at home, in assisted living settings, in an acute care hospital and yes, in a LTC. No matter the living arrangements the root cause of a pressure ulcer is not always a matter of poor care.
Ruby Vee hit the nail on the head. Critical thinking....is asking why and what else? In LTC, you do more focused assessments and a lot of times you can miss the big picture. It is also about priorities. There are a million things to do, but if you have someone that needs meds, ivs, labs....those simple dressing changes are going to have to wait.
How big is your unit/ facility? I am in a 50 bed facility.
MDS nurse should do just that. I can't imagine having enough time to do anything but MDS, care planning and updates for managed care.
We have a referral manager/ admissions coordinator. This person does just that. They visit hospitals and make calls. They are more of a sales/ marketing person. Not a nurse.
We have not admissions nurse. We try to staff with 3 nurses with the RN being the charge nurse and handling the admissions.
Definitely head over to the LTC section to read up. Report is going to be vastly different than acute care and will depend on two things. Has the nurse had the assignment before and are there new residents?
New admits...They get more attention. I will give a complete head to toe report more like the hospital report. Age, past medical hx, significant info from the hospital stay, why admitted to our snf, LOC, diet order, meds whole or crushed, transfer status/ assistance needed, wounds, etc.
Regular report...we go down the list/ hall/ room assignment. If there is anything new (labs, orders, falls, etc) then we list it. If not..we move on. Report and assessments are very focused.
If I haven't worked in a while, I go in a few minutes early and check charts and get my own little report before actual report.
My cheat sheet just lists room #, name and a section for notes.
Yep, you were right in this situation. The order said to call.
You will learn the docs quirks. Some want called for every little thing and some will give you leeway. When in doubt, always call them. I'd much rather get chewed out than miss something on one of my residents.
Do you have any more specific situations?
If you haven't been over to the LTC forum...go on over and read through the threads!
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