Latest Comments by CoffeeRTC

Latest Comments by CoffeeRTC

CoffeeRTC, BSN 14,292 Views

Joined Jan 22, '03. CoffeeRTC is a RN LTC. Posts: 3,520 (23% Liked) Likes: 1,514

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  • 0

    I'm in PA and I thought it was all interactions. Let the state evaluate it and determine if it is serious or not.

    Do you have a compliance hotline to call?

  • 0

    Cob94..me too!

    I guess my question to all is about what happens when the count is wrong? (no math error) or you notice that there are missing pages from your log and the meds are missing (patient is not discharged or the med wasn't discontinued) or that there are weird patterns of waisting the med?

    I would refuse to accept the cart and call the DON/ supervisor. What then is your facility's policy on dealing with this? Incident report? Staff interviews/ statements? Drug testing?

  • 0

    Anyone?

  • 0

    ***I put this in the LTC section but wanted to reach out to the rest of the board. ***

    Old fashion way...paper charting...no computers...punch card system. How are you doing it?

    Of course it is done by the on coming nurse and off going nurse each and every shift. (unless you are doubling and keeping your cart).

    Narc comes into the building from pharmacy.
    Verify the count when you sign it it and take it from the delivery driver.
    Sign med into the master log in the front of the book.
    Complete the count sheet for the med. NOte the page # on the master log.
    During count, I like to see the number in the book and the actual pill count.
    When the card is done, note it on the master log.
    If a resident is dc'd with med, note it on the master log
    If med is wasted/dc'd have two nurses waste and sign and note it on the master log.
    We've now started counting the # of sheets vs the # of cards each shift.

    I've been doing this for 20 or so years, so I'm good with this part. [IMG]http://allnurses.com/image/webp;base64,UklGRgoDAABXRUJQVlA4TP4CAAAvEUAEEB8Fsb Zt09U9iG3bNrpJC+nG6SBlpAHz27bZBqzItlVHa50wM8Mf+4gu jgaOiGgYDTxiHlwBAA0op8ezbV92Uz/Q6DZjtjE13poxWpNrtm3bdgkEUpzCLMd/8s/cltV8QZ/JbdG5Awns/V30mdwmUwpyrywdOUWBIIHp52LJtcfh/+3BucrLR3ZXvSpc/FDP9FiVUmnLItVMh9alJsdA7WPmlaFG/9mYc6hh3DRSFAjXSEuahYZ7YR+eaGwl9v4u4hRCxRfKPN/o/dif77T9LxQslimToSFm6ciRwOB8UrgSjYO6yLTxp5I9NJpZl09 UgYmUEKcQDDaId1+pS4Z0oI84IUNAkqKe3aWA+JcHQThufKYf2 DNOH55RYHSfWoJaGWC69oAaH3+xy2QAALt0DOnCADLkzGFzYSM 5AQBMhsO3owzEeY91x46zhdi7j0wEgPDD8ADEo16CKD7ivce6Y wf4TCbi2539Xp3miRxOE+1ZxEAMEjMS4cUdLM/afBZY5CSxEevCMje2KcY1gO3cVsA35MbEahU6jI0nIRjCgswAI kkBEA5mhiCcgAOwA9ox6SRMADxkYAIP5ILADOAg7iECgBBAEJA AAtgILgAAIAlyCAQI27YdT/W+83ItL9dys23bXrZt27brjz5fiOh/ot/MIoYbGLkk9I9YExqe+/yY7eFkoz8Z7O7nt/eP99enRWMDnYqAyB6/e3p+eX15uourpnrpCKpjKbD5BrcfH261I/c3cnx6aDUJqxNh7+b1svzm7kaGL5z+noFvLNx1uSBfv1uXoqZ3 Pqx9A5/nPD+2xm82ZEj9JYRvTMi39Jmksp5bLZX1tTQAS99LA05T/9kFXMVojU5LosNpgcSKNADBo5PJ+vz2rZ39P9LdvYPDk1NZmm5 rZx8Tde4rHIHg0QlIUZVrZz8iEO2Dfmjv8OTUnYMITBEXJPtYp 2F+NKqhIYzCNO/s/3oUUjoZ/RIqlf6xfRizM7PQT3FBXkl5XUurGNqaaytKy3AI[/IMG]

    What is your policy on any discrepancy?? This is what I really would love to know.

  • 0

    I know this has been beat to death over the years but I want to know if I'm missing something.

    Old fashion way...paper charting...no computers...punch card system. How are you doing it?

    Of course it is done by the on coming nurse and off going nurse each and every shift. (unless you are doubling and keeping your cart).

    Narc comes into the building from pharmacy.
    Verify the count when you sign it it and take it from the delivery driver.
    Sign med into the master log in the front of the book.
    Complete the count sheet for the med. NOte the page # on the master log.
    During count, I like to see the number in the book and the actual pill count.
    When the card is done, note it on the master log.
    If a resident is dc'd with med, note it on the master log
    If med is wasted/dc'd have two nurses waste and sign and note it on the master log.
    We've now started counting the # of sheets vs the # of cards each shift.

    I've been doing this for 20 or so years, so I'm good with this part.

    What is your policy on any discrepancy?? This is what I really would love to know.

  • 0

    I echo the above. i have about 20 years into LTC. I'd love for someone to tell me how you make yourself cough up blood?? Being that he was on Lovenox, I def would want the bleeding under control.

    With the high BP, you tried to treat at the facility and it was ineffective. Without a DR present or close by and with a recent fall (any head injury??) I would have wanted further eval.

  • 0

    I probably would say no to it. I've been doing LTC for 20 years. We have a LTC hall with about 25 residents and a mixed/ short term hall with 25 residents. We each take a hall. Yes, the LTC residents are more stable, but that changes...they tend to have more meds, might need crushed, still have treatments etc. Most admissions come in on 3-11 and more in the evening...around 5 or so. And....I'm still getting orders for other issues from the MD.

    Now...if they are truly stable ltc residents and you have a decent, stable CNA staff...maybe I'd consider it.

  • 0

    Its been years since I've seen or had to do one. Years ago it was common in LTC, but now it is classified as a sentinal event. Now everyone is on a plan and we have a protocol to prevent. I know you need an order but are you asking if it is in the scope of practice?

    Try sending someone to the ER for a disimpaction.

  • 0

    Might want to include dignity covers. Some foley bags come with flap on them now or we use the bags attached to the bed/ wheelchair. You would also want an infection control plan to keep those clean.

  • 1
    IowaKaren likes this.

    Wow.

    A few things. Before you send a resident to the ER, if it is non emergent, make sure you are sending some information to them about the resident. Transfer sheet should cover the basics with a brief history of what is going on, baseline for ADLS, LOC, diagnosis list, etc. We also call to give a verbal report to the triage nurse. This is important especially if you cannot get the paperwork together fast enough. If you are giving them a good picture on what you suspect is going on and their baseline that helps tremendously. Let the ER know that you did xyz before sending them.

    When EMS comes for pick up, give them the same report. Treat them like another part of the care team....they are. Sometimes we bounce ideas off of each other. (and take bets on who is right, lol)

    When the ER calls to tell you they are sending the resident back...ask....hey, what were the results of XYZ labs? i need a copy please! If you send someome out for cardiac S/S...ask about the EKG, troponin levels, labs, chest etc.

    i think that some ERs just get sick of getting residents that are dumped and sent blind (without report) and when they show up without family or with dementia, they might look for the quick fix and send them back thinking the drs in the LTC will deal with it in the morning.

  • 1
    Ladyscrubs likes this.

    I was thinking mattress too! Have you took a culture of the wounds?

  • 1
    Nursenicole1 likes this.

    As a LTC nurse, I find this very frustrating and a common occurance. I've seen it happen a lot.

    if ther is one nurse that is the only person that medicates all the patients all the time and you have really good, top notch nurses on the other shifts that do their jobs and medicate PRN....There probably is something up. It escalates too. Maybe their med isn't helping them like it should (because they really aren't getting it) so the doc gets called for an increase. I've see this happen. Or a resident that might get it once a day now seems to be getting it every 4 hours like clock work when the nurse is going a double. Normally it is the more confused or non verbal resident this would happen on.

    Diversion is so easy in LTC but hard to prove. What we try to do to prevent it is d/c meds that aren't used a lot. Change up the nursing assignments. If you can interview residents do that to get as much information as you can.

  • 0

    This is a very touchy subject for me right now . We are soooooo short staffed at work right now and while I'm not in on all the meetings, there seems to be little done about finding staff/ hiring. I see nothing in the job sites/ news papers etc. Agency is not being permitted. Staff nurses are forced to work OT...same with CNAs. LPNs and CNAs are unionized so there is a bit of protection for them, but it is insane.

    DNS is young....leaves after and 8.5 hour day and loves to post on social media her bar hopping activities. Tell me how this is OKay?? I'm talked about becasue I'm only part time, older and wiser and just say no to the extra shifts. Yes, I try to help when I can, but family situations don't permit me to work more hours.

  • 0
    In Pay

    It will depend on your area.

  • 0

    Most facilities have a complinace hot line. It should be posted.

    Try to work up the chain first. If all else fails, you can call the compliance hotline or state department of aging.


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