CoffeeRTC, BSN 17,179 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,644 (24% Liked)
I don't think that the OP mentioned what type of facility this happened in, but it has LTC all over it. Before anyone jumps all over me, I have to say that I am a LTC nurse with many years of experience. There are good and bad facilities.
I have seen this situation occur way too many times. Dressing is signed off as being done, heck there even could be a nurses note written. Dressing wasn't done. If the patient is A and O X 3 and made a complaint about it then it should be investigated.
There are many reasons it might not have been done. We aren't all super nurses and maybe it was a rough shift and there just wasn't time to get it done. Things happen. It is what happens next that is important. In our place, we would initial and circle it and then make a note on the back of the page. Pass it on to the next shift and ask for help getting it done.
I've seen people out right lie about things like this. I followed on nurse that never did BID dressings. It wasn't as if she didn't have the time or wasn't trained on how to do them. I reported it and it was denied. She even went as far as changing the piece of tape with a new date but not the actual dressing. I solved this by signing the inner dressing then applying the guaze and then signing and dating the outer dressing. Point is...it happens.
All you can do is follow your facility's policy for this event. Report it and hope it gets taken care of by the management.
Sounds like this can be a LTC facility? I'm still trying to figure out your other role.
Have you approached her directly? If this is LTC, there should be an administrator or even executive director. If you've already approached her, then I would move on up the chain.
No secret that it is Norovirus seaason!
A lot of times the symptoms are the same so we are ruling out both Norovirus and C Diff.
What brand/ type of products are you using at your facility/ hospital?
We all know that bleach and hand washing is best for the C Diff. I was just looking at our sanitizing wipes and they are alcohol based??!!
Our P&P lists bleach based cleaner for both organisms.
I did go to the CDC website to look and it does look like "ethanol based had sanitizers (60-95%) is the preferred active agent for the Norovirus gastroenteritis." So I googled our wipes and they are listed as "isopropyl alcohol..55%
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.
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