CoffeeRTC, BSN 16,812 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,632 (24% Liked)
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!
If you do a google search you can find tons of information. The adaptic or oil emulsion dressings prevent the dressing from sticking to the wound. It might also trap drainage. If there is a lot of drainage, is the adaptic really necessary? It might be if the drainage dries. I like adaptic because of the mesh. It is more breathable than a vasaline gauze type of dressing.
Um, no. I''m only signing for the hours they came in to work.
As sad as this may sound, I wish there was this much scrutiny at my last job.
Sounds like a really tough situation. Won't most places keep the name of the person filing the abuse tip annon? At the very least, I would file the complaint. There will be a file or trail started even if the victim won't stand up. Maybe something will shake loose.
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?
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