Latest Comments by CoffeeRTC - page 5

CoffeeRTC, BSN 15,503 Views

Joined Jan 22, '03. CoffeeRTC is a RN LTC. Posts: 3,556 (23% Liked) Likes: 1,564

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  • 1
    IowaKaren likes this.

    Yes!!!!! I argue this point all the time. If I was unable to transfer myself for what ever reason and I had to wait forever for someone to answer my call bell and help me to the bathroom, I would be incontinent. So when the CNAs are doing their charting and marking incontinent because they were....look at how it skews the #s!

    Sometimes it is a fact. 2 CNAs, one nurse and 10 residents that need max assist at once....do the math.

  • 0

    I see most of the threads on hear are for the younger school aged children.

    Are there any nurses here on the college/ university level?

    Looking for what a typical day would be like? What type of work experience would you need?

  • 1
    WinterLilac likes this.

    This is right on line with the "offers you candy, reports to family that candy is stolen"

    Showers/ baths are a big one. Document, careplan, document and make sure family is aware of all of it.

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    Alex_RN likes this.

    After you check the policy and procedure manual and get the go ahead, the biggest thing to remember is that they need to be replaced asap or stat. Many moons ago when it was common to use a foley for a g tube and we were able to replace them in house. These might have been used on the dementia residents that pulled at everything under the sun. At that time, we used a betadine scrub, lubed up the tube and inserted it. Wait too long and you were meeting resistance. We would follow up with checking placement and getting an xray.

  • 1
    ShelbyaStar likes this.

    I've worked in a small 50 bed facility that was owned by a for profit big chain and then changed to a small not for profit owned facility. I miss the big for profit so bad!!! With a corporation, there are clearly indicated chain of command, policies and procedures ordering practices, manuals.....etc. So so much with the smaller not for profit. There are different consultants for everything.

    I've also worked in a few facilities that were around 200 beds. I like my little facility better. We know our residents and families. Staff is tighter knit too.

  • 0

    If you find a discrepancy and it isn't due to a math error, then what? What is the general policy? I looked at our pharmacy website and they had a nice educational video on this and included the Ftags etc.

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    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?

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    Anyone?

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    ***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.


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