CoffeeRTC, BSN 15,495 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,556 (23% Liked)
Could you or should you? You can do anything you put your heart into, but should you....probably not.
Reports of abuse must be dealt with by the director. I would absolutely follow up on that report.
In my 20 years of LTC, I've never had EMS refuse a transport to the hospital.
We call 911 for emergencies and all others we call a local transport agency that is staffed with both EMTs and Paramedics. If they only have an EMT crew available and the situation warrants a paramedic or if they cannot give us an ETA, we are often told to call the local 911.
When you call for a transport, you should be giving a mini report: Why does this patient require transport to the ER?
If it is not a 911 full code/ cpr in progress/ circle the drain type of event....I call the family, make mini chart copies (one for ems and one for ER), call the ER for report etc. If things are going down fast...it is a 911 call and after they get in and assume care, then i make the calls.
Treat all EMS with respect. When they come into your facility greet them with report, go to the room and go over your assessment and why the MD ordered a transfer to the ER...give them the baseline of the resident and most of all...make sure the resident is ready (not soiled)
I've been considering getting my certification for school nurse. In some areas it is a very difficult position to get. (Pittsburgh area)
Many school districts pay along the lines of teachers salary.
We still use paper charting in our facility.
We have a separate order in the MAR that says Check PT/ INR before administering coumadin. It is timed for the 3-11 shift.
The 11-7 nurse redlines all of the charts nightly too. This would have caught the error if you had wrote an order for it but didn't take it off.
We also have a binder where we schedule the labs. When the lab comes back we are supposed to check it off and not if the MD was called and we got new orders.
Since this is LTC, most nurses get to know the resident. Why didn't anyone realize they weren't getting coumadin? It's easy to see on the paper MAR. All the old orders are there and marked off.
Wow...stick with that place if you get the 40 days. That is very generous! There are many threads on this subject in this section..browse thru them to get a little more.
I would make a time line to plan the shift.
7a- 730 Report/ get cart ready
730-8 check for appointments/ therapy schedule..do a quick round to check residents/ treatments
8am -1030/ 11 am Med pass and treatments
11:30 start noon meds and accu checks
12 help with lunch
charting/ follow up calls etc until the end of the shift.
In the morning..residents might be going for therapy or dr appts..try and get them first.
What sad is that some of these things are still common in a good bit of LTC facilities and the VA systems.
Hmmm...is the money good? Do you have any team members that are supportive or on board with the changes? If the answer is no....i'd use my running shoes!
We admit residents from any local hospital and it all depends on the insurance of the resident on where they like to return. Your admissions or business development person should have contacts at the local hospitals. Reach out to that person.
Home health would probably be more flexable. How about dialysis? They do 10 hour shifts around here and have nights, Sundays and holidays off.
LTC/ SNF... if you have a choice in your area, do some research on the facility.
Check your facility policy and procedure manual. It might be under irrigating a foley. Are you sure it is a bulb syringe and not a piston syringe??
You clearly don't know how LTC works.
experienced nurses have....more experience
Some LTCs are more like sub acute care....faster paced, more time management needs, clinically complex residents. It takes time for newer nurses to be trained.
I find there is very little patient education in my facility. Yes, we are so rushed just getting the basics done. That will never end, but when I'm getting ready to discharge a newly diagnosed insulin dependent diabetic that will need to go home with injections and accuchecks and I ask if they are comfortable with the injections and they've never been taught or performed one I get a little bit crazy.
Education can be short little sessions with the resident or family over time. It doesn't have to be a big class. We have forms that we can document what education we provided the family or resident but we have no real program or materials.
This really is a need.
Sounds like in those 5 minutes the patient lost their pulse? So then yes..CPR was warranted. A lot can happen in 5 minutes! Breathing and pulse, no CPR. No breathing and pulse...rescue breathing. No pulse CPR.
Not all LTCs have AEDs...most do. Most are located on each unit, close to the nurses station. If it is a large facility, they normally have them one each unit, near the front lobby and or in the dinning hall or activity room. As soon as things start looking bad, I would grab it and a cart if you have it (ours has a suction machine, O2, ambu, back board ) and head down to the room. Don't wait until things worsen. Now....the tricky part is having some one use a phone to call 911 etc. The phones in our hallway only take calls in bound. To call out, you need to head up the the desk or yell for help.
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