CoffeeRTC, BSN 18,563 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,713 (24% Liked)
Was it a PEG with a crossbar or a tube with a balloon? And did you have a replacement tube on hand?
G-tubes replaced in existing tracts do not typically get XR confirmation, in my experience. In pediatrics, our patients have MIC-Key buttons or AMT tubes and parents are taught to replace those q 3-4 months at home.
Please tell me her refusal for care is well documented and care planed out the wazoo? Why is she refusing care? Pain issues? Has psych seen her?
Psych eval? Depression related to nursing home stay?
I'm the LTC nurse that would be calling you. I like the idea of having the resident sign off on getting the medication too. Does the fent patch need to be increased again? If he is truely in pain, that might help. I'd also make sure he is on a good bowel regime. Of course, I would be making sure everything is documented out of the wazoo and care planed.
Are there any LTC Risk Managers on here?
I've been filling in for our facility. Right now I'm self-taught. I've skimmed our intranet and tried to pull up all info in the RM tab.
How are you tracking your events (incidents)? Do you have a program or spreadsheet?
There seems to be little info provided by our company.
Right now I've been reviewing the event report and any witness statements (hunting them down if they were not done), reviewing the nurse's notes, checking orders and care plans. With this, they have an analysis form. It asks for a description of what happened, the cause, the immediate action or intervention that was taken and then any follow-up actions.
Are there any resources for RM in LTC? Groups or organizations?
I work LTC. We have a mix of skilled residents that need a lot of care and long-term intermediate care residents. When you say 35 residents do you mean each or split between two nurses? Were there CNAs too?
Abandonment only occurs if you accepted the assignment in the first place. If you took report or the keys then yes.
We use this brand of foley and collection tube. The flush port on the actual foley is accessed by a needless Luer lock syringe
and the specimen access on the drainage tube with a needle.
Geri psych stay?? Danger to self (hygiene issues that can lead to serious infections) and danger to others with the hitting, bitting, and bruises. Of course you are doing event reports for the staff injuries? Family involvement??
I work in LTC, we recently had a rep from the company who makes the briefs we use come in and inservice our CNAs. If a brief is leaking and you feel like the resident needs to be double briefed, you are most likely using a size too big. A standard brief can hold about a gallon of liquid if it fits properly. I have been told that it is illegal to double brief in my state (IL), but I have no proof to back it up. I do know it is against my company's policy and at the very least will earn you a write up.
Double briefing is not an appropriate care measure. Get a Foley or a supra- pubic catheter order. You will not have enough time to check/ change your patient every hour. Trust me on this... they will be lying in their own urine for hours.
Welcome to nursing.
I miss being a part of a big company. We had programs for everything. I'm sure I can come up with a spreadsheet of some sorts but just didn't want to re-invent the wheel.
I see that this is an old post, but updated. You would have known by now if it was reported to the state and if there was any actions against you.
As far as suspected abuse. If the CNA saw a nurse handling a resident in a rough manner, they must report it. It is up to the facility to investigate it and determine if in meets the definition and also to report the allegation of abuse to the state.
Every facility should have their own p and p for wound care.
We measure wounds weekly. We are still paper charting so all of our treatments are in a book. We have all wounds (pressure and non-pressure wounds including bruises, incisions etc) on thier own sheets. If we had a question on the size or appearnce of the wound, we are able to see what what documented at the last measurement. If they are on skilled charting for the wound, then there should be a daily nurses note about it.
I have never seen these in SNF or in my state.
Pulse sat of 87 isn't overly low for a pt with COPD.
Post in the LTC forum for more answers. This is a great question. We do a two step PPD on all readmits.
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