Careplans and personalization

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Specializes in LTC-Geriatric-PPS-MDS.

Have you guys ever been told that stating "administer docusate sodium per md orders" on careplans is not acceptable?

I did it this way because Our orders were not matching the careplans as the nurses were not writing the orders properly or the slips that cone to me to update the careplan was getting lost

Our corporate people say its not "indvidualized" enough... However on abt or meds only for a short amount if time is always written out as ordered.

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Do you attend a clinical meeting where you can obtain the telephopne orders to ensure what you write on your careplans is the same orders the nurses have? in my facility for the bowel careplans we write " as per facility protocol" and if we have specific medications present we just write the entire order out. hopefully this helps.

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Specializes in MDS/Office.

If care plans are too specific, that will be a tag by State if the order changes....and who is responsible for noting the changes?

Personally, I don't agree with the MDS Dept. completing all the care plans....who then is updating care plans between the OBRA assessments?

The MDS Dept. is not taking care of the patient, the Staff Nurse is

Our company requires assessments to be completed prior to care planning.

The results of the assessments dictates how to proceed with the care plan.

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Specializes in LTC-Geriatric-PPS-MDS.

We usually just have the nurses leave the yellow copies in a basket- and every morning (mon-fri) i pick them up and up date the care plan.

Just a few months ago- i realized that even tho they may write "Prilosec OTC 20mg po qd" (OTC is our standing order- preferred by facility vs the capsules) on the order and i write that in the care plan-- 1 month later doing the quarterly, i find they are giving the capsules!! Which i heard could be a state tag if state figured it out.

Or another incident of "synthroid 80mcg po qd" --wrote it in the c/p after order written like this-- 2 months later for quarterly-- the MAR states "synthroid 25mcg po qd" then "synthroid 55mcg po qd to equal 80mcg"(i really don't know the dosage--heh) cuz I'm guessing pharmacy couldn't make the dosage without splitting? So! If state would've came in between-- we would've been screwed...

Plus, there was a lot of discrepancies with Norco vs Lortab. (with the tylenol-- our dr. Would switch the tylenol dosage making it change constantly back and forth and none of the nurses would catch it!)

Im personally tired if catching 20yr nurses mistakes that they keep making-- as this facility is a "if u find it, u fix all of it" policy-- so irritating.

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Specializes in MDS/Office.

Allezel.....

Sounds to me like you will be the "Facility Scapegoat" if Nursing gets a care plan tag.

Our MDS Dept. is too busy to even think about taking on the care plan responsibilities.

What size is your building? How many MDS Coordinators do you have?

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Specializes in LTC-Geriatric-PPS-MDS.

We are 105 bed now (used to be 115 but the took 6 of our double rooms and turned them into suites)

Theres 1MDS coordinator,1 PPS coordinator, and 1 care plan coordinator. We usually have up to 26 medicare a day

We just got our care plan coordinator position (our care plans are currently 2-3 months behind) due to the PPS coordinator could not keep up with the changes since april 1st and manage her schedule to do both without being seriously late on MDS's) she was getting yelled at to finish assessments for billing and then yelled at for not doing care plans--- the Medicaid coordinator was behind herself-- she was having trouble keeping up with quarterly's .

So they added me! and I asked our DON (who is new too) if i could change the format of the meds so we wouldn't get dinged on them (as i showed her the med errors every time). She agreed with me and stated "its not the care plan IS the MD orders or MAR"

Plus i saved this places ass from a complaint survey! They just changed to a new computer system PCC and nobody knew how to do a CNA care sheet(not the 2 MDS people who went to training seminars on the new system) so i read the PCC manuals and figured it out myself (didnt bother to tell corporate or my administrator- cuz i figured they knew)--- complaint survey comes in cuz a pt fell while in a hoyer lift... They were about to tag us when they looked in our CNA books and saw that my care sheets were in there and it stated "transfer with hoyer lift x2 at all times" (the cna was only using x1) ... So after we didn't get a big tag on it-- i had corporate calling me asking me how i set those up because nobody in our other facilities has them!!!

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Specializes in LTC-Geriatric-PPS-MDS.

Bella-- how do u address your meds and Tx's in the care plans?

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Specializes in MDS/Office.
Bella-- how do u address your meds and Tx's in the care plans?

If I am doing a Comprehensive Assessment & the Care Plan triggered from a specific CAA has not been updated by Nursing, I will then check the box, "Meds/Treatments as ordered".

The MDS Dept. only re-writes careplans.

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Specializes in LTC-Geriatric-PPS-MDS.

Not computer generated/entered?? Just paper care plans?

We have "interim" paper care plans that are on the chart when they first admit til we can do the admission comprehensive and get the CAAs.

The floor staff is suppose to be responsible for the interim care plan-- but we update them after admit.

I hAVe never actually been in this position with full fledge survey-- do they ask nurses on the floor "what is the plan of care for this residents fall risk?" i know for a fact our floor nurses do not communicate with each other-- when i do a change in care plans(if a request by family or our team feels its needed) i communicate it with the floor nurse/cnas at the time and place everything in careplan and cna flowsheets after that--but i know that the nurses are not following everything to a "T"

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Specializes in MDS/Office.
Not computer generated/entered?? Just paper care plans?

We have "interim" paper care plans that are on the chart when they first admit til we can do the admission comprehensive and get the CAAs.

The floor staff is suppose to be responsible for the interim care plan-- but we update them after admit.

I hAVe never actually been in this position with full fledge survey-- do they ask nurses on the floor "what is the plan of care for this residents fall risk?" i know for a fact our floor nurses do not communicate with each other-- when i do a change in care plans(if a request by family or our team feels its needed) i communicate it with the floor nurse/cnas at the time and place everything in careplan and cna flowsheets after that--but i know that the nurses are not following everything to a "T"

Just paper care plans (at this point) but I'm sure that will be changing when we go electronic.

Usually Surveyors will read the care plan, then watch staff to see if they follow the care plan.

Whether your facility tries to blame you for the "inaccurate" care plan or Nursing is another matter. I cannot tell you the number of times the Nursing Dept. has attempted to blame the MDS Dept. when Surveyors find problems.... :uhoh21:

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