Complaint Survey

SuesquatchRN, BSN, RN · Sep 25, 2011

You're going to need a plan of correction that is measurable and acceptable. I would start with T&P clocks and audits to see that those who must be are where they should be according to the clock. You need documentation of refusals to be repositioned. Can you get some Posi-flo mattresses to use for those with existing wounds? What scale are you using to identify those at risk? What interventions are being implemented if they are? How do you track that they are BEING implemented?

Personally, I would be questioning how these progressed. Certainly it can happen if someone is non-compliant and/or dying, but other than that I'd be down on my staff like flies on - honey. Yeah, we'll go with honey.

txdon · Sep 25, 2011

What are T&P clocks and audits? All residents are on air mattresses, these particular wounds were acquired from sitting - both were on strict orders to only be up with meals. The surveyor felt that one resident should have had more interventions in place to prevent a shearing, such as dietary supplements. The other one, the CNA's failed to adhere to the strict turning and positioning orders. We use the Braden Scale.

SuesquatchRN, BSN, RN · Sep 25, 2011

T&P clocks are just that - xeroxed pictures with clocks with what position a patient should be in at a certain time. For example, at 3 everyone should be on their back and the clock should say so. Hang it in their closet. You can audit by just walking around and looking.

Do you have a dietician? Anyone scoring, say, 18 or below should be looked at by the dietician for supplementation and nutritional interventions. A prealbumin should be drawn. You should be able to get a set of standing orders for labs and consultations based on the Braden.

Now, not all air mattresses are created equal. Look into something called posi-flow or something similar for those at very high risk.

And implement the clocks and start doing walk-around audits. Train the charges to do the same and have them sign off on each patient with the clock in place at least once a week. Keep those handy to be shown to the surveyor. Work up a plan for standing orders for

And good luck.

Nascar nurse, ASN, RN · Sep 25, 2011

T&P

T&P = Turn and position.

CoffeeRTC, BSN, RN · Sep 26, 2011

If the CNAs refused to adhear to the turning and repositioning what is being done about that?? The nurses need to be making sure it is getting done.

How often are the wounds being measured and assessed? How often are you evaluating the treatment orders? What about the Braden...how often are you doing it?

debRN0417 · Sep 27, 2011

You will have a revisit at some point after the date you set as your AOC- allegation of compliance. The team will focus on the issues you were cited for but also can look at other areas as well. Pray that you do not get another complaint before your AOC date is past because that will keep your cycle open and cause other penalities to your facility. Try to get everything done and all your plans put into place as soon as possible but DON'T RUSH and not fully implement your plan of correction. At some point here, Medicare/Medicaid will stop paying for new admissions, and the CMPs will begin for your faciity.

noc4senuf · Oct 4, 2011

Goodness, I haven't used positioing clocks since the 70's. Each of our residents have a tissue tolerance completed and they range from 30 minutes (usually compromised hospice) up to 2 hours that they are all repositioned.

itthybitthythpider · Oct 9, 2011

Goodness, I haven't used positioing clocks since the 70's. Each of our residents have a tissue tolerance completed and they range from 30 minutes (usually compromised hospice) up to 2 hours that they are all repositioned.

How do you determine tissue tolerance?

Long Term Care Columnist / Guide · Oct 9, 2011

How do you determine tissue tolerance?

I think it's a measure of how long it takes skin to be compromised after encountering some form of pressure.......I've seen some extreme examples of people who had to be repositioned Q 30 minutes because the skin would literally turn red and start to break down within an hour! :eek:

noc4senuf · Oct 9, 2011

We go in and check their skin after having been in one position for two hours. If the skin stays red, then we decrease the time and do it again. We begin by reducing in 15 minute increments. CMS regs state each redsident must be individualized.

SuesquatchRN, BSN, RN · Oct 9, 2011

Goodness, I haven't used positioing clocks since the 70's. Each of our residents have a tissue tolerance completed and they range from 30 minutes (usually compromised hospice) up to 2 hours that they are all repositioned.

The clocks are a good way to insure compliance.

What's a tissue tolerance?