Complaint Survey

[txdon]

I just had a complaint survey that resulted in a G tag for wounds - F314. Both cases involved failure to do enough to prevent further progression with a facility acquired wound. Both started as Stage II's and progressed, one resulted in osteomylitis. As a new DON, what does this mean and any suggestions on how to clear this for the revisit?

[itthybitthythpider]

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.

Oooh! I'd never heard that before. Just the clocks.... That's an interesting idea!

[PsychNurseWannaBe, BSN, RN]

Well... I would not go the route of the clocks. That is a tag waiting to happen. Let's say it is 3 PM and it means it is time to be on their back. Ms. Know it all surveyor comes and sees that person is laying on his right side and not his back. Was he not turned. Or is it possible that he repositioned himself??? I would see facility say at a certain time face left, then back, then right, etc. CITE CITE CITE!!!

Being a certified wound care nurse, I would say there are some things wrong with the process of skin integrity at the facility. Do you have a certified wound care nurse? Do you have weekly meeting to go over ALL wounds in the facility? Do you coordinate with a registered dietician to help with wound healing? Do you consult with PT/OT for appropriate wheel chair cushion to off set pressure or a different chair such as a Broda that is at a 30 degree tilted angled? Have you checked with PT/OT for their modailities such as estim, diathermy or ultrasound? How are your beds? Do you have any specialty beds for people at risk? What is your policy? For example, what do you do differently for someone who has a Braden of 11 vs someone who has a Braden of 18?? Do you look at your resident's comoribities? e.g., DM, PVD, PAD, Anemia, hospice. When were their labs last drawn for albumin and prealbumin? Do your CNAs fill out skin sheet when they shower their resident and do you have the nurse sign them that they acknowledge and also then do you keep them as a part of your own record? Do you do Bradens upon admit and then weekly x 4 and with sig changes? Do you get statement of unavoidabilities when the time is right?

I am not trying to be an ass. But skin care is a science that takes a lot of effort and care planning.

I wish you luck!!

[nola1202]

I learn so much from this site. Im in awe of everyone who takes the time to post their experience and knowledge.

[SuesquatchRN, BSN, RN]

Well... I would not go the route of the clocks. That is a tag waiting to happen. Let's say it is 3 PM and it means it is time to be on their back. Ms. Know it all surveyor comes and sees that person is laying on his right side and not his back. Was he not turned. Or is it possible that he repositioned himself??? I would see facility say at a certain time face left, then back, then right, etc. CITE CITE CITE!!!

Once we determine that someone repositions himself we d/c the clock. Also once we know they will not comply. And we document it all over the care plan and in the nursing notes.

[DixieRedHead, ASN, RN]

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.

Who is in charge?

[CoffeeRTC, BSN, RN]

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.

Who is in charge?

I'm not sure what you mean by this? It depends on how your facility works I guess. I'm the RN and work with LPNS and CNAs. I would be in charge of my shift. Both the RNS and LPNS are doing rounds while doing meds etc. We oversee the care that the CNAs are doing and delegate and assist as needed. (yep..we help with turns and call bells etc) If I'm not doing my job, the DON lets me know.

[DixieRedHead, ASN, RN]

What I meant was apparently the CNAs have "refused to adhear". To me, there are only two possibilities: 1. They are insubordinate. 2. They are failing the follow the policy and procedure of the facility.

We have a rule at our facility; everyone is up every day unless they are sick so the turning and positioning does not focus so much on day shift as evening and night shifts. But when they are in the bed for rest or naps, I do take note and I do track. I am in charge, and I don't have to be told what to do.

I do not mean to be hard but it is my responsibility.

[noc4senuf]

Even if they are up, they still need to be offloaded and repositioned for at least a couple of minutes within the individualized timeframe specific for each resident.

[DixieRedHead, ASN, RN]

Even if they are up, they still need to be offloaded and repositioned for at least a couple of minutes within the individualized timeframe specific for each resident.

They are toileted, some are walk to dine, some are simply repositioned, some can reposition themselves.

[debRN0417]

Miss Know-it-all-surveyor should have observed and resident and reviewed the plan of care and should know whether or not the resident can reposition themself or not....