Published Jul 29, 2003
They have started something new at my facility. For all red area's, open areas, scratches and bruises or any other injuries of unknown origin we have a new policy. If we didn't see how it happened we have to call the administrative person oncall anytime day or night to report it. Then we have to fill out an incident report, an internal investigation form, initiate a care plan and document it in the nurses notes. This is for every single one. Our books have completely filled up with these nursing care plans. We are spending tons of time on this. The population we work with are mentally retarded and many of them have self injurious behaviors and often pick and scratch at themselves. This is quickly becoming overwhelming. So are other agencies doing this? We are being told it is mandated by the fed government because of sitations for not reporting these incidents in a timely manner. What I want to know is everyone having to do this or is this or facilities very stupid plan of correction. It is driving me nuts what tends to happen is that most of the other shifts do not want to deal with it so 3rd shift is most often the ones finding these things. So how about it is this all over or just my facility?
Actually, at the nursing home I worked at, we were required to file incident reports on all injuries even if it was just a scratch. We had to file them whether or not we saw how it happened, with the exception of pressure ulcers. We just got used to it over time and we also were given the reason of citations as the cause of all that new added paperwork.
Yup, we do that in Wisconsin also, even with injuries or bruises of unknown origin. The paperwork sucks!
We do an incident report(2 pages-one page is the details of the incident and injury the other is interventions and staff education) Then we do a wound measurement sheet because we measure all of our boo-boo's weekly and we always notify the next of kin (not the admin) Then we initiate the proper wound care protocol.....This has recently saved us-a resident sustained a skin tear which got infected and she was admitted to the hospital for IV antibx-the family was VERY unhappy with the care she received both with us and in the hospital.Nurses apparently expressed disbelief that such a wound could have gotten infected so fat-and told the family that we must not have been taking care of it....Luckily we could show them our wound care protocol and we check these areas every single shift...and docuemtn accordingly. Open communication with the families prevents alot of problems-the minute someone feels that you may be hiding something the trouble starts...
Open communication with the families prevents alot of problems-the minute someone feels that you may be hiding something the trouble starts... [/b]
ALL I CAN SAY IS AMEN. LETTING THE FAMILIES IN ON EVERTHING THAT HAPPENS SAVES YOUR HIDE!!!
VivaLasViejas, ASN, RN
I sympathize with you, angelbear......LTC paperwork is the WORST!! I was a care manager for a couple of years, and I had to investigate each and every red spot, bruise, scratch etc. on 40 residents, write up my findings on the incident reports, and call Senior Services for every single thing that could possibly be considered suspicious. I often had 15-20 incident reports land on my desk during the course of a day, and as you can imagine, I didn't have time for much else. Besides, how do you "investigate" when the only "witness" is demented?! And how many of these poor, fragile people are on Coumadin, or have parchment-thin skin, or pick at everything?
Needless to say, I'm glad I no longer work in LTC, even though I still feel bad about leaving because I know the elderly are NOT receiving good care in many cases. Then again, maybe I'm just dense because I've never been able to understand how taking RNs away from the bedside and snowing them under with paperwork makes for better care.....but that's a story for another day.
If it is "established behavior" such as self scratching or skin picking, then an incident report isn't necessary (where I used to work). But there better be something in the chart for each scratch and pick and a reason why the interventions didn't work or why they were not in place.
Red areas, bruises, skintears, falls (witnesses or not) all require an Inc. rpt.
Pt. to Pt incidents should also include a call to APS.
If you are having more than one (1) a day, then your residents aren't being watched well enough. Utilize activities. Get AFTER you CNA's to not leave the residents unattended.
Develop a plan to not have so many inc. Rpts.
I truely do understand the reasoning for this the purpose is to make sure that wounds are well cared for and are not due to abuse. I just feel that for our population it is impossible to keep up. On my shift alone 3rd we generally have at leaste two area's to report. I honestly feel it is more about the paper than the people. But I at leaste feel better that we are not alone. Thanks for the responses.
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