foot check on diabetic at dialysis clinic

[Healerforlife]

So tonight I was doing a footcheck on a patient for the first time me doing it. He comes by stretcher for tx. he's 350 pound diabetic, who needs bilateral hip replacements, Lives at a nursing home. ANYWAY, his toenails were about an inch long on all his toes. I have not seen his shoes off before as another nurse was checking him. ( that's another story) What can I do about this? He says they haven't cut them since February, which, Um, is coming up. It's disgusting. He's diabetic!! How is this not neglect? Is there anything I can do to scare them into taking action? The nurse at the nursing home said "He's on the list" Not too encouraging. Thanks for any advice

[dishes, BSN, RN]

Fax an objective note of your findings to the nursing home, keep a copy of the note in the patient's chart, next phone the DON of the nursing home and give the facts to her, let her know you have documented your findings and faxed a copy of the note. Advise the DON if anything happens to the patient, you will speak to the patient's lawyer. You do not have to make accusations of negligence, these steps will be enough to ensure that the patient's footcare will be done.

[Postpartum RN]

I wouldn't threaten with a lawyer as was suggested earlier. I don't believe that is appropriate for you as an RN. I would do what the previous poster said though, document and fax it to the nursing home, call the DON and let them know. Some RNs can cut diabetic pts nails, however sometimes if too difficult then it has to be done by the podiatrist who comes to the nursing home.

If you can't seem to get results I would let the pts family know and they can bring it up with the nursing home.

[Hoosier_RN, MSN]

AT any LTC that I have worked at, it is a big no-no to cut diabetic toenails, has to be done by podiatrist, d/t risk for non healing foot skin issues. Most of the time, the podiatrist come in 1 day every month or 2 months, and for a limited amount of time. If the resident refuses to come to them or to receive the service, they are taken off of the list that visit, as there are so many more to see and document on. Perhaps this is what's going on. As pp have said, just send a note of your findings to the facility, the neglect may be self neglect, which unfortunately, the resident is entitled to.

[Jensmom7, BSN, RN]

It's not up to you to "scare" the facility into doing something. Frankly, it's a little high handed on your part to even think that you should.

There are myriad reasons a patient has gnarly toenails. Many of them have been pointed out already, so I won't repeat.

When the facility nurse tells you "He's on the list" is she giving you only that much information because you have an accusatory tone when you ask her?

How about saying "Mr. X has really bad nails. I know he's on the Podiatrist list-does he refuse to go? If that's the case, maybe I can work from my end to convince him how important it is."

Maybe the one or two days a month the Podiatrist comes falls on one of the patient's scheduled dialysis days. Certainly not going to get done then. You may need to discuss it with your manager and SW-is changing his schedule feasible?

It's called collaboration. We give it lip service but rarely use it effectively.

[TheCommuter, BSN, RN]

He says they haven't cut them since February, which, Um, is coming up. It's disgusting. He's diabetic!! How is this not neglect?

It's sad when people are willing to throw the 'neglect' word around so lightly. The staff at the nursing home is strictly disallowed from cutting a diabetic resident's toenails.

A podiatrist is usually scheduled to visit nursing homes for rounds. However, most nursing home residents have Medicaid as their primary payer source, and to be honest, many podiatrists do not prioritize Medicaid patients due to the paltry reimbursement rates.

You can call the nursing home, ask to speak to the DON, ADON or unit manager, and tell whomever you're speaking to that this resident needs a podiatry consult ASAP. However, no one can force the podiatrist to hurry up for a nonemergent condition.

[Jensmom7, BSN, RN]

It's sad when people are willing to throw the 'neglect' word around so lightly. The staff at the nursing home is strictly disallowed from cutting a diabetic resident's toenails.

A podiatrist is usually scheduled to visit nursing homes for rounds. However, most nursing home residents have Medicaid as their primary payer source, and to be honest, many podiatrists do not prioritize Medicaid patients due to the paltry reimbursement rates.

You can call the nursing home, ask to speak to the DON, ADON or unit manager, and tell whomever you're speaking to that this resident needs a podiatry consult ASAP. However, no one can force the podiatrist to hurry up for a nonemergent condition.

While most have Medicaid as their primary payor source for room and board, their Medicare is still available as payout source for physician visits.

[TheCommuter, BSN, RN]

While most have Medicaid as their primary payor source for room and board, their Medicare is still available as payout source for physician visits.

This is very true...unless the nursing home resident is under the age of 65, which is becoming all too common in many facilities. Those under the age of 65 do not qualify for Medicare unless they can prove a permanent disability or have end-stage renal disease with chronic dialysis treatments.

As a case manager for an insurance company who conducts assessments on nursing home residents, the majority of our nursing home clients have Medicaid only.

[Been there,done that, ASN, RN]

Why is this a nursing problem and please explain why it is up to a treatment nurse to do a foot check???? He hasn't had a doctor look at his feet in the last year? Patient sounds competent, he needs to get the nursing home to get him on the almighty list.

[nutella, MSN, RN]

Why is this a nursing problem and please explain why it is up to a treatment nurse to do a foot check???? He hasn't had a doctor look at his feet in the last year? Patient sounds competent, he needs to get the nursing home to get him on the almighty list.

Foot checks for are required for dialysis patients and part of the "package" when they are diabetic. It is a mandatory screening...

[Farawyn]

Foot checks for are required for dialysis patients and part of the "package" when they are diabetic. It is a mandatory screening...

Not just for dialysis.

[Nurse Leigh]

Clearly there is a need for certified diabetic foor care nurses in several areas. My mother is diabetic and has a podiatrist but it is his MA who does the actual nail care which seems odd - would actually prefer a nurse certified in foot care although we both like the podiatrist and MA a lot.

Do any dialysis clinics have trained nurses or podiatrists do checks and care there (in an appropriate area)? I know Medicaid isn't that great but Medicare should cover it.

And maybe ltc facilities should pay one of their nurses to obtain the needed training so someone is available more often.

Heck I think it would make sense for LTC to also have WOC nurses too. But I know the real world rarely meets our ideals...