Frustrated

[OHIOGIRL08]

I Have Been In Mds For About 2 Years, I Am A Lpn And I Work The Floor When Ever They Have A Call Off. We Have A 150 Bed Facility, Icf And Skilled. My Biggest Fear Is Care Plans, No Matter How Hard I Try I Seem To Always Miss Something. I Was Told To Care Plan All Meds Ands Diagnosis. Also I Have A Big Problem With Adl's Section Of The Mds, The Nurse Techs Never Mark Thier Books Right And When You Talk To The Techs, You Get A Different Awnser From Each One. It's So Frustrating..... Does Anyone Else Ever Feel Like Pulling Their Hair Out??? I Have Another Lpn That Works With Me And She's Wonderful. I Have A Great Mds Coordinator, She Helps Us A Lot And She's A Great Teacher.

[flashpoint]

I have pretty similar frustrations. Something we are going to try is to make a photocopy of the care plan about a week before their review comes up. We'll leave the copy in the report room and everyone is being asked to look through it and see if there are things we are missing or things we not longer do. As far as the ADL section...I usually go in and observe the resident during AM cares and base my assessment on that, plus what the NAs tell me...I ask the NAs a lot of questions.

[OHIOGIRL08]

OK, HERE IT IS. THERE ARE 2 OF US IN OUR OFFICE, WE DO ALL THE MDS, CARE PLANS AND CARE CONFERENCES, WE HAVE A TERRIBLE TIME GETTING THE CARE TEAM TOGETHER AND WHEN WE DO NO ONE SAYS ANYTHING BUT US, THEY ALL JUST SIT THERE. IT'S REALLY EMBARRASSING ESPECIALLY WHEN YOU HAVE FAMILY THERE. ALSO, EVERYTIME I TURN AROUND I HAVE TO GO WORK A HALL, DO YOU HAVE ANY IDEA HOW HARD IT IS TO BE ON THE FLOOR, THEN GET PULLED BACK TO DOING MDS, IT DESTROYS YOUR WHOLE ROUTINE....IT DRIVES ME NUTS......... I HAVE TALKED TO EVERYONE I CAN THINK OF, THE DON'S, THEY DON'T CARE, I EVEN WENT HIGHER UP TO OUR MAIN OFFICE, GUESS WHAT, THEY DON'T CARE EITHER. BUT YOU LET OUR CARE PLANS BE WORNG AND SEE WHO GETS IT THEN... MDS'S ARE HARD AND THEY REQUIRE A LOT OF TIME, AND THEY ARE SERIOUS .... WHEN ARE PEOPLE GONNA REALIZE THAT YOU CAN'T DO 10 DIFFERENT JOBS AT ONCE. IT'S TOO MUCH, PLUS WE DO ALL THE SKILLED MDS'S AND CARE PLANS AS WELL. ANYONE ELSE GET THIS?????

[bluegeegoo2, LPN]

I would personally be putting together a resume. There is too much work involved w/ea job separately, much less putting the 2 together. Most higher-ups won't change a thing if they see it's "working" for them. They obviously don't care whether or not it's working for you.

[surveyor2b]

I hear your pain! I'm new to learning the MDS process as well and I'm wondering what you use as an assessment tool for your look-back period. Is it useful or could it be better? If you can get your nurse educator to help teach the techs why you need the Real info on their reports, it might help...sometimes just knowing why the things we do are important and how that information is used is helpful. Once the tech info is correct you should be able to generate accurate MDS and the RAPs that you care plan around. Voila --- the care plan is reflective of the resident...just have to remember to update, update, update with changes. Am I making any sense???

[surveyor2b]

How do the 'higher ups' feel when the survey deficiencies come in?...This might be a good bargaining opportunity.

[edhcinc]

Hi--I actually hate to say this, but...

If surveyors find evidence, through resident/family/staff interview and medical record review, that we did not:

• recognize objective findings which are symptoms or manifestations of a clinical, medical, psychosocial, or other resident problem; OR
  
• plan/provide care (which the resident needed, expected, and was entitled to) for problems we should have elicited through resident/family interview or identified through assessment; OR
  
• assess and recognize the need to plan/provide care interventions (which the resident could reasonably need, expect, and was entitled to) to prevent clinical, medical, psychosocial or other problems, then---

PLAIN AND SIMPLE--THE RESIDENT DID NOT GET A "FAIR SHAKE" AND WE DID NOT DO OUR JOB.

HOW and WHY we (as a facility) did not do our job, or recognize that it was not done properly, are the real deficiencies. Somehow, did we foster ignore, or were unaware that our care-planning process did not encourage, allow, or accommodate TRUE resident/family/direct care-giver participation or even attendance??

Did we forget our "job"? As facility staff, we provide direct care. We also identify--or help the resident/family identify--specific care preferences or concerns, abilities or inabilities and jointly develop goals and a plan to reach those care goals.

Viewing or using a survey citation as a "bargaining tool with higher ups" may yield bargain/short term results. In many cases, a survey deficiency reveals very basic problems--of facility lack of knowledge or inability to perform, or a facility culture which tolerates or cultivates mediocrity.

The thing is...

• Do your residents (or patients), family (or anyone who helps/supports/cares for or about the resident) and staff actually participate in planning care?
  
• Does everyone know about, discuss, and actually consider the resident/family voiced needs/concerns/preferences?
  
• Does everyone know about, discuss, and actually consider the clinical observations or objective assessments made by professional and direct care staff (who do NOT rotate care assignments) which may reveal problems/needs/strengths?
  
• Do staff and resident/family know how each contribute to an individualized plan of care?

Making sure that the tech "marks the book" for John B, or that his care plan includes each diagnosis or medication, will not ensure that the plan "fits" John B's individual needs --he has specific issues, responses, and abilities related to the marked ADL's, diagnosis, or medication.

No wonder we feel frustrated! What is our focus?

Get your team together. Ask your administrator or director of nursing to lead/mentor the team. Try to focus individual efforts on a team goal....to know, respect, consider, and support each resident, and each other, as INDIVIDUALS...most consider that individualized care=quality care.

If you still feel unsupported and frustrated, MOVE or CHANGE YOUR JOB.

Caring for others implies the ability to care for oneself!! :heartbeat