Quote from LegginMF
Facility is LTC
Resident to sent out to E.R. Flu going through the facility like wildfire. Resident readmitted with Dx of dehydration.
D.O.N is insinuating that admitting Dx of dehydration should NOT have been in the admit paper work. I did not do admit....but... was there the following day and seen order for STRICT I&O's. I spoke with D.O.N and told her to the best of my knowledge that since resident was incontinent and wore a brief that we needed a scale to do strict I&O's. Am I correct in thinking we need to weigh the brief to calculate output? Was told by D.O.N to change order to just monitor how many times we had a wet brief per shift. State is coming back to further review this case. Was nurse wrong to put Dx of dehydration on paper work? It's clearly written on the hospital paper work. If she didn't put it would it be considered hiding info or falsification? Also at that time the Administrator had staff pull ALL of the bedside water pitchers from the rooms. Operating on the assumption that because we have a lot of ambulatory (and very confused) residents this would prevent the spread of the flu even further. Any feedback would be appreciated. Thanks.
As a former MDS nurse, let me see if I can shed some light on this. What your DON probably meant was residents generally should not be readmitted with a dx of dehydration, it should be S/P dehydration (on your
facilily paper work, not the hospitals), reason being is that the hospital should have resolved that prior to sending them back to your facility. It may look as though you are accepting a resident that was not "ready yet" (for lack of a better term). She does not want an active dx of dehydration, because it will
trigger in the MDS.
I'd hate to be the MDS nurse handling that case! Dehydration is a sentinel event to CMS, and the MDS nurse reviewing that chart probably wants to cry right about now. When they schedule the MDS assessment, they will have to look back 7 days for clinical s/s of dehydration in the medical record (the hospital counts). If that is captured in the 7 days, it will trigger to the inspectors, and they will look for patterns in your facility.
I hate to be blunt, but I gotta say it: your administrator sounds like an idiot. Taking water pitchers away at such a critical time??? From what I gather from the situation the dehydration was preventable, and that's a big problem esp. if the inspectors pick up on the patterns. It will appear to be a massive failure among the nursing staff such as poor handling of the flu outbreak (removing pitchers). Hydration will become a huge issue. Nurses will probably have to prove how they indeed provided hydration, if and when they noted any s/s of dehydration, if a MD was notified at first sign, labs ordered prior, etc. And sadly your admin. probably will throw all the nurses under the bus, and never admit they had the bright idea to remove pitchers.