Would you report me for this? (new question)

Pangea Reunited, ASN, RN · Oct 5, 2015

That doesn't bother me, personally, although it may be technically wrong.

OrganizedChaos, LVN · Oct 5, 2015

I guess it's technically still wrong because if you don't see it, it wasn't done. But if the patient is A&Ox3, mobile & wants to do it themselves then I guess it would be fine. But I'm sure one could still get written up for it.

AcuteHD · Oct 5, 2015

As a HD nurse I would like to see phos binders left at bedside for appropriate pts to take with meals and snacks. Not gonna happen for all the good reasons from previous thread.

ktwlpn, LPN · Oct 5, 2015

The leaving a pill question made me thing.
What about creams/ lotions? WWYD?
Our LTC still has nurses signing off for moisture barriers (They seem to vary with basic zinc, calmoseptine, or what ever brand they seem to be ordering)
They have this in treatment book so, technically the nurse needs to apply them if they are signing off, right? Some are okay to leave at bedside, but some are in the tx cart. I've seen little med cups with cream left on the res bedside table or dresser or in their drawer for the CNAs to put on with inct care.
Same for the millions of skin preps we do on heels.

NO....had a lady put calmoseptine on a bagel,she thought it was cream cheese.Also have found a number of med cups at the bedside full of cream,never touched.It's not doing the resident any good there......If the aides are still not signing off preventative skin care in your facility they need to call you into the room when they are ready.Which interrupts your med pass repeatedly.And we are prohibited from placing topical treatments in the med cart..So what do you do?You can throw those gross,nasty tubes in your pocket along with some skin preps or lock your med cart,run to the treatment cart and back....over and over.

CryssyD · Oct 5, 2015

When I worked in sub-acute/LTC facilities, I would do at least one round with my CNA(s). It worked out well, because a lot of my patients would have vent tubing, G-tubes, Foley caths, IV lines, and/or dressings, so having the nurse and CNA team up was beneficial to everyone--the CNA got help with moving complicated patients, and the nurse got a chance to really assess and address the patients' skin care needs. Also, immobile and/or incontinent patients usually needed 2 people to clean and turn them anyway, and the nurse could get a good look at common decubitus sites like sacrum and hips.

All you need to do, I think, is coordinate with your aides--just have them alert you when they're ready for you to apply whatever treatment is ordered. It really should be you applying it, since you are the one signing it off. If someone else is allowed to apply skin creams in your facility, there needs to be some record of that, for accountability.

RN9742 · Oct 5, 2015

I usually just ask the CNA/Tech to come get me when the patient is incontinent, or they are turning the patient.

CoffeeRTC, BSN, RN · Oct 6, 2015

Well, after being in LTC for more years than I want to admit, I do have my system for these issues.

First off, there is no reason why nurses should be signing off and applying routine moisture barriers on intact skin for all incontinent residents. This drives me insane! Change it has met on deaf ears. Everytime we get a new DON, things change then change back.

I am very actively involved in the resident care, but a lot of times it is impossible to always be there. I am fortunate to have a great team. Not all inct care requires assist of two. We don't have many totaly dependant residents. But it seems like everyone has an order for it. Last week, I had to DC 3 orders for barrier creams on totally independant residents.

ktwlpn, LPN · Oct 6, 2015

Well, after being in LTC for more years than I want to admit, I do have my system for these issues.
First off, there is no reason why nurses should be signing off and applying routine moisture barriers on intact skin for all incontinent residents. This drives me insane! Change it has met on deaf ears. Everytime we get a new DON, things change then change back.
I am very actively involved in the resident care, but a lot of times it is impossible to always be there. I am fortunate to have a great team. Not all inct care requires assist of two. We don't have many totaly dependant residents. But it seems like everyone has an order for it. Last week, I had to DC 3 orders for barrier creams on totally independant residents.

Your post illustrates the importance of teamwork.With other shifts and the aides.

NurseEmmy · Oct 6, 2015

Leaving any creams or lotions at the bedside is a dangerous habit to start. I haven't read the other topic, but I'm guessing it had something to do with this. As a previous person mentioned - the creams could be mistaken for some food item - YUCK! Plus you are signing your name saying a treatment was done. If you aren't 100% sure it was - I wouldn't be signing my name. That is falsification and can lead to serious legal issues. Sadly we are all pressed for time so working in a team works best. Help your aides with bathing or changing incontinent residents - you can do any treatments required post bath and assess the skin/wound condition yourself. It would be a huge waste of your time to apply a cream or treatment right before your PCA or aide gives that patient a bedbath/shower, since you will then have to do the same treatment again.