what to do..... - page 3

So. I've posted on here enough times with my opinion about a variety of LTC issues. I am at my wits' end now. I've been a DNS for about 4 1/2 months and it seems no matter how hard I try to make... Read More

  1. by   brendamyheart
    Quote from fultzymom
    I am having a problem similar but not the exact same. I took over MDS et skilled nursing in my facility. I revamped the nurse notes to make them easier, put in charting guidelines so that they will know what to gear their charting towards for each patient et what they are there for, and am constantly in contact with the floor nurses making sure they have what they need et know what is going on with each patient skilling wise. Just the other day, a couple of them told me that they do not understand or see the point of what we are doing et they are just flat out not going to do it. If is very frustrating because our charting is one thing that has come up at state inspection et we have a woman who comes in for chart review who looks at our charting like state does. She also says that we are not sure where we need to be. I am at my wits end with it and it has only been since November since I started!! Very frustrating! Not sure what to do to get everything where it needs to be.
    I too do MDS. I do PPS. I do not look good in jail orange!! I cringe at the nurses notes! I also have a cheat cheat for them to document. In service to death!!In the nurses defense, document ion comes last. do to the fact that our patients are very ill. They must care for their need first and document later, which is at the end of the shift. No overtime is allowed. So patient care is given, but cannot prove it do to lack of documentation!!!!!!!!!!!!
  2. by   fultzymom

    Glad to know I am not alone with the charting and MDS. We just had ANOTHER meeting with the nurses. I tried to explain AGAIN that it is required for Medicare payment and they can refuse payment if it is not done. And if they reveiw and we have already been paid there will be fines and consequences to it. But I also just left the skilled unit for this job so I do understand that your documentation is the last thing you do in the day. I try my best to help out on doctor day (every Wednesday) so that they are not doing all the orders by themselves and I try my best to help out when an admission comes. But as you know, how much you can help out depends on my MDS load for the week (we have a 150 bed facility) and two MDS nurses. If it was not my behind out there, I would almost be willing to say, "I give up. Let the chips fall where they may." But a lot of them would fall on me!! So I am not going there. One complaint I got at this last meeting was that there is so much to document. I told them that they only have to document on the back (narrative notes) what is NOT on the check charting on the front. I think that some of them thought they had to document their head-to-toe charting and then also document in the narrative part (we have it all there you just check what applies to your patient). For example: one box for pulmonary and inside of it has CTA___ wheezes ____ anterior____ posterior_____ rales, ect. and all you have to do is check what applies to your patients status. The whole head-to-toe is like this. And a seperate box for each area starting with mental status and cognition all the way through safety issuse such as side rails, alarms, restratint, ect. So lets say your patient has PNE. As long as it is all covered on the front in the check charting, they do not have to document in the narrative execpt for something that may be wrong, labs, ect. I think part of the problem was that they thought I wanted it in BOTH places and they did not want to double documentation. So maybe that will help. How are your nurse notes set up for the nurses? I just revamped ours but they are not so sure they like these either. They said it takes longer but what I tried to do was make it to follow a MDS assesment so that there was less narrative charting to be done and more check charting which takes less time. But they say there is more of the check charting now so it takes longer. Is there any way to make everyone happy and get done what needs to be done?!?!

  3. by   banditrn
    Fultzy - I see 'over-charting' in LTC just like I used to see in the hospital. In the last facility everthing was done in long hand, but in this facility, we have a combination of check-off boxes, and narrative sheets. As nite shift, I start the sheet for each day, but I see other nite shift nurses repeating the vitals that they've put at the top, into their narrative. I use the narrative for anything that is specific to each skilled resident that isn't covered in the check-off part, such as their progress, things they've said to me, problems, etc.

    I don't know why some of them make it so difficult.