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HELP!!!!! care plan question

MDS   (4,514 Views 12 Comments)
by dbsue1954 dbsue1954 (Member)

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I am an mds co ordinator in a small rural facility in northwestern indiana. Recently our nursing consultation recommended that my care plan be more detailed in regards to side effects of psycotropic meds. She advised i should detail most common side effects of these medications individually on the care plans.(example.....resident receives ativan for anxiety/restlessness...common side efffects of this medication is anxiety and restlessness) I can hear my state surveyors asking me when they come how do you know if the behaviors exhibited are from the medication or the condition they receive it for??? can anyone help me with an answer so i can be ready for them????

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Nascar nurse is a ASN, RN and specializes in LTC & Hospice.

2,213 Posts; 31,934 Profile Views

I am an mds co ordinator in a small rural facility in northwestern indiana. Recently our nursing consultation recommended that my care plan be more detailed in regards to side effects of psycotropic meds. She advised i should detail most common side effects of these medications individually on the care plans.(example.....resident receives ativan for anxiety/restlessness...common side efffects of this medication is anxiety and restlessness) I can hear my state surveyors asking me when they come how do you know if the behaviors exhibited are from the medication or the condition they receive it for??? can anyone help me with an answer so i can be ready for them????

Well... as much as I try not to admit to my location, this time I have to say that I am in the exact same location as you and therefore we probably have the same survey team. AND, if in fact we do have the same team, they will "kill" you on this. I have been preached to "KISS" (keep it simple stupid) in regards to careplans. It seems the more detailed info we put, the more trouble we get into. Please PM me if you want to compare survey teams. I don't want to name names here.

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97 Posts; 2,138 Profile Views

sounds like you two should stick together on this one however, wouldnt the side effect you listed be adverse rather than common side effects. More common side effects are things such as dizziness, lightheadedness, euphoria, and sleepiness. listing relief of anxiety symptoms as optimal benifit to the drug.

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39 Posts; 2,763 Profile Views

awesome smiles thank you........i am new at this so......i never thought about the relief part...however my superiors wanted the adverse effects emphasized survey team says........."observe for adverse side effects....what are they.... how will your cna's know what to watch for?? i will talk to my nursing consultant and see what she has to say i think it is a great idea

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fluffwad specializes in MDS coordinator, hospice, ortho/ neuro.

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awesome smiles thank you........i am new at this so......i never thought about the relief part...however my superiors wanted the adverse effects emphasized survey team says........."observe for adverse side effects....what are they.... how will your cna's know what to watch for?? i will talk to my nursing consultant and see what she has to say i think it is a great idea

how about-

"observe for side effects that might cause resident to fall"

or

"observe for adverse drug reactions / changes in cognition / ADL performance" You could add sx r/t GI bleed ( tarry stools,etc) or allergic reactions........depending on the kind of drugs being used.

CNAs are not trained for adverse drug reactions (that is the nurses job) but a good aide will see a lot of things anyway. Keep it simple ....The care plan is NOT the PDR, nor is it a substitute for the MAR or policy and procedure manual.

I don't list specific drugs....just classifications ( ex. admin. antianxiety agents as ordered. monitor for adverse reactions that might lead to falls). Specifics will hang you.

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39 Posts; 2,763 Profile Views

thank you......i will start incorporating some of those too...i agree that i am asking for trouble by specifically listing the medications but.... this is how our nurse consultant requested it ...soooo i guess survey time will tell...i am always afraid i will miss updating a care plan when the medication is d/c'd or changes......thanks

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22 Posts; 1,261 Profile Views

I have added pages in the ADL books that are drug category specific. (purple for antipsychotic, yellow for antidepressant etc). Side effects are generic and I add the specifiec medication and resident name and have put them in plastic protectors so they stay there till med is d'c.d. The page is also in the MAR book as we utilize CMAs. The care plan remains generic.

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2 Posts; 512 Profile Views

I think they are probably looking for both positive and negative side effects of antipsychotic meds. EPS's and tardive dyskinesia to name a few.

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47 Posts; 1,755 Profile Views

In our care plans we write observe for adverse reactions and then list the generic ones for psychotropics such as lethargy, altered mental status, etc. It give you some thing to look for but still keeps it simple and we have never had a problem with out survey team in doing it this way.

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236 Posts; 3,620 Profile Views

i'm thinking it's ok to list the nervousness anxietyas something to monitor. the whole idea being if condition doesn't improve,or symptoms continue, (or seems to ) you d/c it,go to something else more beneficial.

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I use a non-specific..."Medication and treatments as ordered. Monitor for effectiveness, side effect, and adverse reaction. Report as needed." The state didn't object to it on our survey since our CNAs reported that they report anything that is out of norm for our residents. The nurses reported that with this information, they know to watch for anything unusual and evaluate whether it needs to be reported to the doctor.

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24 Posts; 1,261 Profile Views

Isn't listing the side effects on the care plan a little redundant? The nurse's are monitoring for them during med pass. To list them on the care plan is silly. Plus, it is esentially useless information. To apease the consultant I might add an approach that states "report oversedation or an increase in anxiety to MD if noted." but not list the adverse effects of each medication.

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