Help with evidence based nursing practice class

[jenannebeard]

We were given an article and I have to answer a few simple questions. But I want to see if anyone else see anything I've missed. Any help is much appreciated! Thanks!

Here's the article...

CHICO-A nursing home has been ordered to pay a $100,000 fine in connection with the death of an elderly resident.

The fine was levied against Twin Oaks Health and Rehabilitation Center by the state Department of Public Health.

Jason Smith, a spokesman for Evergreen Healthcare Management, which owns the Chico nursing home, said he couldn't comment on the citation because of rules that protect residents' privacy.

A document from the Department of Public Health indicated Evergreen is appealing the citation.

The resident who died, a 98-year-old woman, slipped out of her wheelchair and was strangled by a belt that was supposed to keep her in the chair, according to documents from the Department of Public Health.

The woman, who had to use a wheelchair, moved into Twin Oaks in February of last year. She'd been diagnosed with Alzheimer's, anxiety, depression, weakness and psychosis, according to state documents.

Often, she would slip down in her wheelchair. Staff members had to watch her and pull her up when that happened, the documents said. For a time, a device called a pummel cushion was used to help keep her in the chair, but for some reason its use was discontinued. A restraint called a "soft waist belt" was used to help prevent her from falling out of the chair.

During supper on Dec. 7, the woman kept sliding down in her wheelchair. It happened so many times that two certified nurse assistants (CNAs) who were working in the dining room decided to put her to bed immediately, documents stated.

The two CNAs, who weren't regular staff members but had been hired through a registry to work temporarily, were taking the woman to her room when they were stopped by a family member of another resident, who asked them to put that resident to bed first.

According to documents, the two CNAs said they thought the woman in the wheelchair would be all right by herself for a little while, so they left her in the doorway of her room and attended to the other resident.

Twenty to 30 minutes later, the documents said, the two CNAs came out into the hall and noticed that the door was closed to the room of the woman in the wheelchair. They opened the door and saw the woman on the floor with the waist belt pressed against her neck and chest, the documents stated. She wasn't breathing.

The nurse assistants began performing CPR, but a nurse who had been called told them to stop because the woman had left instructions that she was not to be resuscitated, the documents said.

Twin Oaks reported the incident to the Department of Public Health, which investigated. The nursing home was issued a Class AA citation for failing to keep the resident safe and not providing adequate supervision.

Class AA citations are the most serious the state issues. They carry a fine of between $25,000 and $100,000.

The nursing home was required to develop what's called a plan of correction. In its plan, the Twin Oaks administration said the entire staff, including employees hired through registries, would be instructed that residents' safety must take priority over all other concerns.

• What is/are the problem(s) that you recognize? (For each identify the population of interest: patient, staff, agency, etc.)
  
  • Possible lack of appropriate nursing staff to resident ratios - Agency
    
  • Inadequate training of nursing staff - Agency
    
  • Lack of proper documentation for discontinued use of pummel cushion - Staff
    
  • Abandonment - Staff
    
  • (Should I just state Alzeheimers as the problem and patient as the population, I'm confused what problem I can relate to the patient population)
    

• What information (or type) do you need to address each of these problems? (Be specific and justify your response)
  
  • Possible lack of appropriate nursing staff to resident ratios - Agency
    
    • I'm thinking I need to look up California's requirement of nurse to patient ratio for nursing homes
      

    [*]Inadequate training of nursing staff - Agency

    • Maybe find a study done that tells me the outcome/results of injuries that occur related to staff incompetence?
      

    [*]Lack of proper documentation for discontinued use of pummel cushion - Staff

    • No idea!
      

    [*]Abandonment - Staff

    • No idea!
      

• What information would be helpful to know for each problem, even if it may not be easily available? (Explain)
  

Uhhhh.....

• Identify at least 2 specific sources of information for each of these problems (e.g. websites with a brief description about what information can be obtained).
  

I will do this later, not that hard.

• Provide a brief description of the overall problem(s) and your recommendations to the director to address this issue. Remember that you are not solving the problems but setting up a method to address the issues.
  

I will be able to do this once I am able to identify all possible problems.

STRESSED OUT!

[Double-Helix, BSN, RN]

Please find my comments in bold

• What is/are the problem(s) that you recognize? (For each identify the population of interest: patient, staff, agency, etc.)
  
  • Possible lack of appropriate nursing staff to resident ratios - Agency
    
  • Inadequate training of nursing staff - Agency (Related to what? Restraints? Supervision?)
    
  • Lack of proper documentation for discontinued use of pummel cushion - Staff
    
  • Abandonment - Staff (Are you sure about this? Abandonment how? Is it abandoment to leave a resident in the doorway of their room while helping another resident?)
    
  • (Should I just state Alzeheimers as the problem and patient as the population, I'm confused what problem I can relate to the patient population) (Alzheimers/dementia is certainly a problem when trying to ensure safety of residents.)
    
  • What about the fact that this woman repeatedly slipped down in the chair and had to be pulled back up? Do you find it a problem that this went uncorrected for so long?
    
  • What about the habitual use of restraints on someone who is not oriented in general?
    
  • 
    

What information (or type) do you need to address each of these problems? (Be specific and justify your response)

• Possible lack of appropriate nursing staff to resident ratios - Agency
  
  • I'm thinking I need to look up California's requirement of nurse to patient ratio for nursing homes
    

  [*]Inadequate training of nursing staff - Agency

  • Maybe find a study done that tells me the outcome/results of injuries that occur related to staff incompetence?
    
  • What about finding out what a nurse should know related to this issue (school education)? What training does the agency require? Are their competancies that the staff are required to meet?
    

  [*]Lack of proper documentation for discontinued use of pummel cushion - Staff

  • No idea!
    
  • What was documented related to the pummel cushion? Is there a policy in place for documentation related to restraints? Can an order be found?
    

  [*]Abandonment - Staff

  • No idea!
    
  • Again, I'm not sold on this, but you would definately want to know what constitutes abandonment according to state law.
    

What information would be helpful to know for each problem, even if it may not be easily available? (Explain)

Think about it this way: If you could go back in time and be inside the building while this were taking place, what would you want to know? Here's some hints- What was was nurse patient ratio that night? How long was this resident left alone? How many times had she slipped down in her chair? Was the doctor or charge nurse ever notified about the problem with the chair in the days before this incident? Was the belt being applied properly? Was the resident able to remove the belt? Was the use of a chair or personal alarm ever used to notify staff when the resident slipped?.....keep going on your own.