Help a girl out here...

[mappers]

Hi,

I'm an RN who teaches clinicals two days a week in an LPN program at an LTC/Rehab facility. I'm an oncology nurse in my other life, doing outpatient chemo, and I worked Med Surg in a hospital before that.

My students are in their 4th quarter and are getting ready to graduate. For them, I've been focusing on three things - really good assessment skills, time management, passing medications. I try to get them comfortable with a med cart, where they have a good idea of what the meds are, but aren't afraid to look them up, get good with crushing meds, G-tubes, etc. They also do all the treatments on their halls to get used to the 5-million and a half types of dressing changes there are (and how everyone calls the non-adhesive gauze adaptic, even though that isn't the brand used at the facility anymore ;O). We give a lot of insulin and do as many other skills as present themselves. We are lucky in that we have a very pleasantly confused gentleman who needs to be straight cathed while we are there, so everyone is getting a chance to do that.

Most of the nurses we work with are very helpful, enjoy having the students and are usually grateful for the help. I like the educator, and the DON seems to like having us there.

So, but long intro for two questions:

1. the DON has hired quite a few of our graduates and said they are very good. However, their charting stinks. As an RN who works in an environment with computerized charting, what should I be having these kids focus on? What is "skills charting" and what types of stuff should be included? I found tip sheets the facility uses that outlines what they need to document for assessments, but I'm wondering if I'm missing something else.

2. Do your facilities have policies on PICCs that do not have blood return? We have a resident who is getting IV ABX including Vanc. I was taught that if you do not get blood return from a central line, you should not administer a vesicant like Vanc. (This is the chemo nurse coming out in me.) Now I realize that this facility doesn't have access to Cath-Flo or something like that, so I'm wondering what you do. I've asked about a policy and the educator didn't know. I looked at some policies today on PICCs, but there was nothing that addressed no blood return. The PICC flushes easily and the patient denies any pain, but still I wonder.

[missnurse01, MSN, RN]

I can't speak to the charting question but I know here in the ICU we use PICCs that won't draw blood all the time, for all types of irritating meds (dopa, levo, etc).

Good luck on everything!

[kdhnursern]

Skills charting is charting towards what Medicare patients have been admitted to the facility for such as CHF, hip fracture, ... whatever the skilled nursing is for. Charting should document daily skilled care which is required for Medicare reimbursement or to establish the Case Mix Index for Medicaid. Skilled for nursing can be IV therapy, pressure ulcer or wound management, new tube feeding, or suctioning, cares that require a nurse's skills. Skilled rehab is PT/OT/ST. The facility should have examples of what they require for documentation. Our facility is totally electronic and we have skilled assessments for the charge nurses to fill out every shift.