Journal-"jotting" your daily rounds?

Published

Last night I had a "hall and a half' because we were one person under-staffed and no one else would come in. A resident fell and the family found her. I had been in the room 2-3 times and the resident would not be roused for dinner, so I ok'ed her to go to second seating. She seemed dry (her legs were contorted-closed if you know what I mean so appeared from the front to be dry. With 14 residents due at meds and first seating, I kept on movin-on as they say.

When asked when was the last time I was in her room, I guessed at within the hour. Tonight I am going to begin jotting down every 30 mins or so what rooms I have been in and a brief synopsis:

here's what I might write from 2pm to 4pm:

241- toileted 10 mins

232, 231, 222- toileted 45 mins (waiting for 2-assist transfers also)

222, 212, 214- sleeping

261- light plug 2 mins

212- full code brown 35 mins (bed chg)

With abbreviations this would not take any time at all.

anyway, you get the drift.

Has anyone done this before? What result have you had- what did you learn from the practice? If anything?

I figure in an 8 hour shift it might not take 5-7 minutes out of my whole shift to jot down the acitivities. I do not know if this is feasible but I am going to attempt it.

This same resident that fell later went into another room and scared that person who got out of bed and fell in the elevator all alone. I was in the bathroom with a res and had another res across the hall (not to be left alone on john) also on the toilet so could not leave the two alone to go to 1st floor. She is a wanderer and in her chair goes from room to room opening doors and going in. She really needs far more care and to be kept separate in my humble opinion.

It was a night that gave me my first doubts about my new career choice (have only recieved "one paycheck so far-new").

I am going back today and keep my chin up and keep going.

Up Vote Up Vote ×

I tried to do that but after a few months, I realized that the only things I write down are showers I need to do and vitals that I need to take. Once you get used to the residents I think that you'll intuitively know their schedules. What I learned is not to toilet two fall risk residents at the same time. It's just not worth it; people can really die if they fall and break their hip.

Those fall risks need to be addressed by your management. Do you guys use those WanderGuard ankle bracelets? At my facility, everyone looks out for the wanderers/fall risks. We don't just let their respective CNA deal with it, because it's everyone's fault if they fall in plain sight or somehow end up a few blocks away from the center.

Up Vote Up Vote ×

True. When I get the same hall repeatedly, it helps. I get really thrown off with a new hallway where I do not know names, habits, room numbers, etc! I really have a tough time of that. My regular hallway is getting better as I get more and more familiar with every little idiosyncrasy of the resident(s).

Good advice about the fall risks and toileting. I will be sure to not do that no matter what!

I know restraints are really frowned upon, but when the folks want to stand up out of their chairs, it seems a lap belt would not be so bad, doesn't it? It only takes a few seconds and they could be on the floor on their face.

Up Vote Up Vote ×
Specializes in ED/ICU/TELEMETRY/LTC.

Does your facility have bed/chair sensor pads or PBA's. This person needs one quickly.

Up Vote Up Vote ×

You are so right! I will mention this to the other cna's today when I go in and see what their take on it is.

I know there are a few censors, but none of them are on my hallway so I really have not asked. Thanks for the thoughts, I will do that.

Up Vote Up Vote ×

I wish I could have journaled last night, it would have been informative to look back over my actions. After second seating dinner, I was scheduled with 2 showers, which means I had one hour less time to do what takes me all evening to accomplish!

I had to take my dinner break at 7:30 and the 2 showers after that, one at 8pm and one at 8:30 pm, meaning 1.5 hours away from my residents. I warned the other cna's on my floor several times so they could be watching for my call lights. Coming into one resident's room, he was on the floor next to his bed (I had taken a quick peek in on him earlier between the 2 showers and he was sitting on the bed looking fine) and was OK'd by the nurse, but that meant I stayed with him the whole time waiting for the nurse from the snf part of the blg to arrive - more time taken from seeing the others. Another res had wheeled her chair next to her bed which she has not done before because I am usually in and out during that time, but she was just sitting there and had not attemted to get into her bed.

Besides the fall, I had another res who is totally indepentent who vomited. When I saw his light I went immediately because he never needs assistance. Again, I had to stay with him and clean up and wait for the nurse, more time away from the others.

Being a cna is not a perfect science, but I am really interested in doing the best I can with what I have. My difficulty is mainly after the second dinner because I have 9 who go to that seating and 8 need help getting into bed, and even to get up to their rooms. With 2 showers thrown in and other emergencies, it can get troublesome. Mgmt has really helped by not scheduling me with the feeders during second seating, so I can get my first seating people down and all clean which has been a great help.

Any words of wisdom from the experienced are greatly appreciated. Thanks! I love my job and I really love my fellow cna's they are first class and my place of work also seems above board as far as I can tell from reading allnurses for several years. I think I just need to get a bit spiffier about how and what and why I do what I do!

Up Vote Up Vote ×

My place is restraint-free, meaning we will only use them if deemed medically necessary by the patient/resident's doctor. The WanderGuard isn't a restraint; it's just an alarm that will sound if the person manages to somehow find their way out of a fire exit!

Up Vote Up Vote ×

I'd never survive journaling my night - I have 14-17 total care residents a night right now (gotta love perpetual short staffing) and 7 showers a day :(. However, if you have time and you think it'd help you, go for it.

Up Vote Up Vote ×
The WanderGuard isn't a restraint; it's just an alarm that will sound if the person manages to somehow find their way out of a fire exit!

The door alarms do go off some nights more than others. Only 1 or 2 res actually try to go out doors they shouldn't, but they keep people busy running anyway.

We have no restraints because we are assisted living and by the nature of that designation, no restraints are due. But quite a few res are more than "assisted" as you well can imagine.

Up Vote Up Vote ×
I have 14-17 total care residents a night right now (gotta love perpetual short staffing) and 7 showers a day :(.

The phrase "total care" is interesting. I have one gent, a WW II vet, who might well be total care, even though he can walk with his walker down long hallways, and can even feed himself generally. But he is combative and strong and is difficult to get to the toilet, clothing changed, or his room or bed when it is deemed necessary. He needs total care in directing his activities. He lives from breakfast to late 9-10 pm on the couch of the living room.

Another lady who I call total care lives in her wheelchair and bed and needs to be fed and every ADL needs to be done to her and she cannot communicate anything except a few gestures (airkisses and grimmaces!). She is one of my easiest because she makes NO demands. When it is time for her to _____ I just do it for her and off I go.

On the other hand, I have another res who also lives in her wheelchair and bed but she is TOTAL care (haha!) that is, she has specifications about every little thing- what lamp should be on and what lamp turned off, how her shirt and sweater ought to be adjusted, how low or high her bed and feet and head ought to be, how fast or slow she should be moved from chair to bed, how she should be wiped and with what she should be wiped. . . every movement! She cannot be left on the toilet alone and takes some time about it. She is maybe "total care" in one sense, but not another? Anyway, she is the most time-consuming because of her ability to communicate everything and her strong opinions about each gesture! Now that is also TOTAL care!!!

What do you call "total care"?

Up Vote Up Vote ×

I agree with you there; I work in skilled nursing so most of my patients are psychologically sound and therefore make numerous requests/demands throughout the day. I call these types total care.

Sometimes I get people who will do this, because they seem to be under the delusion that they are my only patient:

2:30 p.m.: Can I have iced tea?

2:45 p.m.: The tea made me have to pee. Take me to the potty while I tell you a pointless story about how great my moody teenage granddaughters are. By the way I don't want to shower. I just got my hair permed, etc...

2:55 p.m.: Can you call my daughter and tell her to bring me my pink sweater with the cat on it? No, not the black cat, the yellow one.

3:30 p.m.: Can I have some yogurt? 2 cups and with blueberries, but it has to be the Dannon kind. By the way I lost my cell phone.

4:00 p.m.: I don't want to go eat in the dining room.

4:05 p.m.: Never mind, I want to eat in the dining room. Can I have a shower right now before we go?

ETC. :banghead:

Up Vote Up Vote ×

In this particular case, I mean total total care. This is a facility for the developmentally disabled, and of the 17 residents on my wing, only one can walk, and only one can talk. The majority of them have trachs, cerebral palsy, and a variety of other issues. None (except for one) can participate in their care in any capacity, be it positioning, transferring, etc.

But yes, it's a very different thing than the oriented-ish demanding residents. The upside is that we don't have call lights. The downside is that you don't realize how helpful that those few independent residents you used to have in LTC were, until you literally have to do every single thing for every single person.

Up Vote Up Vote ×
+ Join the Discussion