Just had survey...need advice on correction plan

leslie :-D · Jul 20, 2004

yes, unfortunately it is necessary, to identify why these pts fell and/or whose at risk....

do these high risk residents have bed and chair alarms?

have needs been met if restless/agitated/pain/toileting?

can rehab aides ambulate some of those who are ambulatory?

for those extra challenging pts. that require 1:1, can they be moved near nurses' station?

has all pathologies been r/o?

surveyors take this very seriously and they do not want to see restraints either. once you have all updates in place, it will be so much easier to maintain.

best of luck,

leslie

BHolliRNMS · Jul 21, 2004

I agree, it is necessary. I just think I would appeal the G tag on an alert and oriented resident who fell. She has rights to refuse restraints and alarms can be restraining. I get tired of everyone saying you have to have a new intervention with every fall, but don't restrain anyone. I have started careplanning "new intervention" as med reviews by rph for fall, sitting/standing bps and reporting to MD. My goodness, there are only so many gadgets you can use. Was everything on this resident on the plan of care? as her removing the alarms? I would fight this tag.

Destinystar · Jul 21, 2004

it would be prudent to review all the residents who are at risk for falls and make sure that their plan of care reflects your new policy and that this is communicated to all the staff. i am quite familiar with the type of resident who will insist on getting up unassisted and then wind up falling. its the proverbial accident waiting to happen. unless these residents have one on ones they will continue to fall from now until christmas. your facility might want to identify residents that they cannot take care of and possibly think about discharging them to a place that can for their own sake as well as the facilities. i was at a facility and we had a policy that once a resident eloped we did not readmit them. if they were caught trying to escape we just discharged them to a place that could contain them better because we did not think the benefit of keeping them outweighed the risk of having them injured. might want to think about that and incorporate something to that effect in your new policy. dont take it too personally. this year its a fractured hip, next year it will be who knows food served at the wrong temperature, you can never second guess. sounds like you have a good facility and these people have to put something under the magnifying glass to justify their position. its like closing the barn door after the horse escapes! :rolleyes: quote=frazzledrn]we just ended our annual state survey this past thursday...had a few cites...7 to be exact...not our greatest survey...but it could have been worse...

anyway, one of our tags was a g tag :uhoh21: for a fall that resulted in fracture...and the surveyors felt that not enough measures were attempted with this alert and oriented lady who removes her own alarms to walk to bathroom unassisted, to keep her from falling. my administrator is being very involved with the plan of correction (which is wonderful)...but it seems as though he is making more work than needs to be...we changed and updated our fall policy...totally revamped and are now having safety meetings two times per week....inservices for nurses to apply an intervention for each fall..and updating the plan of care to reflect this...we have added a different bed to the resident which we were cited on...we have taken numerous measures to correct the old policy and update existing staff.

the administrator wants us to go back into the charts and review other residents (which is a potential of 50 or so residents) who have fallen to evaluate that the "deficient practice" of our old policy isn't affecting any other residents that can be recited in the follow up survey. my question is ...isn't this alot of unnecessary work?..(which is falling onto my shoulders..even though i have been cite free in mds and care plans for the last 3 years....i am thinking that the new policy and upgraded surveillance is what is necessary to prove that we have corrected and that no other resident will be affected from the old practice. is there a need to go back and review past falls? we have already been cited and are out of compliance with the regulation. and we have corrected the policy in question from the date if citation on. we should be back in compliance...with the new policy and standards. is it necessary to go back and review these items? am wondering....any ideas? thanks!

LPN4Life · Jul 21, 2004

When our facility received a G tag, and we thought we had done every conceivable thing to prevent it from happening again, the revisit was done, and they changed it from a G tag to an F tag. So yes, it is definately necessary to CYA when it comes to things like this, however it is unfortunate that it is all falling on your shoulders. Maybe a Fall prevention committee would be a good idea?

Dormkare1 · Jul 21, 2004

I agree. Fall teams are an excellent idea. Our facility intitiated an ACTION team to review all falls that happen in the last 24 hours ( 48 if they happen on weekends). We started thsi for an APS project and display our results in the employee breakroom so everyone can see our accomplishments. First thing in the morning all departments meet and discuss what is happening within the facility then after Med Director and Administrator (and any others who do not have need to know) leave the rest of the IDT review the falls and we all attempt to come up with new ideas. However, in some cases trying to find a resolution can be combersome. Has been successful though. I also agree the charts should be reviewed and all areas ie; pain, incontinence, dementia, meds, labs should be reviewed. Why is she trying to stand up, was she uncomfortable. Maybe it might even be something as simple as an uncomfortable chair. :rolleyes:

FrazzledRN · Jul 22, 2004

Thanks for all of your input! I have started on reviewing all of the charts of residents with fall risks....we do have a safety committee who was meeting weekly and are now meeting 2 times per week. We have stars posted on doors of those who are at risk for falls. We have new forms instituted at time of fall and will continue in charts that follow interventions and dates tried.

Our resident that is alert and oriented and removes her alarms now has a sensor alarm to her mattress as well as bed and chair alarms. New clips that are more difficult to remove. All measures that were attempted, even medical interventions of insulin adjustments and UTI treatment (ambulating to BR unassisted due to frequency...) were documented and care planned.

We have alarms and sensor alarms, a few low beds and blue mats to floor...not alot of gadgets at our disposal. We use full and 1/2 rails, padded rails and beds against walls. DON says is unfortunate that we do not have more to our disposal in our building. :stone

I just thought that since we were already out of compliance that the correction was from that point forward and our new policy is what proves that other residents won't be affected by the "deficient practice". But can see that it is definitely worth it to ensure that they don't return and recite or cite something worse! Again thanks for the input! :)

debRN0417 · Jul 24, 2004

When we have a fall, the Physical Therapy department does a post fall screening and makes recommendations to the team as to how we can best prevent a recurrence. We discuss all falls every morning at our morning meeting of all department heads and then weekly at RISK meeting where we discuss all residents "at RISK" (falls, weights, changes in condition, on antibiotics, etc) We document this in the RISK notes section of our charts. I keep an unusual occurence log and log each occurence, keeping track of all the measures we use to prevent recurrences. The residents who fall are discussed at RISK meeting for 4 weeks post fall. This way we are evaluating them to make sure the interventions we have put in place are effective and practical for that resident. Also make sure that any intervention used is care planned and that notation is made on the MDS of the same. It also helps if the resident has certain triggers on their MDS ( falls, psychotropic drug use, restraints, cognative loss dementia) that you can identify so that you know who is at higher risk. We also have a restraint committe meeting, so that if all measures have failed and a restraint is required, it goes through the committe so that the orders are correct, the intervention is correct, the family is involved, the consent for restraint signed ...etc...etc...We also have a "falling star" program. Hope this helps...good luck.

QUOTE=FrazzledRN]Thanks for all of your input! I have started on reviewing all of the charts of residents with fall risks....we do have a safety committee who was meeting weekly and are now meeting 2 times per week. We have stars posted on doors of those who are at risk for falls. We have new forms instituted at time of fall and will continue in charts that follow interventions and dates tried.

Our resident that is alert and oriented and removes her alarms now has a sensor alarm to her mattress as well as bed and chair alarms. New clips that are more difficult to remove. All measures that were attempted, even medical interventions of insulin adjustments and UTI treatment (ambulating to BR unassisted due to frequency...) were documented and care planned.

We have alarms and sensor alarms, a few low beds and blue mats to floor...not alot of gadgets at our disposal. We use full and 1/2 rails, padded rails and beds against walls. DON says is unfortunate that we do not have more to our disposal in our building. :stone

I just thought that since we were already out of compliance that the correction was from that point forward and our new policy is what proves that other residents won't be affected by the "deficient practice". But can see that it is definitely worth it to ensure that they don't return and recite or cite something worse! Again thanks for the input! :)