Monthly summaries - page 2

Hi. How do you all make sure your summaries are done in a timely manner? I have nurses in the building who say they can't possibly get their summaries done and want to come in on their day off (with... Read More

  1. by   JeanineLPN1984
    In addition to our regular charting- we do one monthly summary a shift. It's broken down by room and bed and date and posted . Usually each unit has about 36-40 residents, my unit is 7-7, so ours are done 18-20 days. Ours are mostly a checklist on the front and the back is for the narrative note, and we chart according to the care plan, thus follows the raps, triggers and mds.
  2. by   Dixiecup
    Wow, that sucks your state still requires it. I live in Missouri and it's no longer a reg.,we stopped doing them a long time ago. The nurses all did the happy dance!
  3. by   DixieRedHead
    In our facility we have weekly charting and skin checks, quarterly reviews (fall risks, contractures, psychotopic meds, AIMS tests if needed, etc.
    The are divided amongst all shifts.
    I have made the nurse responsibile for the weekly charting and skin checks responsible for checking to see that the quarterly reviews are caught up. That gives them 4 chances in the month that the quarterly review is due.
    Don't let me find one late.
    You have to own it.
  4. by   achot chavi
    Quote from CapeCodMermaid
    The reason is when told, they are defiant. They know they can do what they want and nothing will be done because they are in a protected class. Sorry to be so mysterious but one can't say too much on here that would give away one's identity.
    I understand completely, Either you can be heavy handed about it and demand 5 on your desk every week or appeal to your boss to give the extra hours, Only you know if they are working the way they should,
    Can the job be given to night nurses? Can you relieve them of some other responsibility in order to free up time to do their monthlies?
    Look I am sure you have checked out all the angles, Take a deep breath before thinking of some creative and charming way to deal with this,
    You cant be too heavy handed here or you will get it back in your face.
  5. by   evilolive
    As a night nurse, I wouldn't mind spending some time doing summaries if some of the other work was taken off my plate for the last two weeks of the month. In our facility, we start summaries on the 15th of the month and have until the end of the month to complete them. Some of them take me awhile to complete, especially new admits, and people who require different assistance on different shifts. For example, I had two residents who were physical assists on one shift for the first half of the month, who then became total dependents. From what my ADON taught me, she wanted 15 days of documentation to be able to get "points" on various aspects of the summaries. I'm not sure if she means treatment wise only, or whether the 15 days of documentation included the change from physical assist to a total dependent. If a resident is a physical assist on 7-3 and a total dependent on 3-11, then what do I go by? I am still trying to figure this one out after working here awhile...

    How we split up summaries:
    The two FT 7-3 nurses usually get 5 summaries to do. The FT 3-11 and 11-7 nurses usually get 6 apiece. Weekend nurses generally get 3 apiece, and the Monday 11-7 nurse gets 2-4, depending on our census.

    My old ADON used to be up my butt about these on a daily basis. I'm not much of a complainer to management, but sometimes I feel as if they don't understand how unfair it seems to expect getting the summaries done in a timely fashion when you have unclear CNA documentation on what a resident's status is, and also when you expect your "off shift" to do the majority of editing at the end of the month as well. Stuff does happen time to time at night, and can be time consuming.

    Sometimes I help the day nurses out when I know they haven't had the time to complete their summaries, and this past month I came in to find that my last two were done by a day nurse. What a joy! I really do appreciate helping one another out when possible.

    However, from the 11-7 standpoint, I feel like it is getting harder to complete the necessary work when other responsibilities keep getting tossed onto my shift.
  6. by   achot chavi
    Yeah, if the status of the patient changes you have to redo the monthly...or just do them all on the last day of the month :-)
  7. by   LockportRN
    I assign out the monthly summaries for each nurse. It is divided by the am and pm shift. The summaries are divided to only a couple per day and are assigned according to the nurse that usually works with that resident.

    The top of the monthly summary is a flow sheet for basic assessment and the bottom is to be completed bases off of the Care Plans and is numbered. For example: prob #1) Poor intake due to post surgical comps. The nurse would just write #1 and address that issue. She then goes to #2 and so on until all have been addressed. Once the problem has been resolved (surgical site healed) that problem would no longer have to be addressed.

    As for ensuring that they have been completed, I have the ward clerk post the monthly summary assignment list and medical records is responsible once a week to check the charts for placement (not content). I also ask the nurses to initial when they have been completed.

    It takes about 2 months and vigilance on your part (the nurses want to make sure that you are serious and that they are not just wasting their time) but then it goes more smoothly. I make sure to include a copy of this along with the expectation that these be completed timely in the orientation pack (which each new hire recieves and signs that they understand). I can't tell you how much this has helped our reimbursement from M/C and PA payers. It has also served us well during survey to show that a problem has been addressed and resolved (esp with those residents that bring up year old issues with the surveyors but forget to tell them that the occurance was a year ago).
  8. by   BoopetteRN
    We have a flow sheet that follows the care plan, med changes, wt changes, behaviors, transfers, ADLs ect. Everyone usually is behind in their charting. One of our neighborhoods has had the night shift do the charting which I am not sure is such a great idea. If the nurse has a question and she wants to speak to direct care staff that might become an issuse--in fact, she did not know that our operator keeps a log up front for residents who have behaviors and try to elop, I do not see how that can be effective charting.
  9. by   litbitblack
    I work at a private pay facility so i guess its a little different but We have 4 suites that each hold 15 residents. Each suite gets a monthly review calender and the residents are all scheduled on there. THere are no more than 2 on one day and they are marked days and evenings. None on weekends. THey are pretty easy. doesn't seem to take very long. Days usually has 8 and evenings 7 but they are spread out so it doesn't seem like very much. Our charting is pretty much whenever there is a concern or to follow up. We chart when we fax to the doctor and it stays in followup till we get a response. Followup for 3 days on ANY med changes. ect ect.
  10. by   supernurse1230
    that is inexusable! i work in a nursing home where i have 45 resident! thats including pegs, medicare and all and we still manage to get ours done, and its not even a flow sheet summary, where you just check off things, its a summary note in the nn
  11. by   fulzgold
    We used to do monthly summaries when I worked the floor. Now I am ADON / MDS / Restorative / Care plan yada yada. I did away with the monthly summaries. They required lots of uninterupted sitting time, referenceing wt records, intake records, ADL grids, careplans...ugggh. I designed a weekly assessment that follows the MDS questions in a ( check box) type format. It also is a head to toe assessment addressing all body systems. They just don't realise it. So if it happens to be a nurse who is not a thinker, it forces the nurse to address all systems and nothing is forgotten. It includes lines for any documentation required on that patient that shift and this is used as the nurses notes as well. They are assigned by shift and rooms. If the room is empty, hey, lucky you. The nurse were tickled to do these instead, and I hve all the MDS documentation I need without begging.
  12. by   CapeCodMermaid
    If we don't do monthly summaries in Massachusetts, we won't get paid by Medicaid and if the summary doesn't match EXACTLY the flow sheets, care plan, and nurses' notes, they take money away.
  13. by   cruisingdayz
    I would love to see the sheet that who moved my cheese designed. We use a nursing progress note to back up the mds that includes the 7 day look back period -- it has mds supportive questions with simple boxes to mark & a nursing summary note. We also have implemented something called the accunurse system where the cna's document the adl's -- this is supposed to back up the mds data ha! HA! I am actually working with a cross walk for accunurse and american health tech system --- the information the cna's recprd is not accurate most of the time. It takes one hour to correct the documentation for one resident & then inservice the cna. I als am the ADON, MDS Coordinator, IN-Service Coordinator, Care Plan Coordinator, Head Accunurse Coordinator. I educate the LPN working with me to use pack up nursing notes that we ourselves write because none of it matches. Not the notes the floor nurse document's, not the cna information recorded into accunurse, & that leaves us with all the mess to clarify and provide adequate documentation for mds support purposes. Now, that is definately a documentation issue to over come. I like to try to stay positive at all times because I am the leader however, it gets very frustrating trying to complete just one assesment. So, if anyone has advise or a shorter method please let me know.

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