LTC rework

chrisrn24 · Dec 13, 2013

Could you be more specific? What do you mean by double work?

Guest757854 · Dec 13, 2013

i couldnt even begin to explain why LTC facilities have so much work for their employees. i have worked in LTC the majority of my nursing career and it wasnt until recently when i decided that it just wasnt for me anymore. im too shure about whether i like it or whether i am just burnt out on it. i have been a LPN for eight years now and would love to delve into another field of nursing which is one of my reasons for going back to school to obtain my RN. i am currently awaiting to take my nclex and i think i am just going to transition into the RN role at my current place of employment until i get my one year experience. but it is hard work to work in a long term care facility. the only reason i believe employers are making the workload hard for anyone working in long term care is because of the reimbursements from medicare/medicaid and CMS, and usually the largest department in any healthcare setting in nursing and thats where the budget cuts happen first. which is bad for patient care, but to the administration, its a business. so they dont think about it like that.

sunshyne17 · Dec 14, 2013

chrisrn24,

We have 3 systems we use to chart various data on the computer and then theres the physical chart. We put in the amount of fluids we pass with meds in the system that tracks the meds (eMar) then we have to add up those same numbers and put in another system --> REWORK.

We write physical orders on paper to put the same exact order into the online charting -->REWORK.

We fax paper work, stamp that we fax it, write an order in the chart to say we faxed it then put the fax receipt in the log book --> REWORK!!

Just 3 examples!

chrisrn24 · Dec 14, 2013

Ah okay. We do some of that...if we get verbal or phone orders we CAN write them in the chart but we don't have to.

Anyway could you bring that up with your manager? I think it would be a good place to start. Do you really need a fax receipt? Do you really need to write an order out twice?

Or just a whole new EMR!!

pinkiepinkPN · Dec 15, 2013

chrisrn24 We have 3 systems we use to chart various data on the computer and then theres the physical chart. We put in the amount of fluids we pass with meds in the system that tracks the meds (eMar) then we have to add up those same numbers and put in another system --> REWORK. We write physical orders on paper to put the same exact order into the online charting -->REWORK. We fax paper work, stamp that we fax it, write an order in the chart to say we faxed it then put the fax receipt in the log book --> REWORK!! Just 3 examples![/quote']
Oh GAWD, the FAXES!!! It's the most pain in the patoot task of all!

sunshyne17 · Dec 15, 2013

lol pinkiepinkPN - sometimes I just let out a good ol charlie brown "aaarrrgggh!" sometimes. Because we just get so behind.

vampiregirl, BSN, RN · Dec 15, 2013

Is your facility new to EHR/ EMAR? I know that when we first transitioned there were a lot of "rework" or "double/ triple documenting" instances. It has greatly diminished over time for us, but many times it took bringing specific examples to administration so the process could be looked at/ changed.

There were also several instances of us double charting because "that's how it's always been done" when it reality no one knew how or why we got started doing extra work and there wasn't any reason for it.

Long Term Care Columnist / Guide · Dec 15, 2013

Unfortunately, a lot of the excess paperwork that comes down the pike is a result of management overreaction to deficiencies found during surveys. I've seen it every place I've ever worked in LTC, even devised some of it myself back in my days as a DNS. The problem is, the more places we have to document something, the more chances there are to miss a piece.....but of course, management never figures this out because they're freaking out over a few tags and the only answer is MORE PAPERWORK!! :banghead:

bluegeegoo2, LPN · Dec 15, 2013

Unfortunately, a lot of the excess paperwork that comes down the pike is a result of management overreaction to deficiencies found during surveys. I've seen it every place I've ever worked in LTC, even devised some of it myself back in my days as a DNS. The problem is, the more places we have to document something, the more chances there are to miss a piece.....but of course, management never figures this out because they're freaking out over a few tags and the only answer is MORE PAPERWORK!!

Exactly. One building I worked in had a policy that every single I/A report required 5 witness statements. (Even if those on shift had no knowledge of the incident. It was perfectly acceptable to write "I have no knowledge of this incident" or "I was told that this res rec'd a s/t.) They also had policy that any and all falls was an automatic BIL hip xray regardless of clinical findings. Lots of extra time/paperwork just because someone wrote it for a POC ages ago. Silliness.

sunshyne17 · Dec 15, 2013

vampiregirl - I have no idea when they implemented the eMAR system. But pretty much anything gets you written up from what I hear staff say so that's probably the birth of this rework.