15 min per patient!?!?

Cat365 · Aug 17, 2017

I'm not sure I'm understanding your post. Maybe there is a mistake in it?

Are you saying you don't do anything but medications so you only spend 5 minutes vs everyone else's 15 minutes?

sallyrnrrt, ADN, RN · Aug 17, 2017

She probably works LTC, CMS/Rug to consider a neb treatment for reimbursement, it has to take 15 min of documented clinical intervention and patient assesment.....

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN · Aug 17, 2017

So we have to fill out respiratory flow sheets. On these sheets we document that we gave a nebulizer treatment, lung sounds, 02 SAT before and after and how many minutes we were with the pt.
Everyone writes 15 minutes....I'm in there MAYBE 5 if There are a lot of meds.
I don't want to make waves, but I really don't want to say 15 minutes when there isn't any way I could actually do that and still give meds.
I mean, if they did the math that would give me like 20 seconds per patient
Help! What would you do?

Think about the time it takes to prepare the medication and quickly assess the patient prior to medication administration. By the time you complete this initial process, return to disconnect the nebulizer, reassess, then document, would that not equate to at least 15 minutes after adding actual inhalation time? After all, you are having them to cough and deep-breathe after, correct? This will kill 15 minutes easily if done correctly. Factor in a productive coughing spell:yuck:, and there you have it.

In LTC, time is limited or non-existent. But CMS doesn't care about that. The proper process is expected since they are funding the care of most of these residents; it is up to your facility to ensure that you have adequate staffing to properly care for the specific resident population.

As a state surveyor, we observe and time this process because of the regulations, and believe it or not, CMS-appointed surveyors come down to observe us as we observe you. If I was standing there with my pad and pen, observing you, I assure you that the process would take up the entire 15 minutes as you carefully complete each task...even if you stop the timer as you proceed to another patient, and restart it upon your return.

On a rare moment when you have nothing left to do, go in and administer one of your neb treatments without leaving the bedside, timing it from start to finish, and compare your findings to what you believe takes only 5 minutes.

CoffeeRTC, BSN, RN · Aug 18, 2017

Think about the time it takes to prepare the medication and quickly assess the patient prior to medication administration. By the time you complete this initial process, return to disconnect the nebulizer, reassess, then document, would that not equate to at least 15 minutes after adding actual inhalation time? After all, you are having them to cough and deep-breathe after, correct? This will kill 15 minutes easily if done correctly. Factor in a productive coughing spell:yuck:, and there you have it.
In LTC, time is limited or non-existent. But CMS doesn't care about that. The proper process is expected since they are funding the care of most of these residents; it is up to your facility to ensure that you have adequate staffing to properly care for the specific resident population.
As a state surveyor, we observe and time this process because of the regulations, and believe it or not, CMS-appointed surveyors come down to observe us as we observe you. If I was standing there with my pad and pen, observing you, I assure you that the process would take up the entire 15 minutes as you carefully complete each task...even if you stop the timer as you proceed to another patient, and restart it upon your return.
On a rare moment when you have nothing left to do, go in and administer one of your neb treatments without leaving the bedside, timing it from start to finish, and compare your findings to what you believe takes only 5 minutes.

^^This. It really does add up. I try to do all my neb treatments around the same time. Some shifts i have 6 or so going at once......in addition to the 20 other residnets I'm passing meds on.

Glycerine82, LPN · Aug 18, 2017

Think about the time it takes to prepare the medication and quickly assess the patient prior to medication administration. By the time you complete this initial process, return to disconnect the nebulizer, reassess, then document, would that not equate to at least 15 minutes after adding actual inhalation time? After all, you are having them to cough and deep-breathe after, correct? This will kill 15 minutes easily if done correctly. Factor in a productive coughing spell:yuck:, and there you have it.
In LTC, time is limited or non-existent. But CMS doesn't care about that. The proper process is expected since they are funding the care of most of these residents; it is up to your facility to ensure that you have adequate staffing to properly care for the specific resident population.
As a state surveyor, we observe and time this process because of the regulations, and believe it or not, CMS-appointed surveyors come down to observe us as we observe you. If I was standing there with my pad and pen, observing you, I assure you that the process would take up the entire 15 minutes as you carefully complete each task...even if you stop the timer as you proceed to another patient, and restart it upon your return.
On a rare moment when you have nothing left to do, go in and administer one of your neb treatments without leaving the bedside, timing it from start to finish, and compare your findings to what you believe takes only 5 minutes.

Good point! I feel better. I just feel like I don't do enough, because there's not 10 of me....I stay in the general area preparing other meds, starting other treatments and check back frequently but I don't stand there and watch, but you're right. Thank you.

Glycerine82, LPN · Aug 18, 2017

^^This. It really does add up. I try to do all my neb treatments around the same time. Some shifts i have 6 or so going at once......in addition to the 20 other residnets I'm passing meds on.

Yeah, Im seeing how it does, now that I think about it. I usually start all my nebs on the same hall and have them going at once. Then I go back room to room and disconnect, rinse mouths etc. I have one lady that gets 4 of them, another who gets 3 and I think 4 or 5 who get 1 or 2 each. Between that and 8 blood sugars all requiring coverage between 3pm and 5 I'm overwhelmed. But I have 30 new grandparents, so it works out! Haha