Monthly summaries

[CapeCodMermaid]

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 pay) to finish the summaries. One nurse said she just didn't have time...she has 15 patients...no sick people, no IVs, one gtube...15 ! and she wanted to come in on her day off to do her summaries!!?!?!? Is it me or what?

We have all the summaries assigned and they arrive on the floor usually by the 20th of the month. They are supposed to be done between the 30th and the 5th of the month.

[CapeCodMermaid, RN]

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.

[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.

[SuesquatchRN, BSN, RN]

CCM, is your charting paper or computerized?

[CapeCodMermaid, RN]

We use papyrus!...no computer charting at this facility.

[SuesquatchRN, BSN, RN]

Well, I have a computer system that is never accurate so I have taken to keeping spreadsheets. UTIs, psych meds, vax dates, bath days, etc. Makes it easy to pull it all together quickly.

[Melissa Doyle]

Exactly! Sometimes it may not be state required, but for reimbursement and state surveys it is required! Good job to you! I have been a DON in the past, starting a new job as same, I am hunting for a monthly summary check off type sheet and was wondering generally if people are just getting the cookie cutter models (bought) or if you are making your own.

[LockportRN]

When we didn't have computers, I made up a form. The top was boxed with your basic check off info...BP/AP/Temp/Resp. Then a job throught the systems with just enough info to cover the usual things....resp reg, lungs clear, etc. All systems had an *other which then required that the nurse write whatever the other was. At the bottom of the page it was lined for the nurse to write this as well as to give a general overview of the month. And this is BIG as to getting a higher rate of pay.

So for example, the nurse would complete the top system check off. Then go to the narrative and write something like "This 69-year-old male was admitted with _______________ on __________. His vitals have been stable. Appetite has been much improved over the past month as his _____________ condition is resolving. Wt has increase to ___. Participates in PT/OT 5 times/week and is tolerating well. Client has upgraded from using a walker to using a quad cane to ambulate on the unit with staff assist to stand. MD has made 3 medication changes to treat his depression and client reports that his mood is much better and is even participating with group activites and becoming more involved with other patients on his unit. Client also has begun to ask questions about his medications and nursing staff is providing education to assist him with this new interest in his own recovery. The goals for the next month include that he continues to gain weight to his previous healthy weight, continue to express his sad feelings with staff, continue to participate with his own recovery and socialization on the unit, sit-stand independently and ambulate with a regular cane.

[susanthomas1954]

Wow! Our monthly summaries loosely follow our MDS calendar for quarterlies and annuals. We really need them to be done during the look back period, so MDS assigns them. Then we see the nurses doing them at the desk! Excuse me, but I am amazed out how many floor nurses think their residents are continent, or able to perform their own late loss ADL's. They are frequently clueless, but if they would go to the bedside to do the monthly summary, they might gain a new respect for their CNA's. Ours is a checklist, but I would pay good money to see a nurse doing one while actually looking at a patient. Actually they are worse than no good, because then the inaccurate information goes in the chart, and people (like the Medicaid case managers) want to know where we got the MDS info. (We get it at the bedside, and create our own source documentation-no choice.)

[debRN0417]

I know it is so time consuming, but I really like reading the handwritten summaries. It is nice to see documentation like we used to do it in the"old days", but the acuity and demands of the profession have driven us to a "check list" which we have to use because nurses now have one-million other things breathing down our backs.

[CathiP, ASN, RN]

In my faciltiy, the ADON's do the careplans. We do them quarterly and annually, along with new assessments at that time. Of course, if there is any change of condition, we do them again. The MDS coordinator gives us a list of who needs to be done. Sometimes we just did the careplan a couple weeks before but PT picked up the resident so the careplans have to be done again! The floor nurses do the admission assessments. The medicare residents have to be charted on every shift. Others, just when there is a change.