Need help!! First week in assisted living

[Shell5]

This is my first week in assisted living as RSD. I come from med surg, skilled nursging background. I am coming into a situtation that has no systems in place. I have found numerous meds that have not been given on the MAR, BS that were not written down on the MAR, service plans that have not been done. The pervious RSD is not there any longer. We are due for state to walk in the door any day now. I am doing all I can to get these issues fixed asap by holding in-services and getting all I can done with the time I have.

The question I have is will I be held responsible for the way the place is now if I just got hired on?

I have found narcotics that weren't locked and so many med errors that I can't possibly write them all up. Just really need some direction here. Thanks so much.

[MarggoRita]

Document your findings and all interventions you are putting in place, inservices for staff education and such, make a record to show them that these problems have been identified and you have started procedure to fix them, document EVERYTHING and anything that will show you are not ignoring the problems.

[indiechic, LPN]

I've been there... Hang on! Assisted livings have such vague regulations (at least in Washington) that coming from any other nursing environment, it appears to be a madhouse. And sometimes, AL is an easy trap for nurses to become lazy since it's a very independent role as a nurse.

One of the first things I would do is hold a meeting for all staff who assist with medications (med aids/techs or nurses, whichever your facility uses) and let them know your expectations for quality of work, missing meds, missing blood sugars, unexplained med exceptions, MAR holes, etc...

When I started this AL position, we were behing on service plans as well, so I'd recommend to start scheduling them and type up a schedule. Our assistant-admin (or business office coordinator) did this scheduling. I did an intensive 3 weeks of catch up where I'd have 4-6 care plan meetings per day, it was exhausting! But, it got the work done quickly and it helped me learn the resident population and their families.

As far as the narcotics, I ran into this as well... But, this can differ between what tiers of controlled substances want to lock-up. My current facility was not locking Ativan, but I changed that. Like the previous poster said, documentation is going to be your best friend! Save the memos you create for all the in-services and have it signed by all employees to show you are working to clean up the facility and it's mistakes... For as unregulated as the AL community is, it's incredible how far administrators and nurses let them fall! Keep up the good work! It just takes time. :)

[stardust80916]

The regulations are just as vague in Colorado. Sounds like you need to review the company's policies and procedures and retrain EVERYONE in accordance to those policies and procedures as well as your state's regulations. Anyone found not following these rules should be terminated immediately. Also, at the facility I worked at we locked up the narcotics as well as any antibiotics to ensure that the antibiotics were given according to physician's orders. We had a problem with staff not administering antibiotics as prescribed.

[SuzieVN]

As far as the med errors, triage them as to potential for harm, and put them in a pile, worst cases on top. Take care of one at a time as you have the time. Have an inservice, and scan the MARs every day for a week- every blank, follow the routine to discipline, and fire the people that don't comply. If you are consistent, the place will shape up real quick.