New DON LTC

[Jcanales]

I am a new LTC director of nursing in an 80 resident facility. I am thinking about pulling the daily skin assessments from the floor nurses and have the wound care nurse assess. Trying to organize and shift some assignments to have the floor nurses more available for bedside and documentation time. Suggestions? Can the wc nurse handle her wc and 16 skin looks a day? What do you do in your LTC?

[litbitblack, ASN, RN]

Why only 16? Are there separate halls? At my facility the skin assessments are divided by day and evening shift. Its not that difficult to complete 1-3 skin assessments a shift for weekly skin assessments and they can be divided between the shifts.

[Jcanales]

You are right. Thank you very much. I have divided them out betw all three shifts. We r an 84 bed facility with an 80 census today.

[amoLucia]

Just be careful about assigning assessments to the 11-7 shift. State surveyors can zoom on this and view it as an unnecessary task that takes away from pts' sleep time. Some survey teams are real noodges about this.

And it's best to leave any open wounds to the day shift wound nurse for all those measurements. Remember if you have agency nurses, you may find that the skin checks may not get done. It's the nature of the beast with agency nurses. If you get good regular ones, NO PROBLEM!

Just FYI.

PS - You're NOT doing daily checks on all 84 pts daily, are you? Twice weekly on each pt is usually the norm.

[Jcanales]

Wound care nurse has all wound care residents in addition to those with potential or past breakdowns on her list for the week. Then, I split the other 60 to the 3 shifts, listing those with early 5am whirlpools to the night shift. Does this sound ok? Thank u so much! I want the assessments done.... No agency used:)

[CapeCodMermaid, RN]

Weekly skin checks by a licensed staff member are the norm here. CNAs are expected to pay attention to any changes and report them to the nurse.

Anything-meds, treatments, skin checks- done on the 11-7 shift should only be done if absolutely necessary and certainly not for the convenience of the staff.

[Jcanales]

Thank u! Every shift is responsible for skin assessments now. Wc nurse has taken about 20 res and the remaining have been split btw all 3 shifts. Night shift signs in meds.... Which I have to work on.... Some are and some aren't following. Matchbacks are also split btw shifts.... Having trouble getting those done... Any ideas?

[amoLucia]

What are matchbacks? Never heard of it!

Are you talking the monthly recaps/rollovers of orders?

[Jcanales]

Matching the orders, med card, and mar together for each resident. Done weekly per res.