New don seeking advice from experienced don's

Published

New DON to Assisted Living facility. The facility I work at is having trouble with medication documentation. They are staffed with LPNs, CNAs, and RMAs. They are Pre-signing the MAR before giving the meds and also they are failing to follow up if a medication is not available during their shift (like it may need a pre-auth or pharmacy hasn't delivered it to the floor.) How would you all recommend fixing this? they have had in services, they have been talked to, they have had to resign their job descriptions and they still are not fixing the problems! Also, what other advice would you recommend as a new DON? Thank you for your time and your help!!!

Up Vote Up Vote ×
Specializes in LTC, Hospice, Case Management.

I think it's time for you to be the boss. You've given them every opportunity & now they are taking advantage of your niceness as a new boss. Write a couple up & word will quickly spread that you mean business. You may eventually have to fire someone....or all of them BUT as the DON, you're responsible to ensure compliance. Audit those med books daily until compliance improves. Call them back in to sign wholes or fix errors.

Up Vote Up Vote ×

You could ask your pharmacy to perform med pass observations. Also, you may want to do your own med pass observations and monitoring. Progressive discipline for those who dont comply.

Up Vote Up Vote ×
Specializes in OB, ER.

Well said nascar

Up Vote Up Vote ×

Thank you all so much! I just started at this facility this week so I am just getting my feet wet within all of the problems! I am planning to do my own med pass observations and have had to implement documented coaching sessions this week. I am hoping to fix all of this. I am trying to step up and put my foot down but as the first week I am trying to review the state survey and see what all needs to be fixed! I didn't know if you all did anything differently in your jobs! thank you for your help!

Up Vote Up Vote ×
Specializes in MDS/ UR.

Do they understand presigning is a serious violation? The BON would frown highly on that.

Up Vote Up Vote ×

yes they understand that according to the administrator and with the talks I have had this week but if it doesn't straighten up then further action will be taken

Up Vote Up Vote ×
Specializes in critical care, ER,ICU, CVSURG, CCU.

when i mentioned that I was obligated to refer their lis. to BON....for continued infractions, better compliance was demonstrated :yes:

Up Vote Up Vote ×
Specializes in retired LTC.

For EVERYBODY who's non-compliant or slipshod, start a progressive disciplinary process. I'd bet a box of donuts that'll wake them up.

But make sure you're catching everybody - you're new and you don't want them to say you're playing favorites.

Then when you see improvement, plan some type of reward activity for the staff GROUP as acknowledgement.

Up Vote Up Vote ×
Specializes in LTC, Hospice, Case Management.

This is only my opinion. Some will agree/some will disagree.I think threatening to notify the BON of their infractions comes off as a very passive-aggressive way to deal with compliance issues. YOU have a policy in place, YOU are the manager & YOU should handle it by following the disciplinary policy. It just comes off as it did when I was a kid & mom said "if you don't behave you just wait til your Dad gets home". Take ownership & deal with it. I promise they will have more respect for you.

Up Vote Up Vote ×
+ Join the Discussion