Nine Or More Meds?

CapeCodMermaid, RN · Apr 9, 2009

Why in the world would you care plan for 9 or more meds? It's not a RAP...most people take at least that many. You should only care plan if it's a problem or a potential problem.

mdsdebbie · Apr 10, 2009

I so totaly hear that, but it comes up on our QI's, so the DON wants us to have CP in all charts . Extra work, but what makes "DON" happy makes everyone "Happy".....LOL

Have a great weekend

Debbie

catnip3 · Apr 10, 2009

It's really an alert to assess residents for polypharmacy- do the residents REALLY need all those meds? We cover it with the pharmacist's monthly review- he has a special form for this documentation.

nursekara78 · Apr 11, 2009

I don't care plan for this either. We document in our care plan meeting notes that......Res. cont. on # meds, meds are reviewed q month by MD and cont. to be necessarry to treat mult. Dx. We also have the MD doc. q month on rounds to support us if he can't d/c any meds.

Try to suggest an alternative to your DON. Explain that it is not needed for RAP and you are still documenting in the med. record etc.

edhcinc · Apr 13, 2009

Is the problem of concern to the resident?

The care plan is not for--staff problems, DN problems, surveyor problems, lab tests, diagnoses, etc.

Don't think I ever heard a resident say "I have an ADL functional decline" or "I'm here for treatment of QI9meds" or "I'm S/P ORIF". :grn:

lisalake · Apr 14, 2009

so right! we should be care-planning for the resident, not the staff, the qi’s or the surveyors….but this is what’s happening everywhere, and debbie is right….coordinators are expected to, and instructed to care plan anything and everything whether a problem or a potential problem, or not a problem! it has become a tedious, all day long, never-ending job, and in many cases, without team participation. whenever the resident farts, the first question to the mds coordinator….”did you put a care plan in for that???? did the resident smoke 20 years ago? better care plan that! did the resident complain about a staff member?? better care plan that they are uncooperative and non-compliant!! were they sad and crying 15 minutes ago??? better call psych...and don't forget the care plan! we care plan the disease, the fall, the behavior, the mood, the med, the splint, the meal…and on and on, without really identifying if it is an actual problem for the resident…all to cover our butts….and please the surveyors’.:angryfire

LHH1996 · Apr 17, 2009

All i do is make sure that any major meds are included in the appropriate care plan. EX: atb for infection, or diuretic for edema,or bleed risk for anticoagulant etc etc. as far as QI/QM i make sure all dx are current, match the reason for the drugs, and make sure there aren't any unnecessary dublicates. of course this involves discussion with their physician if needed. i don't see a need to do a specific care plan just for 9 or more meds.

mdsdebbie · Apr 17, 2009

Thank you so much Lisa. :yeah: You are so right, some where along the line the true meaning of care planning was lost, now it's all CYA. I am just as annoyed when the DON wants to CP something totally off the wall, but she tells me, she has been a nurse for 38 years, and is the way she wants it. :confused:

evalesco · Apr 23, 2009

so right! we should be care-planning for the resident, not the staff, the qi's or the surveyors....but this is what's happening everywhere, and debbie is right....coordinators are expected to, and instructed to care plan anything and everything whether a problem or a potential problem, or not a problem! it has become a tedious, all day long, never-ending job, and in many cases, without team participation. whenever the resident farts, the first question to the mds coordinator...."did you put a care plan in for that???? did the resident smoke 20 years ago? better care plan that! did the resident complain about a staff member?? better care plan that they are uncooperative and non-compliant!! were they sad and crying 15 minutes ago??? better call psych...and don't forget the care plan! we care plan the disease, the fall, the behavior, the mood, the med, the splint, the meal...and on and on, without really identifying if it is an actual problem for the resident...all to cover our butts....and please the surveyors'.:angryfire

:yeah: :yeah: :yeah: :yeah: :yeah: :yeah:

i laughed out loud!! so funny and true!

amylpn24 · Apr 26, 2009

We have to careplan for this as well. This is a quality indicator and if it is not careplanned you are likely to get a tag. At least here in Kansas. My careplan goes something like this; problem: Potential for complications related to multiple dx's as evidenced by recieves greater than nine medications routinely. Goal; Mr. so and so will recieve therapeutic effect of all medications and will have no adverse effects. Approaches: pharmd to review meds monthly (in ks); observe for s/s that may be indicative of adverse effect; labs as ordered; vs as ordered; any special instructions such as rinsing mouth or take with 8 oz. of water etc. Hope this helps

Nascar nurse, ASN, RN · Apr 30, 2009

We have to careplan for this as well. This is a quality indicator and if it is not careplanned you are likely to get a tag.

I have never heard of careplanning an issue because it is a quality indicator??? I thought we careplanned an issue because it is or potentially is a problem for the resident!

We often careplan our high risk meds (insulins, coumadin, psychotropics, htn if unstable, etc), but otherwise, that is just silly and a waste of time.

But, it is interesting to see how others look at/do things.