Non-Direct Care Staff

[TigerxLiLy]

How many other PPS coordinators are considered "Non direct care" staff. My administrator always tells me "You should not be doing the nursing care for these residents, I should answer the calllight abd notify the floor staff of the patient needs and/or notify supervisor or chRge nurse of medical needs."

Yeah that doesnt work when your a RN and your fellow workers expect that if you find a issue/u deal with it.

As a Assessment Coordinator-- I usually find "issues" everyday.

Example: In therapy room going over RUGS when ST pulls me aside and says med A pt sating at 75% RA.. I look at pt- he isnt in visual resp distress.. so i call the supervisor and inform her. her response, "Oh, well put some O2 on him then."... told her that id bring the patient to his ro if she'd meet me there with the concentrator/tank.. response"oh, im dealing with something else, ur gonna have to do it."-- I got the o2 and placed per our standing orders, Elevated to 82%, auscultated rhonchi bilat, coached the resident to deep breath/cough= huge phlegm amounts and O2 sats to 90-92%.no resp distress. Told the cart nurse the assessment and to call the MD to inform and resident will need breathing tx probably. Then I also informed the supervisor and asked her to f/u on cart nurse. ... 5hrs later ask the cart nurse"what the dr say? he give brthing tx orders or anything?"

"oh i havnt called him yet, was going to let supervisor do it"-cart nurse

"why dont you do it since your the one who assessed him"--supervisor...

Sigh--- i did.. and ended up with IV abt which I had to start because "I got the order"...thanks! love the team work!

[NurseMellie]

I personally handle alot of things that happen with residents and not because I have to but I want to. I get it done and know how its supposed to be done. Usually if I tell a cart nurse something needs to be done, they do it. They are always asking me for advice on different situations, etc. Plus, if you are out and about keeping an eye on your folks, they will come to know you and trust you. This sometimes can make your interviews so much easier. Plus, you never loose how to provide patient care. I also work the carts periodically, usually as an extra shift or a couple hours of fill in.

[TigerxLiLy]

How big of a caseload for PPS do you have? How do you manage reviewing therapy notes and ensuring therapy is meeting/upgrading goals as IDT plans?(im constantly having to ask them to upgrade goals when they tell me "we met their goals, we can come out now"... noooo... the Prior level on eval was Mod I... your goal was Limited assist with a person going home alone..."... )

Reviewing and meeting with the DOR to go over ARDs and ensuring RUG lvls are being met

Reviewing to make sure your nursing skilled patient is still skillable

This is what confuses me, and I really need to sit down with my DON and discuss: The facility has a "Medicare Nurse"-- they hired under the expectation to do daily observations(as she is a LPN), document, and pretty much follow through with the patients medical status and support therapy and work with the IDT (DOR, myself, SS, ADON/DON, RNP nurse) in helping the patient get the best outcome from our facility yet follow Medicare guidelines.

With daily "reviews" of therapy minutes, notes (not all of the case load-- just usually start looking weekly at any pt that has been with us past day 14- have avg of 4 people to review daily to make sure we havnt plataued/need to change goals-I have had too many issues in the beginning of my 3yrs as PPS with therapy continuing a Part A pts 2-3 weeks past the 2 week plataeu with the DOR saying "the pts doing great, still making gains!" usually 4-5 assessments a day, Dealing with finding Innaccurate documentation and tracking those CNAs down to further investigate/document/educate..How do you do that?!??

Maybe im just over attentive from being burned by therapy too much... too many CMS audits from my 1st year that has taught me Medicare doesnt play around...

[TigerxLiLy]

addendum: to the DOR stating "Pts doing great, still making gains in therapy"-- the medicare nurse would just nod her head in agreement when asked "and nursing shows improvements?"... Back then tho.. doesnt happen anymore ...

[NurseMellie]

Im responsible for 48 beds, some of them are long term but some are medicare. Right now a big stressor is empty beds, I have quite a few due to deaths n dc's, etc. Almost every morning before I do anything else I review therapy minutes. We also have "Stand up" 3x/week. The goals for therapy are monitored by our head therapist, which we also review in stand up a lot of the time. We also have Medicare consultants who come and review monthly for input and therapy goals are always on her topics to talk about. It helps too at this time, I have someone who runs care conferences so that's a huge chunk of time that I have now compared to some others who do this. I also take residents to our Mental Health committee weekly so that's also a lot of prep work. I also do some staff relief depending on case load n how far behind I already am.

It does take a lot of leg work time to track everyone down to ask them the right questions. Most of the time I get "oops, I was in a hurry and hit the wrong one." I can't use that excuse when I make a mistake LOL. Of course I know my residents very well and know what they can do so when I see charting that is wrong, I fix my coding because usually I can't wait until I talk to the folks that have messed up in the charting. That will come later. I do often leave them notes regarding what I found and if that really is the case, they charted someone as limited when I know they are extensive or extensive when I know they are total. Some residents have good days but often I get the response that no they were extensive or total depending on the case.

When someone comes in, I usually map out what their assessment dates may be. These can change depending on COTs, Missed days etc. But this gives me a good idea of when I need to be ready to do those folks. Now, my therapists are good with conversing with me saying "Hey, we are almost at goal for this person. Maybe another week." We start really looking at goals and dc planning which we do a lot of right from the start.

My predecessor had some good things in place that she taught me to use. And I do use them. They have saved my bacon more times than I can count.