Pressure relieving devices, etc

The MDS nurse is responsible at my facility for coding of wheelchair cushions, I usually have no problems there.

But I never mark the turning and repositioning on a MDS (it is my area) but I choose not to mark it because I do not have the time to set up a turning and repositioning program designed on a individual basis then to monitor that it is being done, documented and evaluated.

We document our pressure-redistribution devices on the TAR each shift, thus we have proof that they are being used. Our restorative nurse tracks the devices each resident uses.

So your nurses actually LOOK every shift to make sure the pressure relieving device is on the bed or chair? I'd be willing to be that if they are anything like 90% of the nurses I've worked with, they sign off the treatment book without actually looking.

I'm sure nurses do that almost everywhere (sign ahead), but our aides and restorative aides are good about letting the nurses know if a cushion or heel protectors have somehow grown legs and walked away :-)

So your nurses actually LOOK every shift to make sure the pressure relieving device is on the bed or chair? I'd be willing to be that if they are anything like 90% of the nurses I've worked with, they sign off the treatment book without actually looking.

I do spot checks and ask the staff to check the mattresses and wheelchairs cushions at every shift change. I don't think 90% is fair- but if you think its a problem in your facility- ask CNA to be quality control and twice a week check the pressure releiving devices and report problems. These devices are important to prevent skin breakdown. Without them there will be a lot more work for the staff trying to heal decubiti.

We had a problem keeping the laundry and equipment stock room neat till we appointed a CNA to be quality control, she loves the authority, reports problems and there has been a 75% improvement.

Good Luck!!!

My restorative hand me a sheet with the restorative miniutes to code . on this sheet they alos have any other extra "stuff" the resident is using. pressure mattress, bedside commode, wheelchair, gerichari, splints, oxygen ,etc. they track these thing every day as well as who has an rfa/ 1/2 lap tray/velcor alarm seat belt,etc. makes it a good source of info and then i follow up and make sure these are all in place.

As far as who is responsible for coding something on the MDS that should be set up per facility policy. Then the use of the positioning device would need to be either in the MD orders or the nursing care plan. If it is in either one of those places then it is supposed to be used on the resident every time they get out of bed or are in bed depending on where it is supposed to be used. If it is not being used then it should be noted on the nurses notes as to why as in the resident refused it, didnt need it. If the resident doesnt need it then the MD order and/or entry on the care plan needs to be discontinued if the resident refuses it then there needs to be documentation as to why, and resident teaching to inform the resident of the risks and benefits of the device, then the resident needs to go on alert charting to see if the resident will experience a decline in functioning as a result of this, attempts to try alternative methods or devices, etc.

If something is ordered or care planned and not being used you can talk to the staff about following up on it. The staff isnt supposed to not use a positioning device without documenting this in writing.