Apentti

Sounds like a reaction to the adhesive in the drape. There are some things that could be done to protect the skin but seeing the doctor really is best at this point. Is a wound doctor or practioner following the case?

It was harder than nclex. I recommend a study guide or flash cards. My exam had a lot on fungating wounds and venous ulcers. Also a lot on diet and labs.

What state are you in? As far as billing in advance and not completely using a product due to order changes, I always send unopened unused product back to the pharmacy or supplier for reimbursement. And I was told that as long as the product is sealed, it can be removed from the resident room and put back into general supply. Perhaps I'm wrong. I'm in Wisconsin and if Wisconsin regulations say we can't yhen I won't, I would just like to see the actual guidelines stating so in order to know what I should be doing.

No, all the supplies are already purchased and sitting in storage in the maintenance department with staff time budgeted in for installation.

Interesting. My argument to that would be that these supplies (tube feeding, wound care, prescription items) are there property. I guess in your case, I would try to come up with some sort of consent/refusal form to have the residents decide if they want to allow in room storage.

Thank you for your input. The plan was to store items specifically ordered for and billed to patients such as wound care dressings, topical agents containing medications, topical prescriptions. Only the nurses would have access. And I would monitor the usage for effectiveness appropriateness and avoiding waste

I work in a LTC facility (SNF) and have been working on getting locked treatment cabinets in each patients room for improved accessibility to supplies for bedside treatment. I had everything ordered and ready to proceed, when a new nurse consultant stepped in and put a stop to the whole project. She claims locked cabinets in patients rooms are a violation of CMS regulations, but couldn't cite why or give any evidence of this. All she could come up with is that the patients could jimmy or break the locks and tamper with supplies. What?!? Does anyone know the actual guidelines in place for storage of treatment supplies in a SNF? I really can't see any reason having locked cabinets could be a violation. Hospitals have them, other SNFs I've worked in have them. Any input is appreciated so I can effectively oppose this.

Actually the staffing is overall pretty good. Our ratios are better than most. On this particular unit there was one nurse, one RT and two CNAs for 10 long term care vent patients. It really was nurse neglect. The nurses have since admitted to signing out the treatments and not actually doing them, and there were no reprocussions.

Thank you for your input. I think I just need to get out at this point. They keep admitting more and more patients with wounds and pressure ulcers, because "the wound care nurse should be able to handle it". I just see them dumping more and more on me, and I'm not willing to risk my patients care or my license.

I think she reacted this way because last year we got cited on 11 different wound issues. So she's trying to protect the facility, which shouldn't be the concern. The concern should always be the patient

I did. She needed to know in order to provide appropriate care.

That's one of my concerns is retaliation. I report directly to my DON and have to work with her on a daily basis. Thanks for your input.

I recently found myself in an extremely uncomfortable and infuriating situation. I work in a SNF as acting wound care nurse. During my weekly rounds, I noticed a patient with a chronic but stable wound suddenly had worsening of the wound (increased size, purulent drainage, redness, odor). I realized the dressing he had in place was dated for 3 days prior, this is a dressing that should be changed daily. So for 2 days, the nurses did not complete his wound care, leading to worsening of the wound (which constitutes neglect and potentially abuse). I investigated, gathered evidence, then reported the incident to my DON per protocol. My DONs reaction was to suggest to me that I "don't tell the nurse practioner that our nurses didn't do the dressings changes, just tell her the wound is worse but don't say why". I was shocked, and refused, and proceeded to update the nurse practioner on the situation. I could not believe my DON encouraged me to withhold vital information. My question is how severe is this? Does this warrant me reporting the incident and subsequent conversation to someone above her? How far should I take this? Or should I talk to her one on one first and give her a chance to apologize for her response? Also I'm concerned that the nurses involved causing the harm will not be investigated and disciplined accordingly. My DON doesn't seem to share my same concern for the seriousness of this situation.

Can you get nylon boots so they don't stick to her skin?

I feel your pain. I recently took on the role of wound care nurse at the SNF I work and was immediately dumped on. I don't do daily treatments, but pretty much everything else you mentioned I too am expected to do. My administration has (in their opininion generously) given me one day a week to focus on wound care, the other 3 I work I supervise the facility AND am expected to also do all things wound care related. Like you said, you need time to think about what you're doing, you are being scrutinized and if come survey time your facility gets cited...it's your career on the line! I wold demand a job duties description in writing and once it's given to you go over it with a fine tuned comb and negotiate. And the feeding at meals has to stop. You are a skilled professional trained to deal with medical issues no other staff member is trained to do, don't let them waste your time feeding residents. A cna can do that as long as one of the floor nurses is supervising.