jkw

In our facility, Our evening med nurse is responsible for checking the bm list. If a resident has not had a bm in the last 3 days, the prn is implemented (mom,ducoolox etc) We also have a fecal impaction prevention program. Fortunately we have a QA nurse that follows up on these residents that trigger fecal impaction risk and monitor hydration status, medication useage & immobility problems. Repeative documentation which proves you have done as much as you possibly can do for the resident to prevent fecal impaction appears to appease the surveyor when they ask "Was this avoidable or unavoidable?" jkw

I agree, I think you need to go with your gut. If it were me, I would contact a local hospital that maybe your doing your clinicals -and see if they have an internship program or even some time in which you can just observe some time- a teaching hospital is very good about doing this. I think you would have a better learning experience. I wish I had done the internship like some of my collegues had done. Because sometimes when you get into longterm care, it is very difficult to get into a hospital. Good luck. JKW

I am a RAI Coordinator in Missouri. I think the best thing for MDS Coordinators are to have developed mini QA programs within the sections of MDS. Our facility has 300 residents. At this time we do not have Medicare residents (PPS). We have 3 RAI coordinators for each floor (100 residents a piece)! We have developed several programs. We keep track (monthly) who has restraints, who has what kind of side rail-down to even what kind of rail type is on their bed regardless if they use rails or not. You have to have QI programs on all Sentinel Events ( dehydration, low risk pressure ulcers, and fecal impaction) Have a standard protocol on how you keep track of these items when reviewing charts. We keep track of risk factors for Pressure ulcers -using the Norton Assessment. We also have developed protocols for restraint use, residents at risk for dehydration and residents which are considered High fall risks. We monitor these residents Monthly and document. We keep an ongoing log of all our residents infections for the month etc. You have to do this to be accurate in fed and state reg eyes. You will find that you know your residents so well- you wont be worried if you get cited if you cover all your bases. Just remember! Careplan , Careplan,Careplan!!!!! That is what they look at the most-and making sure you have good communication with your direct staff-so that everyone is on same page. We have mini careplans for CNA staff, they update the CP 1-2 weeks prior to Careplan day, that keeps us more informed about behaviors, decline, abilities etc. It really helps. Also gives information on how they can best take care of the residents -especially if you have a new CNA-and we all know how they come and go. Good luck-email me any time if you have any questions-been doing this for 4 years and counting! In Missouri.