panurse101

I, too, am new to this and would GREATLY appreciate any tracking forms; cheat sheets, hint, tid bits etc. Please PM to me

I just started doing MDS' recently, but I still do the staff education. I am looking for any tips, tricks, etc on getting the aides to understand how to code correctly on their 7 day assessments. ( We do not have the caretracker..yet) Thanks... panurse101

in our facility, we have found that using unifiber, works really well. this is day one of our bowel protocol, and like i said usually works. the protocol is started on day 3, unlike most facilities. this is given on the 7-3 shift, with breakfast and lunch, then the 3-11 shift give mom. day 4 the 3-11 shift gives a ducolax supp. then day 5 the 7-3 shift gives a fleets. our cna's make out the lax list when they are doing their books. they look at any resident that has not gone in 2 full days, then puts them on the list. the 11-7 shift, double checks this list, and makes sure all residents have the order for the "bowel protocol per policy", and sends the notes to dietary to make them aware. it works really well. the problems we did have with it, was not the cna's not marking residents down, but with the nurses for not following the protocol. they dont give anything day 3, then day 4 they give a fleets.??? the unifiber is not like the other fiber drinks, that you dont have to drink 8 oz's of fluid with. unifiber can be given in a small amout of food if needed. good luck tracy

Thank you to those that replied. We are using basically the same kinds. The mat ones are terrible. With them constantly going off. The state told us to be careful with alarms, not to jump right to them. which is what our nurses were doing. Also, if a resident is always taking the alarm off then they shouldnt have it, we need to look at other interventions. Alot of facilities here in Pa, have gotten cited due to falls, and the facility relying on alarms. Thank you all again.

i am wondering what kind of patient alarms everyone is using? do you use a variety of alarms, different brands, or do you stick to one brand. right now, we mostly use posey bed and chair alarms. but we are trying to stay away from them, since the state doesnt like to see you jump right to personal alarms, and we are always having trouble with them. Tracy

I LOVE this ideas.. Im already working on schelduling a communication one for October. We too, have a BIG problem with that... it just doesnt happen. I really believe that if you make the inservice fun, interesting, etc, the staff get more out of it, it makes them laugh , which helps relieve some stress. I have played darts with balloons, and had questions inside the balloons.. only have to be careful ... make sure not too many staff members are pissed off at you.. so they dont.. opps, miss the board.. and hit you with the dart.. ahhahaha .. thank you for the other ideas. I have been at a stand still lately with ideas. Where did you get yours from? Thanks again Tracy

For anyone out there that has been in staff dev. in ltc. I am looking for ideas for inservices/ meetings that would make it fun and interesting. I know from my own experience that to sit in a room listening to someone talk and talk and talk or put on a video gets very boring after the first 10 minutes. I just read somewhere to use toothpicks and pass them out for anyone that repositions themselves in the chair during a meeting/inservice, to show them that some residents are unable to do this, and need our help in pressure relief. Any other ideas.. on ANY subject. Thank you, Tracy

Does anyone have any good websites or books or anything that can help me learn the qa process, how it should work, how to go about it, team meetings, etc. There are so many issues in ltc, how do you get started? What do you do? What is your process? Any info would be greatly appreciated. thank you,

I am expected to give up more of my time for qa's, state survey time, etc. I did make less money yearly when I first took this job. However, thanks to our recent raise, Im finally making more. There are good points and bad, just like anything else. I have more flexibility of my scheldule. If I have to leave for an appt, I dont have to use vacation time, I use "comp" time. However, thanks to people abusing the "comp" time, we can no longer take a whole day off, and use the comp time. Otherwise, for example, I had to submit a doh report last saturday and was there for about 5 hours, then the sat before that, I was in work approx 4 hours, I wasnt able to take a whole day off and not use vacation time, it has to be used on individual days. I dont know how everyone else works this way. Im curious to know. You can email me if you want to talk. Good Luck, Tracy

I just want to thank you.. you have made me realize .. Im not "crazy". Everything I have learned.. this just doesnt seem appropriate. However, I just cant seem to get through to anyone, except ones that don't have a say in the matter. I recently ordered some allevyn for a trial on some residents...but that has now gone to the waistside. Thank you for helping me keep my sanity.

My question is regarding Calcium alginate and duoderm. I know a wound bed needs to be moist to heal, although, not wet or it will macerate. I understand the use of calcium alginate. However, our facility has begun using cal. alginate and duoderm on things such as pinpoint st 2 on the buttocks, say on someone that has a foley, and not incont. of bm. They put the cal. alginate on dry, and cover it with duoderm. They are also using this on small scabbed area's. I have not seen them use the alginate yet, on someone whose wound is draining, or on a wound bed that is dry and needs to be kept moist. It seems this has become the standard for using the cal. alginate and duoderm. I am not understanding this rationale. It is working on some, and making some wounds worse. Does anyone use this the same way? Please respond. Thank you.

I am the "risk manager" in our facility. I finally got the DON and NHA to give my idea's a try re: investigation unknown injuries ie: bruises, skin tears, etc. The state DOH requires an investigation to prove that abuse did not occur, and that requires obtaining statements from anyone involved with that resident's care, or witnessed the incident, or anyone that can shed some light on the subject; visitors and staff. Previously, we had the supervisors in charge of obtaining statements. This is and has been a problem, because there just isnt enough time in the day to get everything done, and obtaining statements is the last thing on their minds. (even though they know how important it is) DOH recently came in on a revisit and thankfully, cleared us of past deficiencies, however, they did see a problem with statements not getting done in time. I, as the "risk manager", asked to do the investigation, and take it off the supervisors on the floor. They can start it, obtaining the first ones, if it occurs on their shift. But, otherwise, I would make the calls, track staff and visitors down. My question to everyone out there is: Is this how your facility is handling investigations for injuries of unknown origins? Who is doing the investigation? I just want to update our process, and looking for ideas as well. Thank you, Tracy

I can sympathize with you. I worked as an aide in my facility for 9 years, then came back as an RN. I worked as a charge nurse, became a supervisor, and now in an adminstrative position. I still have some problems, when, for example, "management" is making changes that will effect the floor staff, but they dont take into account, what is really going on out there on the floor. I have earned the respect from the aides, and nurses, that once worked with me side by side, so I don't have too many problems there. Im the one they all seem to come to, if there is a problem going on. "Because I understand". I love my job, I do Staff Dev. / Infection Control and Risk Management. I am learning alot, and always looking for more information. All nurses.com is a great site, I have utilized this forum many times, when I have come up against a problem, or looking for ideas. Many many good people here that are willing to help. Good luck Tracy

Our facility doesn't place anything re: DNR status in the resident's rooms. We only have the code sheet on the front of the chart. Because there really isn't alot of full code residents, this really isn't a problem.

I know exactly what your saying. I was a cna for about 9 years before becoming a RN. I have never forgot what it was like to be a cna. They are the ones that work physically the hardest. If it wasnt for them, nurses wouldnt be able to do their jobs, facilities wouldnt be open and operating. When I want to know something about a resident ... I ask a cna. Tracy