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Geri, psych, TCU, neuro--AKA LTC
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mlolsonny has 15 years experience and specializes in Geri, psych, TCU, neuro--AKA LTC.

Currently RN in LTCF. Have been DON for 2 years and wanted to beat people with a stick and light my hair on fire!

mlolsonny's Latest Activity

  1. Big discussion at nursing home. Single lumen PICC. Educator says aspirate for blood prior to every flush and infusion. A couple of us think that's asking for trouble. What is best practice in home care or outpatient setting? We're measuring exposed length and arm circumference daily. Aspirate for blood or not?
  2. mlolsonny

    I am going over the wall....

    Don't slam the door behind yourself! You may just need a new boss!
  3. mlolsonny

    What is this fascinating specialty?

    MDS (Minimum Data Set--nothing minimum about it) is the federally required Resident Assessment Instrument for nursing homes that drives further assessment, care planning, reimbursement, and nursing home quality measures. It's a Long term care sub-specialty, as most MDS coordinators are first and foremost nurses, but also detectives, teachers, reimbursement specialists, and documentation pros!
  4. mlolsonny

    To code or not to code??

    Anticoagulant works with clotting factors, not just platelets as ASA and Plavix. christinaxrn hit the nail on the head!
  5. mlolsonny

    ADL coding question

    Your assumption is correct. Because supervision occurred 3 or more times, code as supervision. With the information presented, there is absolutely NO justification to code as extensive.
  6. mlolsonny

    MDS reasons for assessments

    PPS schedule restarts after they go out and come back from hospital.
  7. mlolsonny

    Right to Refuse

    and nowadays, Gero-psych won't even take them without a bed hold...
  8. mlolsonny

    New nurse, extremely late on my med pass

    Also a difficult lesson to learn, but until you can get your own work done on time, you can't do anyone else's work. I.e. helping with transfers, bringing people to the BR, etc. Your scope of practice is much broader than a CNAs, so anything that they can do, you can do, but they can't do your work for you.
  9. My Trifecta patient for complexity has had CVA, CHF, COPD. Add in DM, renal failure, Parkinson's, chronic infections, immunocompromise...
  10. mlolsonny


    Rails can help confused and agitated people be more mobile and help them get out of bed!!!
  11. mlolsonny

    Bed rails protocol/algorithm?

    The first two questions with rails, grab bars, assist bars, etc. are restraint and safety. Looking at safety is much more broad than the aspect of acting as a restraint. Here are the questions from a side rail assessment that we developed after a survey tag r/t safety. Physical restraint: Any manual method or physical or mechanical device, material or equipment attached to or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to ones' body. Does side rail use meet the definition of a restraint for this resident? Yes/ No STOP HERE-SIDE RAIL USE NOT INDICATED FOR THIS RESIDENT Mark rails with Red tape or remove from bed. Is resident immobile (comatose, paralyzed, no spontaneous movement)? *Yes/ No If primarily immobile, does the resident have enough mobility to turn or slide to one side? *Yes/ No Has resident ever sustained bruises, skin tears, lacerations or fractures from a side rail? *Yes/ No Has resident ever become entangled in the side rail or entrapped between the mattress and the side rail? *Yes/ No Is the resident able to turn from side to side independently with use of rail? Yes/ *No Does side rail use increase resident's physical mobility? Yes/ *No If any starred answers chosen, side rail use indicated only with presence of staff. Mark rails with Yellow tape. If mobile, does resident make any attempt to get out of bed? Yes/ No If mobile, can resident get in/out of bed safely without any human assistance or assistive device? Yes/ *No If mobile, is the resident at risk for orthostatic hypotension or does resident have difficulty with balance/trunk control? *Yes/ No If mobile, does resident have decreased safety awareness due to confusion or judgment problems? *Yes/ No If starred answers chosen, rails increase risk for falls. Document increased risk and informed consent from resident/ family member (include name of family member giving consent). Does side rail use increase resident's risk for falls? Yes/ No Is this resident safe to use rails when they wish? Yes/ No If yes, mark rails with Green tape. Is OT/PT evaluation needed for transferring and/or ambulation skills? Yes/ No After completing assessment, please mark side rails with appropriate color tape: Green= Go-may be up at any time the resident wishes. Yellow= Use with caution- staff presence required for rail use. Red= STOP-Do not use Side rail(s) for this resident. Analysis of risk factors: RN Assessor: Date:
  12. mlolsonny

    New nurse, extremely late on my med pass

    Unless your start time is absolutely set at 2000, try starting earlier. Group some tasks together, like starting nebs, giving supplements to people that are getting only supplements, etc. Don't get hung up on going to rooms in order. I suspect that some of the difficulty is because as it gets later, you're needing to wake people, sit them up in bed, etc. That was a huge issue when I was a new LPN on PM shift. Talking to the other nurses is helpful, but don't forget your biggest asset....talk to the CNAs! They know that Mrs Jones likes to go to bed at 1830, while Mrs Smith doesn't go until later. They can help you get to people while they are still awake. If there are certain residents that are very difficult to get meds into (or unsafe), closely look at admin times and discuss with the clinical manager. They may just need admin times adjusted.
  13. mlolsonny

    Signs You Won't Pass A Survey

    In the simplest: Preventable Problems. Think pressure ulcers, contractures, weight loss, non-healing wounds, medication errors, decline in mobility/ ADL ability. Rationale: If adequate care is provided, most of those are prevented. Certainly you're going to have patients or residents that surprise you, and develop/ decline in condition. If you're diligently monitoring and putting interventions in place, you won't have big problems with these things that are supposed to be prevented. Look at your staffing patterns. If you don't have enough registered nurses to assess, and plan care ; enough LPN/LVNs to monitor, implement, and notice the daily changes; enough nursing assistants to provide the hands-on care, declines will happen. Talk with your residents: Use the QIS Resident Interview and Observation form. The surveyors will ask these exact questions. Don't be surprised by your resident's answers.
  14. mlolsonny

    How much staffing do you have?

    200 hours of staffing for 53 residents @ 1.16 MCM per 24 hours. 24 hours RN (one AM charge, One PM charge, One with focus for the day-- Assessments, Wounds, MD rounds, Mood/Behavior monitoring, Restorative, etc.) 12 hours MDS 40 hours LPN (16 hours AM and PM and 8 hours night) 8 hours TMA (on LT unit) 115 hours CNA (16 nights, other shifts flex with census)
  15. mlolsonny


    We use EMR and ours uses Events as "to do" list for charting. We open a Clinical Charting Task event and put in what we want documentation on. Our nurses love our events.
  16. mlolsonny

    Need a plan

    Use the Seven Habits quadrants to help you prioritize?? I'm amazed at how much more I get done with this type of prioritization. Q1: Upper Left is Urgent and Important-- These are the fires that need to be put out! (80% of your day) Q2: Upper Right is Important, but not Urgent-- After Q1, then work on Q2. (They recommend 20% of your time daily) Q3: Lower Left is Urgent, but not Important-- Delegate!!! Q4: Lower Right is Not Urgent, Not Important--IGNORE! Use your Outlook to it's fullest. I'm using Tasks now and am able to prioritize them. I had no idea how much more organized I could be. It's a lifesaver. If one of my nurses asks what she can help with today, I share my Tasks. Get to know your staff and their strengths. Use THEIR strengths to YOUR advantage. I have a really picky, OCD RN that is awesome at collecting data for Infection control and QA. Once I taught her the process, she's continually collecting the data, so it's not a ton of work at the end of the month (or the day before QA if you're a reforming-procrastinator like me). Sounds like you may need a day just to sift through and figure out where you're at. DO IT! and start your priority list.