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CoffeeRTC has 25 years experience as a BSN, RN.

CoffeeRTC's Latest Activity

  1. CoffeeRTC

    Strategies for HAPU prevention

    LTC nurse's view.... I second the previous posters. Look at the entire patient and get the entire team involved. Braden scores are helpful but only if completed accurately. Repositioning is important but only if it is done correctly. What are your bed and chair surfaces like? Do you individualize your plan of care for each patient? OT should be helpful with positioning devices. Where are you seeing the most pressure injuries? With each newly acquired PI we do a root cause analysis. maybe it isn't just the positioning but incontinence or poor nutrition? Do you offer supplements if po intake is poor at meals? What about moisture barriers? Heel ulcers can actually be related to some of the bunny boots that are used.
  2. CoffeeRTC

    Inserting Indwelling Catheter with No Foley Kit

    LTC nurse and infection control preventionalist here..... I agree! The waste of opening up other items to make it work isn't effective and is very risky. I help with ordering supplies. Most of our items can be ordered by the case or per item.
  3. CoffeeRTC

    Organization tips as RCM

    if you keep the 802 and 672 up to date, those forms have a good bit of information on them. I will also make lists from there.
  4. CoffeeRTC

    What am I missing?

    I've guessing section means to do an involuntary commitment to a psych unit? Lotsa questions? What was the resident's background? History of physical aggression? Behaviors? Was this random or something that escalated? What precipitated this act? Med changes? UTI? What did his care plan say? Was it being followed or addressed before? Was this resident a danger to himself or others? By no means should it be "swept under the rug". An event report should have been initiated and based off of the questions above, we would call our crisis team (county offers psych services) and then proceed from there.
  5. CoffeeRTC

    When residents want you to save thier food.....

    What is the dietary department manager saying? Where would you store it?
  6. The floor nurses obtain consent for the psych meds in PA. It can be done over the phone with a family member too. I don't have the form in front of me, but it lists the class of meds and general side effects. We list each med and the targetted behavior/ reason for use. I have never seen a DR get this or any other form signed by the resident. I guess we could have our psych CRNP do this when he comes in once per month if he is there when the med is prescribed and it isn't done as a verbal. As far as getting things done or not... There is always going to be something that crops up and makes the shift a mess, but if things are not getting done on a consistent basis, then a conversation is needed with each offending nurse along with an education on why things need to be done.
  7. CoffeeRTC

    Blood cultures from a PICC

    Hmm. I will def go and check our P and P but we do draws off of the single lumens. In this case, maybe they are looking at the iv as the source?
  8. I'm confused. How is this not your resident/ patient if you are the charge for all 40. If the aid was assigned to that resident and knowingly left the unit without reporting off then there should be a write up.
  9. I'd start by getting a copy of what is needed for an admit, a transfer to the hospital and a discharge. There might not be many actual papers since most things are done on EHR and then just printed out from there. Labs are done online too. xrays are called into the company...no forms. Event reports are done online but we have staff write out statements. We don't use side rails, but we do have a consent form for Psych meds that is done on admit or with each new med. many forms are going to be specific to your facility. Our dietary dept wants us to do a req form for diet changes. We still have physicians hand write their orders. We still do paper skin assessments weekly and weekly wound measurements. There really aren't that many paper forms. Most of what we do is electronic forms. What EHR system are you using? We have Point Click Care and it cuts down on a ton of paper forms.
  10. CoffeeRTC

    When They Don't Want To Pay

    OUR BOM/ social worker meets with the family regularly and lays out the expectation of private payment and also starts getting the discharge plan ready. There is an expectation of some form of payment or they start working on applying for medical assistance when needed. If they are refusing to pay, was a 30 day notice issued? We cant forcibly evict though, so I guess they have us in a no win situation.
  11. CoffeeRTC

    Infection Preventionist

    I'm doing the one from the CDC and it was free.
  12. CoffeeRTC

    Documentation Inservice

    I was planning on changing information so as to not identify the resident or the nurse. You are very correct, public shaming isn't professional or effective. I've also started a collection of great nurses notes. We had a complaint visit a while back that was cleared very easily with a review of the nurses' notes.
  13. CoffeeRTC

    Major shift in practice...

    Is it a skilled facility? What is the structure of the facility? How many nurses vs CNAs? Do you have 24/hr responsibility or is there a DON?
  14. CoffeeRTC

    Any way you could stay over and work a few hours

    Yep, they just negotiated a new contract with our new company. I'm soooo glad I'm not part of the union. It is insane. The longtime employees are comfortable with their rate and raises. A suggestion was made to increase the starting rate but they won't vote on it because they won't get an increase in their pay. They don't want new employees coming in and making a fair rate because they've had to work their way up to what they are making. ???
  15. CoffeeRTC

    Documentation Inservice

    Does anyone have a great site or resource for an in-service? We have so many issues with even the basics. We use PCC so it is either a skilled note or nursing progress note. Oh, the things I've seen!! I was planning on doing a quick case study or chart review using a large screen and projector and projecting images of actual charted information and do a "what is wrong with this picture" and "what can we do better?" Any suggestions?
  16. CoffeeRTC

    Any way you could stay over and work a few hours

    This post screams our LTC staffing. What ruins it are the ones that love to pick up OT until they don't. I developed real thick skin and great avoidance of the "can you help out for a few hrs?" when I was part-time. Now that I'm full time, I just get pulled to the open shifts. Makes it real difficult to get my real work done. As a union facility (LPNs, CNA, Dietary and Housekeeping) we have a hard time attracting new employees because our starting rate is ridiculously low for those positions due to the contract. How about pay a fair rate to start with? We already have flexible scheduling and a decent working environment, but when you are working short due to call offs....no one except that one nurse wants to pick up. BTW, DON picks up tons of shifts (gets a bonus) and I will fill in. Its just insane.