CoffeeRTC

Are they and ADon or assistant to the director of nursing? I'm willing to bet that if they are calling themself an assistant to the director and they are doing clerical tasks, that it might be okay. Using the LVN title is fraudulent and should be reported unless they are an LVN.

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.

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.

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.

All new employees must do a two-step (unless they had a two-step done within the last 6 months and then it becomes just a one-step) We do annual screenings and annual facility risk assessment evaluation. This is for LTC.

Why do some choose med surg, ICU, ER, L&D, home care, Peds, OR, Pacu ??? Um...because! Pay....RN's are well compensated in my area in LTC. I never thought I would choose LTC. 20+ years ago I graduated from a major teaching university that was in the top 10 for BSN students. At that time, jobs were scarce and the pay wasn't cutting it. I worked as a CNA to get experience in patient care that the nursing program lacked in teaching. I thought I would stay for a while, get some experience, earn some $$ and then go look for a job at one of the local hospitals when the time was right and pay was right. One thing led to another....I started moving up in the company, 1 baby became 5, I got comfortable with the short commute to work, no traffic, didn't have to pay for parking, etc and here I am 20+ years in LTC. LTC residents have changed over the years. SNFs in our area offer skilled post-acute care. Complex wound care, TPN, wound vacs, ortho rehab, cardiac rehab are our biggies. We see a lot in my facility. We also have stable LTC residents and also do hospice. Our staffing is often at state minimum levels but more often that not it is higher. As an RN, you might be a supervisor or cart nurse. I've now taken on the role as a staff development coordinator/ infection control preventionalist/ adon. I don't work weekends!! If I wanted, I could pick up a ton of OT or work as little as I want to.

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.

What is the dietary department manager saying? Where would you store it?

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.

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?

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.

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.

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.

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

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.

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?

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. ???

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?

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.

They should have a POLST form or advanced directives https://polst.org/polst-and-advance-directives/ The old "when in doubt, send them out" is a thing of the past. DNR doesn't mean, don't treat. The polst will be more specific on what the resident wishes are. Do they want IV fluids? Antibiotics? Comfort measures? When 911 and they is no advanced directives or original paperwork they will normally assume CPR. Early detection of changes is key. If you can act on that and get orders in place that is the goal. Most LTC residents with DNRs in place would want to be comfortable in their own home and have a peaceful passing. Our facility is equipt for IVS and pain management with our emergency supplies. Labs and Xrays can be done in house.

Agreed! This would be a good item to take to Qapi and do a PIP about this.

Well....a good bit has changed in the last year! We are now owned by a new company that requires completion of Relias modules on a monthly basis. We do have more laptops and computers as we are almost fully EHR. We just need to get the EMAR in place! This new company relies heavily on Relias for the mandatory education requirements. I'm not 100% sold on this model. I lean to a more hands-on approach. I'm constantly hounded for the percentages of staff completion....it is all numbers on paper. I get it, because if it wasn't documented....it wasn't done and if it wasn't done...then you are not permitted to work. Nice in a perfect world, but we rely heavily on part-time and PRN staff and like most SNF...we are in a staffing crisis. I've been running contests or drawing for staff that gets their education completed on time and a bonus one for those getting it done at least a week early. This seems to help.

Does anyone have a great website for these?

i would write up a statement about this and include the statement from the other nurse who gave the med. Only the facts. The prn that you gave...was it ia narcotic? How does she have access to meds? I can see her argue that your PRN caused the sedation. This would then turn into a he sad, she said.

What an awesome idea!