Milehighnurse

It was news to me as we'll, but look up F431, think its open to interpretation from whomever didn't have their Snickers bar that day. Have less narcs in the e-kit combined than I do in each cart. Another thing for bldgs using flow sheets with b/p and fsbs. Make sure that your nurses back up any entries where they marked " MD" notified, with documentation. They weren't to happy with some the documentation, will spare you my rant on that ( slowly beating head, repeatedly).

We got the word on Friday, 13 tags, all low level- thank you Jesus! And thank you to all that tolerated my long post. Been through many surveys, but first time in this capacity. Was indeed educational. Went around and high 5'd floor staff for bustin their backsides during survey, let them know about final results, told them how proud I was of them. Also stated that we're going to take a little bit of time to let the dust settle from survey, do the poc, then start prepping for next survey. Have never understood why facilities seem to get lazy about these things until window opens and then that's all one hears. One thing that I'm still puzzled about is something the Federal surveyor brought up. Made a point about our narcotic e-kit that we keep in one of the med carts. It's always under double lock, etc, but she told me that it wasn't permanently affixed to the cart, therefore someone could walk away with it. Ok, point noted, makes sense, no way to permanently affix it as the whole kit is exchanged when a new one is brought in from pharmacy. Federal surveyor told the D.O.N that it was because the cart could be removed from the bldg. Ok, so what about the carts that each have patient specific narcs in the narc bucket? She never said a thing about that. Still under double lock, etc. I don't get it. Admin had maintenance guy go out and get a large, heavy utility cabinet for med room for the narc e-kit, so now under 4 locks, but not permanently affixed to cabinet. Med carts are still on floor with double locks. More concerned about location of narc e- kit now as it can be still be removed. If a nurse was wanting to take entire kit, they could go out of med room, around the corner and out the back door. I seriously doubt a nurse would put her license on the line for that, but these days you never know. Any thoughts on this?

Colorado

Long vent, my apologies in advance. We took 13 tags, no IJ, will let us know about scope and severity. Ok, have been through the bowels of Hades for 7 days straight, nerves are shot, can't formulate an intelligent sentence and have PTSD from hearing "they just walked in." Have never been in this capacity (only 3 months) with survey before and I sincerely hope I win the mega millions lottery before next year. We've had noro in our bldg (107 bed cap) that closed us for admits about a week before "they" arrived. We were somehow misguided about State not coming in for annual survey with noro outbreaks. Found out real quick that's a bunch of bull lol. I'm usually the first mgr in bldg m-f, so last Monday arrived at usual time, about 0600, check in with the units, get census reports, etc, get morning mtg stuff ready to go. Got excited as finally had a chance to start my day in non-911 mode. About 0730 housekeeping walks up to me and says " there's some people from The Health Dept here, I put them in the conference room." HR jumps to 1,000bpm as I'm doing The Green Mile walk like the Tinman up to conference room. Sure enough, full survey team. bright eyed and bushy tailed. Haven't heard so many expletives used in one breath like I did when I got to call rest of mgmt team who usually don't start arriving until 0800. Like I said, we were misguided about State not coming in for survey with a noro outbreak and were looking fwd to some extra time to go over nooks and crannies. Just coming off a high census, high acuity, no staff run, plus noro outbreak, so we'd gotten behind on a few things-aka,we got caught with our britches down. They are starting to have a federal surveyor go with certain survey teams to monitor the surveyors. Great, just great, just what we wanted to hear. One of the surveyors was sent home 2 days after their arrival with "noro symptoms." See what happens when you don't wash your hands? And yes, we all did an unprofessional nanny nanny boo boo when we heard that news lol. Had our outbreak just about gone until they arrived, then it started spreading again. Wonder if we can IDR THAT infection control tag. State is focusing on skin and weight this year. They are also looking at Coumadin, fsbs, and b/p flow sheets with a magnifying glass. They find one thing out of whack and they pull all charts r/t same bldg wide. Would advise these items be scrutinized and supporting documentation if values out of range. We learned the hard way that the new grads that are coming out don't seem to grasp the not documented/not done concept. State says they are seeing the same thing everywhere. Checking the "MD notified" box on a flow sheet is not proper documentation (beating head on desk). Thanks for taking the time to read this long vent if you got this far lol. Wow, what an experience/educational crash course it was.

Ironically, a new Rph consultant was there yesterday and I did just that. She is in 100% agreement and will help me. Between her knowledge base and my ability to nag, think we should be able to get a grip on this.I told her about this article I read about the precsription cascade that occurs and she was very familiar with the process. So feeling very encouraged.

I'm an ADON of a 45bed skilled care unit in a 100 bed SNF and was wondering if anyone has had any luck with implementing polypharmacy reduction at their facility? Spoke with our medical director yesterday about his perspective and got the usual MD procrastination response... what was I thinking? Have looked to see if any programs have been implemented, but not having any luck. Anyone have any suggestions? Don't want to go "Rambo" on my docs, but am about there with these patients being on so many meds. Thanks in advance.