dhsieversRN

Thanks so much!

Thank you!

What state was your ALF in? My facility has been self-med assessing quarterly. I have only been their 6 weeks so I am new to all the laws. I will check with our Department of Health and Social Services (I think it is). Not sure if we have a Dept. of Aging. Thanks! :)

Thank you so much for your input. :) A large majority of our residents have some level of cognitive decline. Maybe I should have said cognitive level screening instead of dementia screening. I have used the MoCA test before many times for LTC insurance assessments. It has the CDT has part of it. I am just trying to decide if it would be beneficial to track a residents level of cognition because many are self-med and maybe they should not be. Besides an interview we really don't do cognitive assessments when the resident first moves in. I am not looking to diagnose or "find" dementia among our residents. If a resident showed significant decline from one assessment to the next then I would have rationale to take appropriate steps regarding self-medication and yes I would have suspicion to recommend professional evaluation if appropriate.

The only tool they have is one that is subjective. I am looking to use objective tools such as the MoCA or Clock Drawing Test (CDT).

I work in an assisted living facility and I am considering using dementia screening tools such as the MoCA along with self-med assessments and post fall assessments. My thought is to discover any possible issues with self-medication safety and possible links to falls or history of falls. Does anyone have any thoughts on this? Ethical? Legal? I am in Washington state. Thanks, Diane

Thank you so much! Wow that's a bit scary. I will make sure that what ever I do it is "unofficial" and for me to monitor. I think may make an unofficial flow sheet for weight day to only be used and seen by the med aids getting the weights and make sure it is turned into me promptly.

The "monitored" residents (the ones with doctors orders, or ones I want monitored) are weighed weekly. I'm talking about the residents that are not being monitored weekly because they have not yet had weight issues identified.

Thank you Lissa. The RCC does a flow sheet for me of the "monitored" residents. But I could start a clipboard where monthly weights of all residents get listed. That is a good idea.

I am the RN at an assisted living facility in Washington. I am the only RN. I delegate tasks to the CNAs who are also med aids. I have very busy days with training and delegating, making sure delegations are current, resident assessments are current, doing incident report assessments (ie: falls), reviewing new orders and the MARs, managing the overall health care of the residents, as well as being the liaison between the resident and or their family, and their PCP. I know weight changes are significant especially since diseases and medications can be the cause. I would like any advice anyone has as to better monitor weight changes. The med aids get weights monthly on every resident and this goes in the resident file. So if the resident isn't currently being monitored "regularly" due to doctor's orders I may not know if a resident has gained or lost a significant amount of weight (I figure 5lbs is significant) in a month's time. We are paper not electronic. Which if we were electronic this would be so much easier. I just don't want a resident to slip by for a month or two losing or gaining weight until it is noticed (prob by a family member - yikes) and I don't know about it. Any advice? Thanks, Diane

Hi, I am working on my BSN. I am currently taking Collaborative Healthcare. It focuses on delegation and management of patient care. This is a good class for me to be taking right now as I am working for an assisted living facility as their Director of Healthcare. I do delegations, resident assessments, resident care management, as well facility healthcare management and organization. I have a project due for this class and I need some expert opinions to include in a paper that I have to write. I would like to get opinions each of my goals (there are 4). My goals are ones that I am currently working on implementing at the assisted living facility. They are: 1) Create a plan for continuity of communication through the shifts (day, eve, noc) with the use of a shift planner/change of shift report. This will allow better communication as well as improved resident care. The ball won't get dropped on follow through with orders or resident alerts. See attached for what I designed and is currently in use by my med aids. 2) Develop a daily planner for myself (my brain) that I will use to organize my day allowing me to complete resident assessments, delegations, order and MAR reviews, and other management duties in a timely and effective manner which allows me and the staff to provide the best resident care we can. See attached for what I designed and am using as my "brain". 3) Create a protocol by which to best monitor weight changes among certain at risk residents. Includes tracking weight changes, notification to primary care providers, and follow through with PCP orders for continued weight monitoring, medication changes, and/or requested office visits. So far I have given the following notification to my med aids: "Some residents have disease processes and/or medications that can cause weight loss or gain. A gain or loss of five lbs. can be significant and mean the resident may need to be seen by their PCP or have a change in medication. From here on out please forward me your fax to the resident's PCP regarding the wt. loss/gain of five lbs. or more. For residents not currently being monitored weekly: if you feel they have lost or gained weight please notify me". I also have a list of monitored residents with monthly weights. These are usually residents on medications like lasix, or who have diseases such as CHF. 4) I will assess the need for the facility to use standardized dementia and Alzheimer's screening tools (ie: MoCA and FAST) in conjunction with the current facility assessment templates. I will determine whether or not these tools to assess for level of cognitive impairment may be beneficial in determining self medication safety, self care abilities, and overall well being of the resident in an assisted living facility. I could use these screening tools along with self med assessments, incident assessments (falls), etc. Please feel free to give your opinion (even a brief one) on one or two or all of my goals. Give brief rationale for your opinions or opinions that I can readily find rationale for. My paper is due this Sunday. I know you are very busy so I am very sorry for the late notice I thought I could use opinions from authors and have recently been informed I need opinions from people I know. So if you are able to send me your comments I would be so grateful. Also when you send your "expert opinions" please also include your title and credentials. Thank you so much!!! Diane Sievers,RN Shift Planner Report-Template.doc RN Daily-Planner1-Template.doc

Does anyone know where in Texas is the best place to look for a job? ...for a new grad RN (ADN), working on BSN. What parts are the nicest weather wise...not humid? And where would someone want to live if they were liberal?

I totally hear you. I too have not been able to find a permanent job. I have had two interviews since passing my NCLEX in March! The hospitals in SW Wa. are just not hiring new grads. Any jobs are ones for internal applicants...mostly management. I have fellow classmates that have gotten laid off. I did get a temp job with Mollen Immunization Clinics, but that will be done at the end of the year. It pays the same as nursing homes, which also are not offering a lot of job openings. I have to hope that this "economical situation" will improve soon. I don't want to relocate because my 16 year old daughter is here. I am almost divorced and she lives with her dad so she can stay with her friends and school. I am trying to stay positive...but rent is almost due and I am going to have to be late. Believe me I totally understand what you are going through. We just need to live day by day and keep pushing forward... I right .

Thank you for your story. It had me in tears. You were great...just being present like you were. I'm going into 3rd qrter (in the fall), and the first half clinical is in L&D. I will remember your story. We have been taught the importance of being present. You are the perfect example of this. It was nice to know that you cried along with your client. I have always been so self-conscious of crying and afraid to do so in front of clients. Maybe I shouldn't.