the_alchemist

Hi all! I just want to know how other facilities conduct their weight variance meetings: who attends the meetings, how often, how long it takes on average, and follow up procedure. Our building has been through changes for the past 3 years and nothing has been well-established in terms of this. To make it more complicated, now come EHR. We just started using PointClickCare and using the weights feature, it spits out all triggers that would not otherwise be triggered using our "not-so-old-school" spreadsheet, which calculates for 5lbs/5%x30days, 7.5%x90days, and 10%x180 days (btw, is this guideline the same throughout US? or is it by State?) For those using PointClickCare, does your weight feature calculate and trigger for 5lb variance? This doesn't in our facility. Any tips how you use yours? Thanks in advance!

Thank you for your replies. We do not have Medicare residents. I am told that my job is "simplified" because of that. We have 98 beds and I am the only MDS personnel. And since I am the only person to do the job, I only do things related to MDS: care conferences, treatment meetings, updating care plans and assessments, submit MDSs, and whatever I need to do to accomplish my work. I am trying to make a spreadsheet and I am just figuring out what other things might need to be included there. I also want to keep track of admissions/discharges/transfers. Also, for someone who is just starting in this field, would you recommend using the printed MDS first and then input to the computer? Or will directly entering answers in the computer be less complicated? Just a thought, I could help save trees, just wondering if it will be helpful to a newbie.

I am a new MDS coordinator. No MDS experience at all, but like everybody else would say, my personality fits right in, and of course, i'll learn along the way. My first week of orientation dealt mostly with the basics. 3 days of practice on the computer and I'm starting to "create" a system that might work for me. But then of course, the MDS office literally looks like a mess right now, and I kinda have this picture of a more clutter-free desk as soon as I officially start owning the little room. Simply put, it'd like to get some ideas how to be more organized, efficient, less stressed-out (we all wish, if not stress-free!), and of course stay on top of our schedules. Any input is greatly appreciated. Thanks in advance!

I have a potential Health Care Coordinator position waiting for me at a Sunrise Senior Living community. I am currently a SNF supervisor. While I like what I'm doing right now, I dont think there is room for growth because of poor management and the fact that my efforts are not acknowledged, worse, if I do something out of the ordinary, the DON steals my show and pretends that it was her accomplishment. Also, talk about power tripping there, I was given a very minimal increase given my outstanding job (based on other employees, resident and family comments). This new position is offering just a little bit more that what I'm making right now but I am very excited about the challenge and a great chance to advance in the ladder. Yes, I may be ambitious but I know I can do it. I am just afraid that I regret leaving my current job (I am able to use my Clinical skills and my team is great). I can potentially be a DON at another SNF in a few years if I decide to stay. I'm not sure if my goal of being a DON is still possible if I stay in assisted living. What will assisted living bring to an ambitious nurse's future? I'd like to know your inputs. Thanks in advance.

I went for an interview last week and they wanted me to start 1st week of May. That same day, I was asked if I was ready to provide a urine sample. I wasn't ready due to the fact that I had to go to the bathroom just before I went in for the interview and didnt drink anything since (interview lasted for about an hour). Over the weekend i've had terrible migraine, eye pain, nasal congestion and flu-like symptoms and the doctor recommended Excedrine, Mucinex, Sudafed. I used to take Aleve. This week I'm supposed to come back for the drug screen and other pre-employment exams. While I've taken only one dose of each since i realized thay could give false positive results, will it still be a good idea to take the test this week? or to wait another week until the drugs are out of my system? I'm not sure what to do right now but im excited about the position and they want me to start soon. Please advise.. thanks!

Going back to this case, let me write down more info about this patient pre-fall he was non-ambulatory with 1-person assistance with transfers he had a fall 6 days before, in the fall, he fell on his rear end, pelvic x-ray done without any fracture he has history of cerebral bleed he was taking ASA 81 mg PO daily

There's no official report yet on cause of death, but the MD who saw him at the hospital said 'they found a lot of blood in the head"

they weren't. There was another RN who asked if 911 was called, and she asked before she saw the patient. After seeing the patient, she agreed that the patient was not in an emergent situation and advised about the importance of documentation, which the attending nurse did well.

The patient stayed in the hospital for about 16 hrs before he died. The DON and MD understood that pt was in no acute distress and not in an emergency situation, given the pt's condition before he left as witnessed by the EMTs and as documented. Unfortunately, the other nurses are the one questioning WHY not sent 911? A company consultant was also aware of the situation, the same consultant who questioned another nurse a couple of years ago why a patient who fall with no injuries but c/o headache was sent 911, thus wasting the governments money. It is not normally written in our facility whether or not for emergent transport, however that sound like a very good way of saving our butts. Our facility has fairly good protocol. we do xrays, ct scan, or what have your after EVERY fall and the doctors agree with the protocol. if a doctor doesnt agree after we explain the need to, we document and monitor the patient.

he expired about 17hrs after the fall. MD order was to send to ER for further evaluation. No change of condition the whole time pt was in the building. EMTs arrived about an hour after the fall, and exited the building 20 mins later. Like i said, they exited the LTC facility with patient still alert, with GCS of 14, A&Ox1 same as baseline. Now the nurse is being questioned why 911 wasn't called.

to follow up on this thread, unfortunately this patient died. he was sent to the hospital an hour after the fall. he left the LTC facility still alert, with GCS of 14, A&Ox1 same as baseline. What are your fall protocols in your workplace as far as calling 911 vs non-emergent ambulance?

thanks for your responses... btw, it happened in a LTC facility. given the above assessments, would you call 911? Or would it still be a prudent action to call the Doctor, get an ambulance and send the pt to ER?

Please share your response on this scenario: Demented geriatric patient fell on concrete floor from wheelchair, sustained a laceration near the corner of the eye and bleeding was controlled. c/o pain in injured area. He is able to mention his name when asked. He is disoriented to time and place, same as baseline. He moves his hands as he has been known to do. Vital signs stable.Neuroassessment done. Pupils round and equal, able to follow objects. No distortion in the face. No fluids coming out of facial openings. Able to move extremities when instructed to do so. Grasps hands when asked to do so, equal. No episode of unconsciousness, no seizure, no sign of distress.

thank you for your responses... like u said, it couldve been the tourniquet. the pt was really skinny and dehydrated. in fairness to the nurse, she did apply direct pressure. guess it was just the way it was. and i agree, let's not forget that we were once new nurses. and even with an already admirable amt of experience, we still learn new things along the way. :)

I was orienting with a nurse who was to start IV hydration to one patient. After preparing everything, I came closer to her to observe the insertion. When she hit the vein, there was blood return, i thought to myself wow that was pretty easy! as soon as she started flushing it though, there was a bulge. The patient did not complain of pain or anything. The nurse said it needed to be reinserted. She pulled it out, applied pressure and covered with a piece of gauze. I watched her opened the second needle (which was at the table right next to her), and as soon as we turned to the patient's hand, it was bleeding under her skin and it was fast! she got a tourniquet above the site, apparently to prevent further spreading. my question is, why did it bleed under her skin? that was a huge hematoma (like the size of my hand and the patient was skinny).. what could have been done to prevent it? any comments?