jaimemds

Where I used to work, the nurse who was orienting me had put in her two weeks notice and went for exit interview. She was honest about why she was leaving and was told not to come back or finish her two-weeks.

Never chart I in reference to yourself, only in quotes as the resident stated it. never chart told resident to go to room, or put in room to calm down. this is considered isolation. Never chart med errors. And never include in the note any staff's quilt regarding an incident, i.e. supervisor failed to notify MD of blood sugar 459 or CNA did not place call light within reach.

what must be looked at with skin breakdown is checking/changing Q2H and whether or not ALL shifts do this. Also look at how often they are being washed. Just one shift failing to properly cclense and wash a resident can result in skin breakdown. Cloth pads are generally better for the skin because they wick the moisture away form the skin, where the paper chux hold the moisture and heat. they also bunch up and make pressure "points" under a resident.

My facility makes it a practice to give yogurt at least BID w/anyone on ATB's. If they will not eat it, we have the MD order acidophillus QID. We also have the person with C-diff use a BSC. A word of caution though, alcohol hand wash DOES NOT kill the c-diff spore, soap and water must be used. C-diff is very contagious, but standard precautions are usually effective in preventing the spread of infx.

I am using the directed learning system through Rue. I know my learning style, and I cant just dowwnload an outline and go. I know there is a lot of debate about publishing companies, but it works for me. Got a B on my first exam. i know I didn't study enough for it because I thought it would be a cake walk. I found these test set up much like the boards. PM me if you have anymore questions/concerns. Jaime

Take it from someone who was sabotaged. If you feel you are being sabotaged, you are. LEAVE, ASAP!!!!!!!!!!!! I had the feeling for months, but did nothing and ended up fired. Shortened version of the story, The nurse I replaces on the unit, came back and obviously there were not enough hours to go around. I had a pt. go bad, and was already on the phone w/transport to transfer him. The next day I came down with the flu, lasted a week. While I was gone, It was told that I had neglected the pt and did not notify MD. Of course I had. Everday I notified MD of status and received no new orders!! Leaving is the best option because you will be miserable if you don't.

management must follow facilty P&P, starting at step one. They cannot jump to termination. Management must also look at everyone for the amount of calloffs, because if they just go after her, it can be seen as favoritism. there may also be special circumstances that the rest of the staff is not privy to. Voice your concerns to your supervisor, and let them handle it from there.

I usually put "resident will not receive serious injury r/t accidents" or "resident will utilize all safety equipment (i.e. body alarm, walker, etc) with staff supervision and education daily" sometimes you have to get very creative. I have also put the goal as number of accidents and severity of injury will decrease with use of ..."

I think we need a forum just for MDS/PPS. There are so many times when I would love to bounce info off another coordinator and there is noone else in my facility who knows anything about it. There are so many knowledgable MDS people in this forum!!!

You have to have two nurses sign for insulin before you give. Is this just in Texas or other places too??

I started my own MDS QA which I turned in at the monthly QA meeting. At my facility we go around to each department and bring up any problems. So I would rattle off, Activities was late on 19 out 0f 20 ax's this month. SS late 15 times, etc. After a couple of months being called out in front of the Adm and DON, they were perfect angels!

I am also an LPN/MDS coordinator and do it all!!! i love what I do and love care planning. My DON signs R2b, but I do all the scheduling, care plans, raps, pain and restraints ax's, etc, etc, etc!!! Not to mention keeping my Administrator in line. I often find myself writing P&P's. I do not have a back up. I wonder when they think I'm going to take my 3 wks vacation! LOL

Being an MDS coordinator for years, I have to say that ANY time a resident rolls oob, even if to a blue matt or blue matt to floor, is a fall. Any time a resident stumbles or trips and needs staff assistance to prevent them from falling to the floor, it is considered a fall. It is important to document these incidents as falls because it triggers certain risk areas. This pt could be receiving a pyschotropic medication that has resulted in AE's. The stumble/unsteady gait could also be from psych meds or deydration, etc. For the facility w/a no restraint policy, SR's used to enhance/enable a persons independence ARE NOT RESTRAINTS! I hope no one has fall and received an injury in that facility d/t not being able to get oob safely because of no sr's, state will have a field day with it. It could lead to an actual harm citation. SR's are an effective fall prevention if used correctly.

OUr act. dept. talks to pts. about past events. They try to stimulate their long term memory. Say, the depression, games they played as children. Dementia pts. usually remember events of LONG ago. Try asking them about their first job/life's work, farming, old cars etc.

If I were you, I would report the med error per policy. You don't want it to look like you are trying to covering anything up.

state wants to make sure you are following the 5R's with med passes, knocking on the door and privacy for inj. and FSBS. With wound care they want to make sure you are following the order, changing gloves between old and new dressing and privacy. ALWAYS make sure you tell the resident what you are doing and why. Plus, knock, introduce yourself. Also with med pass, make sure you are waiting the proper amount of time between puffs of inhalers and eye gtts and between different inhalers/gtts. Hope this helps. Jaime

Look for inservices in your area regarding MDS and PPS. Autumn Enterprises has a good program it's called the ABC's of MDS, I don't know if I would have made it without that course. Does your owner own multiple facilities? If so, see if one can train you. By the way, what state are you in?

worst: a laminated poem that was printed off the computer and some candy! best: a keychain cpr mask

I had an elderly woman in a skilled LTC unit. She had MRSA and was on Respiratory isolation. This was Christmas time. She has to spend all day every day in her room. She was sad and depressed. She would sit in her room writing Christmas cards, all the while hooked up IV's. She was very lonely. After a few shifts working with her, I fell in love. She was sooo sweet and loving. I felt so bad that she could not see the xmas trees or lights. Her family rarely came to see her because of the isolation. One day, i took it upon myself to speak with one of the maintainance men. Together we hung lights in the shape of a xmas tree on the outside of her window. We also decorated another small tree that was within her vision. When she saw those lights for the first time, she broke down cryng. She told me that noone had ever done something so thoughtful for her in her life. I think of this anytime I have a pt. that is lonely and try to do something special just for them.

I usually use my right hand to separate the upper and lower lids and use my left hand to instill the drops. You have to be careful not to apply too much pressure to the lids. And, reassure the resident the the drops might sting at first, but not for long.

Generally the Ax coordinator is responsible for updating careplans. They need to make sure that the care plans meets the pts current needs. I personally update the immediate needs care plans, adl's and long term care plans on a daily basis.

Also LPN and currently making 21/hour in southeast Ohio. If you are able to push for extra tools i owuld suggest the MDS 2.0 book from briggs. They send you undates to the manual automatically. i would also suggest a membership to AANAC, American Association of Nurse Assessment Coordinators, this site give you updates daily, there is also a forum of other MDS nurses that you can ask q's or bounce around ideas. Good Luck!

Enulose

My LTC facility uses the 3 colors to indicate the shift the med needs passes on on the MAR. We only chart in black ink. We used to chart in colors,but it made it easy for State to see when an entry was missed.

Not knowing Mass's regs, I would say to call your risk management company they should be able to guide you. I would say that is all paper, esp. for lesser infractions.