santeeaholic

DHEC has LEFT the building. We were deficiency free, second year in a row. WOO HOOO!! Observation of a tube feeding med never occurred. I was blown away. They didn't want to see it because everything else went so well. Kinda proud of our nurses!! However, I was told we should be following whatever our company policy states (off record by the survey team leader). That way, if there is a citation, the policy is cited and not the procedure making a plan of correction so much easier to accomplish. Thanks everyone!!

Our facilty policy states flush with 30cc before medications are administered and 30 cc's after medications are administered. Nurses are following that policy. But I just have this nagging feeling in my gut the surveyors won't be happy with that. Crossing my fingers, and my toes, as well as sending up lots of silent prayers!! Thanks guys!

Order the medications from your pharmacy. Cover yourself. You cannot administer medications that you do not have. But, instead of not giving the medications at all you can try this... Contact the prescribing physician (or whoever is on call) and alert him of the situation. "I'm sorry to bother you but I find myself in a situation that I msut review with you. We have on hand 500mg tablets of Tylenol. Our order currently reads 2 tabs of 325mg. Will you provide me with an alternative order?" At least this way, you have notified the physician that you need a new order, you have administered your medications as ordered, and both you and the facility are covered as far as your 5 "Rights" of medication administration goes. Good luck. And remember, DON's are very busy doing things floor nurses are not even aware that need doing. Be as patient and understanding as you can. Don't make a situation that is easily corrected into a larger one.

With the new "Memo" sent out by CMS for clarification on GTube medications, and the Regulation still posted online conflicting what the update says, what is everyone doing as far as GTube meds go? Online, the CMS regualtion states as of this morning on page 432 "While it is noted that some facility policies ideally adopt flushing the tube after each individual medication is given, as opposed to after the group of multiple medications is given, unless there are known compatibility problems between medicines being mixed together, a minimum of one flushing before and after giving the medications is all the surveyor need review. " It is utterly rediculous to sepearte crushed meds that are mixed in water just to pour them down the same tube during the same administration time. Next they will be asking us to administer crushed meds PO seperately. They are going into the same stomach at the same time. What difference does it make if they are seperated or not as long as the meds are compatible? What is everyone doing for this situation? We have surveyors in house at this very moment. So far going well but I highly anticipate a citation on this very topic. Thanks!

I am a former graduate of LPN and RN program at FDTC. Best advice is to print of the pre-requisites (CPR certification, immunizations, physicals, background checks, etc.) and have ALL of them completed as soon as possible and PRIOR to application into the program. There is a limited number of spots and a huge number of applicants. The ones chosen are the ones that have ALL of their stuff in order and everything is done. Personally, my experience with FDTC Nursing program...some of my instructors were great (willing to help, friendly, approachable, helful, etc.) and some of my instructions were just the exact opposite (if you get it, you get it; if you don't, you don't and did not even attempt to help students who were struggling). This is, of course, pretty much the same at any college with any profession. Tread lightly and keep your nose clean. Don't be late for any of your classes. Make this program your entire life while you are in school. Go over and beyond on your assignments-don't just try to "get by" doing as little as you can. Effort in your studies will make a lot of difference. Get all of your related courses out of the way as soon as you can. English, speech, anatomy, microbiology, math, etc. Try to get yourself in a position that the only classes you have to take with your nursing classes ARE nursing classes. It will be much easier for you to focus your attentions on your nursing classes as well as stroke the egos of some of your instructors that will need that from their students. Most of all, GOOD LUCK!!

OK. Lots of great advice here. And yes, I do realize this is an old post. But...I was hoping someone could offer me some advice. In almost 20 years of being a long term care nurse, I have NEVER encountered a family member quite like the one we are dealing with now, and trust me I have seen some "doozies" over the past 2 decades. When do we get to put an end to this? Do we have the right to stop this? How do we stop this? What can we do? What are our rights as a facility? Any suggestions would be tremendously TREMENDOUSLY appreciated!!! This family member writes down everything. From the time they walk into the building to the time they leave, they write down everything. Even the names of the maintenance personnel who have had to go into the room because "the nurse's can't hear mama through the call light system" (which was not the case). Asks them questions like "are you the head of the maintenance department?" "who is the head of the maintenance department?" "How long has he been here?" Steady writing the entire time. They STEAL copies faxed to a referred physician's office and then come back to our facility and want to know why "bedtime snack" is on mama's physician's orders and why ALL of mama's allergies (we have been furnished quite an extensive list of allergies) are not printed on the orders by the pharmacy...where did this diagnosis of the bottom of the orders come from? Etc. etc. etc. The resident is wonderful. No problems, no complaints, and sweet as the day is long. She is the kind of elderly resident that makes our job so very enjoyable. She smiles and laughs at us. She sings occassionally. But this family member is so bad that even the primary physician (who usually has the patience of Jobe) has started using the back entrance of the facility to try to avoid this person because this family member ties up 45 minutes of his time with all of their questions when he is in the building to make rounds for all of his residents. This family member even attempted to get a diagnosis of "allergy to all generic medications" which is in and of itself rediculous because we've been administering generic medications since the day of admission. The family member wants to know "the side effects of the medication at the current dose mama is taking" and when PRN meds are given due to complaints of leg pain "well what exactly did mama say". If mama recieves antianxiety medication ordered for anxiety, "what exactly was the anxiety? Was it different than her normal anxiety? What is the nurse's name that gave her that medication? What did she chart? Can we see if her doctor will order a substitute for the Klonopin and see if the side effects of confusion are not as much?" (mama has dementia at almost 80 years old) This family member lives out of town (THANK THE LORD) but when they come into the building, they "make the rounds" to all the staff members. Social Services, Dietary, Medical Records, Nurses, Activities...and during these "rounds" as we now refer to them, this family member ties up about 30 to 40 minutes of time for EACH staff member. (the room is too cold, the room is too hot, the food is too salty, the food needs more salt, the (newly hung at their request) curtains need to be dusted, when is the church group coming back that was here 2 weeks ago on tuesday afternoon-not the one that was here tuesday morning?) When they call instead of coming to the building, this family member ties up the nurse on duty for 30-45 minutes on the phone with rediculous complaints and questions not voiced by the resident. We have had 4 (FOUR) care plan meetings with this family member in less than a week. (which decreases the time we can spend with other family members at care plan meetings) Each of which has lasted 1-2 hours. It is CONSTANT questions. No matter what our responses are, there is NEVER an end to the constant questions, or writing. The writing never ever ever stops. This family member comes into the buiding with an expandable folder to keep this "documentation" in. And let me not neglect to mention the fact that this family member informs us of conditions that the resident has because they "Diagnosed them" and would like for us to do things like put baking soda on a rash (which wasn't even there) HELP!?!?!?! I have never encountered someone such as this, but before we lose really good nurses (who are threatening to quit over this family member) I opted to try asking this forum for advice. We honestly believe the family member has some serious psychosis issues occurring. At the very least, OCD regarding mama's health care. What do we do?

I too am facing "taking over" infection control. Since this is one of the MOST cited deficiencies in a long term care setting, I am sure you can understand my anxiety. Please let me know of any resources that may be available to show me what I need to do. I will be more than happy to comply with all requirements, but I don't want to overdo and I certainly don't want to under-do. Any help would be welcome. Thanks!

Just returned from HCPro's Medicare Bootcamp for Long Term Care in Atlanta. Dissapointingly, yes, the MDS 3.0 will contain a "RAPS" section which will be referred to as the "CATS" now. Can't remember exactly what he said it will stand for, but it will basically be the same thing. I believe my resources at my software vendor, American HealthTech, have stated that electronic signatures will be a required portion of the new MDS 3.0. This information I would verify if my facility was not capable of electronic signatures, however, if it is indeed a requirement then my facility and the software we are using must be modified to permit us to do such a thing. Once accomplished, we will no longer be required to print hard copy MDS for any resident chart. I highly recommend this 4 day seminar on Medicare. It was extremely helpful. So much valuable information I could not even begin to put it all on one post. ALL MDS and Billers need to attend this training. It could literally make thousands of dollars difference in the way you approach your medicare.

Thank you both so very much. It's always nice when CMS offers a tiny bit to make our lives easier. I am heading to the Medicare BootCampin Atlanta Georgia tomorrow for four days put on by HCPro...will take great notes and share if anything sticks out in my mind when I return. Sometimes it's stuff we should already know, others it is really good information. Again, thank you both so much!! I am certainly glad to have found this website.

Oh my....I could kiss you...that is exactly as I was hoping it was interpreted...we have networked computers all over this facility...with access to the eChart at each station. And...it contains well more than 15 months worth of MDS information...it has all of them in it without regard to date... YOU are mahvelous... Thanks so very much....I have recommended your site to our DON and ADON as well...we really did not know you guys even existed. Nice to see a site for nurses by nurses!!

soo...even transmittal 41 released on 04/10/2009 gives us the option to store the records in the manner the facility chooses and NOT be required to maintain "hard copies" on the charts.... Correct?

Thank you for responding so quickly. I am new to this site and for some odd reason finding myself praying that someone else reads this and tells me I am not entirely mistaken.... CMS Reference S&C-09-22 Cover page... 5th bullet, "Deleted guidance requiring paper copy storage of Minimum Data Set (MDS) in nursing homes with electronic records at Tag F286, 483.20(d), Use; and" Then ...page 4 says... R Appendix PP, TagF286, Use - deleted a sentence requiring storage of paper copies of assessments in facilities with electronic records" Then I read it one more time on page 95 "Deletion of sentence at F286 (MDS Use) requiring storage of paper copy of MDS for homes using all electronic records. This is no longer required for these homes. Instructor's notes: The following sentence is being deleted: "Whether or not the facility's clinical record system is entirely electronic, a hard copy of all MDS forms, including the signatures of the facility staff attesting to the accuracy and completion of the records, must be maintained in the resident's clinical record." Maintaining 15 months of MDS data is still required. This deletion simply removes the "hard copy" language for homes using electronic records. The MDS records must still be accessible to clinical staff, the State, and CMS, as stated by current language that remains at this Tag." Someone please tell me that I am reading this correctly....pah pah pah pleeaaasseeee!! This is actually what led me to your site. I wanted someone besides me to say, "Yep, that is exactly what it means"...

Greetings to all...new to site...I am an MDS Coordinator for an 88 bed facility. Have been doing MDS here since 2003 so I am quite familiar with the process...6 years in this office. Have many of you read the specs on the MDS 3.0? I have downloaded the form from many different sites and from what I can gather, there will be no RAP on the 3.0. Am I correct in this? Second, did I read the new guidelines from CMS correct in that if your MDS is maintained electronically you no longer have to print them and put them on the chart after June 17, 2009? 15 months worth of MDS information in one chart takes a lot of space in the record, is costly for the facility (paper and toner), requires filing time, and is not "envirnomentally friendly" because of all of the paper required to do this. :yeah: