nursy54

Thanks for all the comments. I spoke w the DON about AMA , and how other facilities deal w/ it. She still insists , and ill quote, " When a resident wants to leave AMA, we still need to keep them as safe as possible. Which means EDUCATE, EDUCATE, EDUCATE! If the're not here on med a then give them there meds, do the referral to home care and call APS. If the home care agency doesn't pick up the case, at least we can say we tried to keep them as safe as possible despite education !" I appreciate all the comments and agree with all of you. :) Thank you again

Hello. I have the same concern. I work in a LTC facility where there seems to be a much younger population than there was a few years ago and they always seem to have pain no matter what there on. Its usually the younger residents I have the problem with. Meaning, when I ask them "In the past week have you had any pain.? they almost always seem to say yes, its a 9 or 10 , I can't sleep, It hurts to put my shirt on and comb my hair, ect....So then Ill ask if they get relief after taking the pain meds. Agian the answer is usually "no". Most of them tell me the pain is still around 7 or 8. One of the residents is recieving oxycotin ER 10mg BID, Oxycodone 20 mg Q4 PRN, Cymbalta 60mg Q day and valium 2mg TID and according to him before he takes his meds his level is a 10, after he takes his meds his level is a 7 or 8. So, to try and answer your question, I always write down the answer they give me because the MDS wants to know what there highest level of pain has been in the last week. I then make sure I follow it up with a nurses note Re; his complaints , the meds he was given, the outcome (according to the resident) and I make sure I chart what he did throught the day and that the MD is aware along w what the doctors respons was.. I also make sure the back of the careplan is updated (Despite res. recieving.......he continues to complain of pain, refuses hot/ice packs, refuses therapy,ect) This paticular resident propells himself throught the day w no assistance, goes LOA several times a week and he has been observed getting in and out of his brothers car showing no s/s of and discomfort or pain. I know pain is subjective but this guy is on a lot of meds, NEVER shows s/s of pain, is always going on LOA's. If you could give speeding tickets out for W/C going to fast, this guy would get one every day ! So, when the state comes in and wants to know why so and so has so much pain , all they have to do is read the nsg. notes , MD progress notes (I always ask the MD to write a progress note reguarding the residents complaints of pain ) and review the care plan and I'm sure they will see exactly what we see.... Last year one of the surveyors reviewed this residents chart because of the pain and they said we were doing exactly what we should be doing. Unfortunately updating your care plan and writing good nurses notes wont change your QM ratings, but the charting will at least cover you butt.

thank you for the replies. when the very first DON was there, thats exactly what she said... they get nothing. as time went on and our DON's changed, so did the "policy" (its in quotes because I cant find a policy on AMA anywhere !! OMG....) I brought this issue up in morning report again today and the DON is still saying we give them Rx, and D/C summary. The SW tried to explain to her, they should get nothing. No Rx, no D/C summary.. NOTHING. I looked on line at DOH , but cant seem to find anything. Does anyone know where I migght be able to find a regulation reguarding AMA , or is it just a facility decision ?

I have a resident that says he's signing out tomorrow (AMA). My question is, do we give him a discharge summary, or just his RX ? The last time a resident signed out AMA, all the departments filled out a discharge summary. My new DON said we only need to give him his Rx then call APS after he leaves. When I asked her why we wouldnt fill out the D/C Summary she said because if we do, then it looks like we are agreeing to the D/C. In my opinion, even though he's leaving AMA shouldnt we try to make it as safe as possible , which would include a summary Re; any follow up appointments, wt.bearing status recommended diet ect? I looked for the REGS reguarding AMA Discharges but was unable to fine one. How d other facilities handle AMA's, Any input would be greatly appreciated . Thank You in advance for your jelp :) Christine

Hello. When I ask the resident if they have had any pain in the last 5 days I always code what their answer was. Just because they are recieving pain meds doesnt mean they are/ are not in pain. The pain meds they are recieving are most likey working if the resident is answering "no" to the pain question. You should only code what the resident says not what you think. I could be wrong, but while reading your question it looks to me like your answering the pain question for the resident. I have residents who are on A LOT of pain meds which include oxycontin BID and dilaudud for breakthrough. But everytime I ask the question about pain their answer is always "10". In this type of situation I always chart in a Nsg. note or CAA (If appropriate) something like "despite 20mg oxycontin ER BID and dilaudid q4 prn for breakthrough resident cont. to c/0 pain 10/10. resident propells self throught facility throught the day, goes out on LOA with family/friends several times a week. Resident able to transfer in / out of car independently , no s/s pain or discomfort observed. We actually have several residents who complain of 10/10 pain despite all interventions. In facility I work for we happen to have a lot of the younger residents who seem to be drug seeking..Some of them actually dit outside and talk about how much pain medication they are on, how often they recieve it and what kind... I could go on and on about this. But we need to remember pain is subjective despite what we may think. Back to the original question...your answers to section J of the MDS should ALWAYS be what the resident tells you, not what you think. Unless you have to do the staff assessment ( section J0700) . But again, even that section is what you observe, not what you think. Hope this helps.