txdon

Just curious have other DON's handle abuse allegations. What is your process? Also, how are incident reports handled? The DON at my facility handles all of these and a lot are getting lost or not being investigated.

More than half of my staff are wearing artificial nails with outlandish nail polish. This is not allowed per policy but the staff has gotten away with it for years. Not only is this against policy, but the risk of infection increases, not to mention ...

DON's I need your help. I need help developing an effective wound care program at my facility. I currently have a wound care nurse who does all the wound measurements for pressure and non-pressure wounds weekly. She puts them on a special tracking...

Okay, I need more help or suggestions. My facility has serious issues with the number of resident's who receive daily baths. There are two sides to my facility, one side gives atleast 14 baths per shift. A total of 28 baths per day just on one sid...

My facility was recently retagged for incorrect diabetic flowsheets. Nurses either forgot to put the correct insulin given or forgot to notified MD if bg was outside of parameters. During the state's revisit, the surveyor randomly selected 6 diabeti...

First, does anyone have a clear job duties list for CNA's on nightshift. This shift is my weak link. Basically they think their job is just to answer call lights and maybe clean a few w/c's. Second, I am having a difficult time getting my nurses...

Help! My facility is having its annual survey and we are possibly facing a g tag. I am apprehensive talking about this situation online but really need so guidance from someone who understands actual harm citations.

Does a resident have the right to demand who his caregiver will be? Is that consider a resident right? I have had two residents who have demanded or refused care by a caregiver because they only want a certain aide or nurse care for them. They don...

More than half of my staff are wearing artificial nails with outlandish nail polish. This is not allowed per policy but the staff has gotten away with it for years. Not only is this against policy, but the risk of infection increases, not to mentio...

I just had a complaint survey that resulted in a G tag for wounds - F314. Both cases involved failure to do enough to prevent further progression with a facility acquired wound. Both started as Stage II's and progressed, one resulted in osteomyliti...

Ok, I will admit I am not at all familar with MDS. I am a fairly new DON and need some MDS advice. The current MDS nurse wants the floor nurses to do careplans when they write new telephone orders that would warrent careplanning a new diagnosis or ...

I need help developing an effective wound care program at my LTC facility. I currently have a wound care nurse who does all the wound measurements for pressure and non-pressure wounds weekly. She puts them on a special tracking form that includes tha...

What are T&P clocks and audits? All residents are on air mattresses, these particular wounds were acquired from sitting - both were on strict orders to only be up with meals. The surveyor felt that one resident should have had more interventions...

Recently our corporate pharmacist did an audit and identified several times nurse's circling their initials on the MAR and writing on the back," Medication unavailble". Can someone tell me what nurse's show write on the MAR when a medication is unav...

My facility cencus is 89 with 19 Qmix. Thanks for clarify careplans and quarterlys. At my facility we don't have unit managers to oversee this process. Each nurse is now responsible for careplanning t.o's and changes. They are assigned 8 resident...

I think a large part of the medication not being available is due to nurses not reordering the medication in a timely manner. Usually this occurs towards the latter part of the weekend, leaving the weekend staff scrambling. Any suggestions on how to...

Thanks for all the wonderful advice. At my facility the "wound nurse" is responsible for doing weekly documentation on all pressure and non-pressure wounds. She follows the resident weekly until healed. She is responsible for doing a weekly assess...

Help, we have a resident who is declining rapidly. She developed a stage II and within a couple of week's time it has progressed to a Stage IV! She was just put on hospice but I am concerned how to clearly document this progression effectively to s...

My facility policy is to write an IDT note on every person with a non-pressure wound. We are expected to write a note weekly until healed. The problem is I have multiple residents with non-pressure non-healing wounds that remain status quo. I need ...

Does anyone have a list of appropriate behaviors to use when doing behavioral sheets for psychtropic meds? The nurses are having a difficult time with this.

Thanks for the responses. One problem I have is with new admissions who are on psychotropics. We have to fill out behavior sheets upon admission, but often times behaviors are unknown as to why they are taking the medication. Largely in part becau...

I have a resident who "slides" out of bed onto the floor when trying to ambulate to wc. She is a one person assist and has a transfer pole to promote more independence to and from bed. When she slides out of bed onto the floor she is unable to get up...

Thanks debRN for your comments. At my facility our policy is whenever the resident falls and it is unwitnessed, we have to do neuros. How should I go about changing that if that if that is the policy? Also, we have had a high number of falls last ...

Why would your facility want you to do away with bed/chair alarms? We use them not as a form of restraint, rather as a reminder to seek assistance before getting out of bed for those who are impulsive and forget to call for assistance. Alarms don't...

Can someone please help me understand why unplanned hospitals discharges are such a negative in LTC and SNF's? I recently had 6 patient go to the hospital, five out of the six were admitted. Only one out of the five I feel we could have treated wit...