RNLew

DebRN, I was thinking 5-7 also for incident reports as well. I think they are treated more like a part of the record, even though not filed there. More so than our QA type documents.

We have a kit that mesures side rail safety for entrapment. It has several components, and found that only 1 of my side rails was "safe". The worst side rails I found were ones being used with an air mattress. I couldn't get any airmattresses to pass the test. Although I will say that most of the openings in the rails passed. It was mainly the space between the rail and the mattress, and the space between the bed frame and the bottom of the rail. I would have a hard time with just a simple measurement, because this does not allow for the fact that weight changes the size of the openings etc. BUT I do know there are some guidelines on the FDA website that helps you measure. There are 4 "zones" of entrapment to look for. The first is through any holes or openings in the rail, second is between the mattress and rail, third is between the frame and the base of the rail. And the fouth, hard to describe, so please bear with me. Is the angle of the rail at the top and bottom outside angle. It ensures you cant get caught coming from higher in the bed, and your head/neck over the edge, and then get caught under the outside of the rail. That one was also impossible to pass with an air mattress. We had several different types of rails, from the top of the line "safest" joerns, to lower priced ones. The best thing I could come up with is a very thick mattress, that is very firm and wider than what we had. And all of our ones that failed were very nice brand new mattresses. Hope that helps!

I'm afraid in even the most ideal of circumstances you may still feel pulled and scattered! It's the nature of LTC management! What I've done recently for a new ADON I hired is assign each day a focus. Put it on a calendar. If it's not a focus day for orientation, you let it wait. Unfortunatly it looks as though you will have to inservice yourself, or keep spinning your wheels. Don't try to perfect every system all at once. You may have to do enough on a few of them to just get by while you are focusing on the one that made the top of your priority list. Try not to do too much at a time. Just give yourself a free pass for a month or two where good enough will have to be good enough in some areas! Just don't forget to get back to them and perfect them! Just the fact that you're concerned tells me you're doing a better job than you realize! Take a deep breath! It's been broken for a long time obviously and no one has been murdered Bc they didn't fix it! Prioritize by what relates to patient care and good outcomes! Weights, falls, skins, infection control. Work your way down from there and allow yourself time.

I work for one of the largest LTC providersin the nation, so we actually have a specific skilled note form. However, I think it comes from Briggs. You could check it out. It has a portion that is checking boxes, which saves your butt on reinbursement and a narrative space at the bottom to CYA for the nurses. I've also went through a rough spell with documentation, mine was pressure sheets, and fought this battle with my day shift for months. All I would ever get was victim type excuses, I've got too much work etc. So funny thing is that I ended up terming one of the day shift charge nurses over it. She was the worst one. Crazy part, after that, they tried the excuses for about a week and then next thing you know, they are all doing an impeccable job! I don't think it was the old "make an example" scenario I believe that one bad apple ruins the bunch! They all jumped on her ban wagon of excuses! Then convinced themselves they couldn't do it. Truth is, the one I got rid of really couldn't do it well, but the others were more than capable!

Ive never been asked to produce the individual pharmacy recommendation letters, they usually want the entire consult report. The consolidated version which includes all the data that won't be placed on the chart. Ie med pass validation, or med time changes that don't go out as letters to MD. The psych med review portions. They aren't interested in individual recommendations in my state, they are interested in her consult report. Could very well be different unless you're in Texas as well, which I can attest to with certainty that it is a document you shouldn't discard! And the vodka, that is also vital here in Texas, and again I'm not sure about your state, but I would hang onto that as well!

Explain to the how much money is lost bc they didn't do their job. Usually upward of 10k a month on a partA. Get real numbers, have your MDS nurse explain what happens without the documentation. Usually people will do tasks when they understand the reason they are doing it.

Nursing is YOUR department, and your MDS nurse and ADON are yours to manage. I agree you need to be in the dining room, but not IN PLACE OF your charge nurses. You should have a nurse there whether you are there or not, and on the days you are there in the evening, you should come in later that morning. But in MY building, I expect nursing managers to be in the dining room at least 20 minutes each day. Its for me to decide who does what meal, not my administrator. Sounds like she has hijacked your department. But, in her credit, your presence in the dinning room is vital in my opinion, and should not be looked at as taking you away from your work, after all, what is our work? How can you manage weight loss if you aren't consistantly in there? I don't go every day, and don't stay an entire meal usually. What I do is have my other nurse managers on a schedule to be there and I come when I can, which is usually 4 times a week. I prefer to catch the end of the meal vs passing trays so I can load up on the supplements and alternatives for my weight loss residents. (disclaimer... All of the above should be prefaced by "in my opinion")

Well, the only thoughts I have are, every time I have surveyors in my building they ask for pharmacy reports for the past 6 months, so I do save those. And the incident reports, we also have to think of litigation, which usually doesn't occur within a short time frame. So I won't venture out to say how long they are needed, but I do think there is some reason to keep them for a period of time. Dietary Consult reports, same thing with state, you get one complaint on weight loss, and it might be in your favor to be able to produce those quickly.