Shell5

This is my first week in assisted living as RSD. I come from med surg, skilled nursging background. I am coming into a situtation that has no systems in place. I have found numerous meds that have not been given on the MAR, BS that were not written down on the MAR, service plans that have not been done. The pervious RSD is not there any longer. We are due for state to walk in the door any day now. I am doing all I can to get these issues fixed asap by holding in-services and getting all I can done with the time I have. The question I have is will I be held responsible for the way the place is now if I just got hired on? I have found narcotics that weren't locked and so many med errors that I can't possibly write them all up. Just really need some direction here. Thanks so much.

They regulate in Texas.

nurse to patient ratio

Thank you

That's what we call them where I am at in Texas. If you have any ideas for what I am asking that would be much appreciated.

plan of correction that is required sometimes by your company for issues that are above company benchmarks like falls over a certain expected number or pressure ulcers over a certain number. Could also be plan of correction that the state asks for when they find a problem and they expect you show them how you are going to correct the problem (plan of correction).

The worst thing you can do is threaten the nursing staff with calling the state and feds in when some paperwork is wrong and no narcs missing. That's what happened to me. I had a new DON start and she threatened to call state and feds in because a nurse didn't sign a discharge sheet. She then wanted me to take a drug test and took my keys. She blew everything out of proportion, went through my desk and lied about it. She has started on the wrong foot and is acting like the place is a mess when we have been working hard without a DON. Not a way to start at all. Very hurtful and threatening. Best thing you can do is when you find something not up to par is to teach in a nice way. My situation is a nightmare. I wish you luck. Just try not to put anyone down and keep any negative comments to yourself or talk with ED about it. Remember the ones that have been have probably been doing the best they can.

In my nursing facility (SNF) we continue to be over benchmark with pressure sores, falls, infections, psychotropics. I do everthing in my power to keep all of these down. I do education, skin care, QI, speak with NP's about these issues, etc. I get so frustrated about this stuff. It seems I am putting the same B3 Plan of corrections for all of these topics. If anyone has any ideas for me for B3 I would appreciate it.

Keep praying about it. Nurses eat their young is a saying that is true. There are sick people out there. Stick to your guns and believe in yourself and your decisions. Make sure you know the policies and procedures that is what the BON examiners will look at when they look at your decisions.

It's not.

A simple staff nurse? Never minimize what you do or how hard you had to work to get to where you are. We all had to start somewhere. Benchmarking is the process of comparing one's business processes and performance metrics to industry bests or best practices from other industries. Most facilitites do this. My facility sets certain percentages that say this facility cannot have over this many pressure sores, residents on psychotropics, UTI's, ect and if you go over this percentage you have to do what is called a B3 (plan how you are going to get these percentages/benchmarks down.) These things like pressure sores, UTI, psychoactives, falls, med errors are what others look at when showing if a nursing home is providing quality of care. If you go online you will be able to compare nursing homes. It is good to have your numbers down as it shows you are providing quality of care. I hope I clarified.

Maybe I did not make myself clear. I realize some of them are needed. I do think that the Dr./NP could try something else first like Trazadone or something else instead of going straight to the antihypnotic. I suppose I need to be addressing this to a pharmacist. What I really want is to prevent our benchmarks from increasing. I would like to see our numbers stay the same or decrease intead of increase every month. I hate this part of my job.... trying to maintain the benchmarks. I know I am a nurse and I am a patient advocate, but I do think sometimes there are things we can try before we automatically go to the stronger meds. If anyone has any experience with what I am going through I would appreciate your input. Thank you.

I seem to have the same problem every week at the long term care facility where I work. We only have 2 people on antipsychotices, but our antianxieties and antihypnotics seem to stay the same and cause us to be over benchmark. I have tried everything to get them DC'd, but a lot of residents and/or their family do not want them DC'd or the dr. does not want to DC them. I keep putting the same thing under plan of action every month for plan of action and would like to at least to do someothing else but I feel stuck. I don' t know what esle to do. Can someone help me? Does anyone have any ideas what to suggest to the doctors? It seems like they automatically jump to an antianxiety of antihypnotic. Help!!!! Thanks.

Sounds elementary, but sometimes we have residents in long term care that will need a band aid and a nurse will put one on and not write an order. This happens a lot. I think they need to be writing orders, but they don't. We had a resident come in the other day who had an appx 1/2 cm open area to back of calf and a nurse put a band aid on it. I didn't find out for a few days when it became a blister. The lady is on coumadin. The open area turned into a bruise, then blister filled with serous fluid. Now, there is brown crust on top that is either a scab or eschar. It is very difficult to determine at this point. We called in a wound specialist, surgeon. Our DON is acting as if it was no big deal; we didn't need to write an order to put a band aid on it at first. Nothing has come on it, but one day it might. What is your opinion? There is an order to for wet to dry until wound specialist can come. Thanks in advance.

Thanks Dixie.