MarggoRita

Toileting ur, ac & pc, hs, & prn is also standard practice, not a program. Toileting programs are resident specific, evaluated and reassessed to reduce incontinence based on each residents personal pattern.

Walk to dine can only be counted if the resident is otherwise in a wheelchair. If they walk at all times, either independently or with assist, then it is not counted, it is simply their standard care. Restorative programs are to be above and beyond standard care. If they only need directions to locate the dining room then it absolutely does not count.

If they are independent with ambulation they do not qualify for walk to dine. If they are high risk for fall, then they should have assist with all ambulation and not be considered as independent. If they wish to have more freedoms, see if therapy can improve their ability with independence as a goal, or else allow for w/c use for independence as desired and continue walk to dine or as able with staff to not lose that ability.

This is standard nursing care at our facility, not resident specific, and does not count as toileting program. To be resident specific, you must monitor output for a resident for 24/day for three days. Note when they are incontinent. Then careplan a specific routine for that specific resident based on their incontinence. Then, prove that the careplan was followed, reassess their incontinence, show if it was effective or not in reducing incontinence, continue the careplan as is if effective, or repeat the cycle until you can actually reduce incontinence. Document all assessments/monitoring tools.

Our facility got rid of audible alarms years ago, we only use silent alarms. Not only do they alert staff just as well if not better than the audible alarms since it goes through the system and you do not need to be in earshot, but they also decrease stress and resident behaviors caused by all the noise of an audible alarm, not only for the resident in need of the alarm, but also for the roommate or neighbors who also must suffer through the noises every time someone shifts their weight. Audible alarms have actually been found to increase actual falls since the sound spooks the resident and possibly adds to loss of balance, not to mention the emotional disturbance, indignity, and depression associated with sounding alarms with movement of ones body.

Thanks again, very helpful the way you explain it.

Thank you for the info, next question, the tx must be over 15 minutes, but do I have to stay with the resident for those minutes? Given that my resident in question received his Nebs through a face mask and we know he receives the entire tx because he does not remove the mask, we do leave him during that time, but doc 15 minutes for the time it took for the tx? And assess before and after the tx, but would be very poor utilization of time to sit with him during tx's since he has five separate Nebs each day.

What exactly constitutes as "trained" respiratory nurse? Aren't all nurses "trained" to assess lung sounds? Only asking because we are to document HR/LS/minutes to claim for neb tx's, but I have not been "trained" beyond nursing school, is that enough?

I have written a note in the chart after sending someone in to ER stating that they had been admitted and why, but it makes no sense to obtain an order as once they are sent to the ER they are no longer in your care until they return, and what happens at the hospital is documented at the hospital.

Our facility has two dogs that belong to the facility. A couple of our residents take responsibility for feeding and watering them, and alerting staff when to let them out. Pets are a big draw, gives the resident a sense of purpose to tend to them, and many have always had pets do it makes for a more homelike feel.

I would assume that, because it is Inservice, it is likely reiterating information that has already been taught? In regards to resident-care, as long as a nurse does the initial teaching the unlicensed staff can continue to reinforce the teaching. While I was a CNA I did lift/transfer training at Inservice. Of course, all staff had already been through appropriate courses and training upon hire, and the Inservice was to reinforce the material.

I love LTC, I love being able to treat the entire person, not just their acute illness. My friends that work in the hospital setting are not even allowed to trim a jagged fingernail to bring a pt comfort if that is not part of their admitting dx.

Then why not just make it prn? I guess where I am coming from is, are you who think it is ok just omit certain meds at leisure still signing that they were indeed given? I hold meds per nursing judgement, and chart to show that it was held. Everyone makes med errors at one point or another in the chaos that is ltc, the reports are not made to get anyone in trouble but instead to gather data and eliminate common error... Which has been successful. We follow the date on the card and are able to tell if a med was omitted, we sharpie bid meds to read 7am 7pm 8am 8pm etc, we sharpie date everything and have reduced omissions 99%. Also, ours is not a paranoid or hostile environment, we fully understand what we are trying to accomplish. Our strictness stemmed from having discovered a simple order for culterelle that was bid for a 2week span, we received from pharmacy the exact amount of meds needed, but they were in a zip bag instead of a card and therefore placed in a different drawer. After the two weeks, over half the cops remained but all had been signed as given. Needless to say, as a group we decided this was not acceptable nursing practice, and took great lengths to make great improvements and not allow for anyone to be sloppy. I don't find striving for improvement petty one bit.

Our senna is on a card, we do not have house stock for anything scheduled, and yes we do report I administered medications regardless senna or norco. We are very very hard on ourselves and write up any and all med errors because it keeps us from becoming sloppy and is in the best interest of the resident. 'Just a senna' is just as important to the resident as any other scheduled medication, it is scheduled because it is necessary, if it is not than seek to have it d/c'd.

I love working with med aides, allows me to spend time focusing on my residents needs, tend to occurrences as they happen, chart throughout the day, and not have to meet the time demands of that ball and chain med cart. The med aides report all prn requests and seek approval before giving, and as the assessments happen you just notify them to hold or give appropriate meds, otherwise your time is spent caring for the residents, addressing concerns with the drs, and having the time to truly problem solve.

Make the meetings interactive, games to elicit participation, (toss candy for the right answers), seek volunteers from the staff to present on some of the topics, they can own that topic and become the go-to person. Not only does it improve retention of the material but also improves cooperation in practicing per protocol on the floor.

My facility had once talked about keeping meds in the rooms as well, I hope it never happens for the very reasons you spoke of, and I would insist on keeping my title as a nurse, after all I am a nurse, and that does not make me un-homelike, it makes me a nurse. I feel for you. I also feel that all the changes are almost adverse to creating a homelike environment, like saying it is negative to need a nurse, we are why they live there. Our dietary manager gets mad because we don't transfer some of our residents out of w/c into dr chair at meals to make a better dr appearance, this is their home, and if a w/c is what they need and want to remain sitting in they have that right without it being a 'bad' thing. Just out of control.

I guess I am curious now, how is it considered dispensing? They have already been dispensed by pharmacy, they should have pharmacy labels with the residents name, and they are being sent with the resident they belong to. Also curious, does the insurance then have to pay for duplicate pills? If we have to waste meds and thus run short, the insurance will not cover the cost so the facility must cover. How is this covered for the resident?

Wow, that seems a bit harsh. We send our med cards out with the family. I would not consider saying, "sorry, no meds" to them, they are 'their' meds after all, and it is well within their right to go out of the facility with their family. At what point are policies actually a punishment for being elderly, frail, and dependent?

Where I work the bath aid is responsible for getting a weight at the time of the bath. Has never been a problem, and if we have residents with daily weights then the aid that gets them up grabs their weight on the way to breakfast.

Sounds very much like one of our little ladies, and yes, many of our staff now have agreed it is likely a behavior. However, we did run labs, and have her and her medications evaluated before noting it off as possible behavior. Never hurts to rule out and not just ignore.

At our facility the nurse that finds the error photocopies the mar and med card or makes a note of explanation of what was found, turns it into the don, and then the nurse who made the error is handed the photocopies and incident report to fill out, makes more sense for the investigative part since they can explain better the hectic interruptions or other reason the error was made.

*cognitive impaired residents that have learned to respond to a safety cue

Analyze each fall, what was the resident attempting prior to? Often times there may be a scrap of paper or something that catches there attention on the floor and they are simply trying to pick it up, so assure floors are clean and clear of temptation. the usual toileting needs are probably the most common factor--assure toileting schedules are being followed to anticipate need, some residents will continue to have falls no matter how many different things you try, so do your best to make the environment as safe as possible so that WHEN they fall the chance of injury is decreased. Strength building and safety awareness building takes time to accomplish but is well worth it when you can set a standard cue term such as "remember safety first" to trigger better transfer habits, then you simply keep eye on how they are transferring and cue as needed if they are not doing so safely. We have a couple cognitive residents that have learned to respond to that cue, and their falls have decreased as their better habits have been reinforced by all staff.