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Maddie86's Latest Activity

  1. Maddie86

    "After the Fall" LTC/SNF Nursing Know-how 101

    In our center where I manage a unit in LTC, we got cited for an inappropriate intervention for a fall in our last survey. Our state is going after falls hard and heavily. We treat a fall like a crime scene, that is the key. We involve everyone in the response. When a resident is found on the floor, a "Code Star" is called to the location and dept heads and managers respond including the assigned nurse and CNA and any other CNAs that are available on that unit. We have a form the nurse fills out that answers important questions in order to get to the ROOT cause of the fall. For example, if a resident is found in the floor and unable to verbalize what he or she was doing that caused the fall, we take note of all surroundings and examine the resident to determine the need that was not met. The resident may be found to be soiled and there may be no other clue, so we begin a B&B assessment and start a toileting schedule. I've got the highest fall risk resident in our region on my unit and I have gone so far as to have customized furniture made for her by our maintenance dept. With all of the interventions we began since our new fall program began, we have decreased her falls from 34 in a year to 10 this past year. So, it all works...but it is a real culture change. CMS is heading towards a new world and it is difficult, even for me as a "new school" nurse to change my way of thinking to personalized care from a traditionally run unit that is set up to meet the needs of the staff. If you have any questions, feel free to get back to me! Meghann
  2. Maddie86

    LTC-Reorganizing & Need help!

    I am a unit manager in a LTC Center and I have been here almost 2 years. I've gotten my unit a long way but we have just transitioned our CNA shifts from 8 hours to 12 hours and I am hitting a few bumps. So, I am looking for some input! I am trying to spread out the work load and need to move some responsibilities to my 7P-7A shift. All 3 meal passes are now on day shift's shoulders and they are also having to do several showers. I need input as to the following: -What is a reasonable number of residents to have on a "get up" list every morning for a 43 bed unit with 3 CNA's? -What is a reasonable number of showers for the same? Thanks for any advice! Meghann
  3. Maddie86

    Advice on dealing with confused patients

    I am a Unit Manager at a LTC facility. I have worked with dementia in one way or another since the beginning on my nursing career 6 years ago. I'll tell you what I have learned works best for me. Keep it personal, speak softly as you can and make your voice as pleasant and as sweet as you can. Be sure you smile widely or look concerned, whatever suits the situation the best. Smiles go a long way. Your initial approach to a confused and/or a combative patient is key. Try to make eye contact with them and keep it, get their attention focused on you if you can and keep it there. Ask them questions about themselves: where did they grow up, what did they do for a living, where and how did they meet their husband or wife, etc. With a pleasantly confused patient, this works 95% of the time. You did well with the towel folding. Usually if you figure out what they did for a living, you can come up with some creative ideas related to that to keep them occupied. A lot of my older folks used to work at a cotton mill in my town. I have loads of clothes and sheets we bring out for them to get their hands on and they will fold alllll day long. If they did something with their hands, find something for them to do that will resemble that feeling in a tactile manner. Something familiar such as this almost always has a calming effect. I had a little woman who was a housewife. I would go into her room and put things out of place, unmake the bed, etc. She would go back in and clean everything up. Just some ideas, hope it helps!