maddock26

I was seriously asked by one of the attendings to text pictures of wounds during rounds to his cell phone. Needless to say I said "No, but you're more than welcome to come on fridays when we do rounds with the specialist if you'd like to see for yourself how they're healing." My facility does not photograph wounds during weekly measurements/assessments with the wound specialist and there isn't a chance in you know where that I'm going to take a picture of a wound with my personal cell phone to send to the MD or anyone else. I told my DON/Admin about this and they will be taking care of the situation. When I confronted the MD about the request with the statement "why did you ask me to do something you knew illegal?" He stated a lot of the MD's at the "big hospital" do it. I'd be ****** if someone took a picture of a wound on my rear and sent it around to anyone/everyone. Has anyone else heard of doing this? Texting pictures.

@ CapeCodMermaid- Exactly! It's the dumbest thing and a complete waste of time.

I was asked to do the same thing. Help initiate a wound care prevention and management program. Fortunately I have an absolutely wonderful Wound Care Specialist who does weekly rounds at my facility and is availible by phone at all times. I started with the orders, our were a hot mess! One person referred to a wound as an open area, one a stage 4, another an abrasion. I walked in to each room not knowing what it was I would find. So I clarified all the wound classifications, made sure the treatment order was appropriate, referred to the RD for dietary consult, referred to PT to see if they required a specialty cushion/brace/PRAFO boot/shoe/etc. Than set up interventions to prevent future skin breakdown such as lotion to applied daily, gerisleeves, long sleeve shirts, moisturizing body wash, bath oil, heelzup, positioning devices, specialty mattress, gerichair pads, strict turning/repositioning policy, every single aide on every shift is responsible for completing a skin sheet for each resident they were assigned. Gave inservices on proper transferring, body alignments, pericare, etc. I'm not done yet as I'm only 2 months in to developing the program and I know we could do more. I'd love to hear tips on what other facilities do to prevent skin breakdown. Any tips?

First and foremost protect your residents and protect yourself. I'm a little strict with my CNA's most of the time and they do great work. I love the girls I work with and they know it. I'm fair and have no preferential treatment. Everyone is treated the same. If someone's laziness or uncooperation leads to anything that appears to be neglect or abuse get rid of em. Here's what I do: the first time it is a learning experience and teach them what to do or not to do, the second time for the same incident is a write up, and the third time we march to the time clock and the DON/DSD get to deal with it. I have so much to do and so little time that babysitting staff doesn't rate high on my agenda. If my DON had to remind me to do my med pass or chart or follow up on labs/x-rays/etc how long would I last?

I work at an LTC in california and we count MDI's, ABT's, narcs (obviously), lyrica, belladonna, lidocaine, everything.

Well, if the person has chest pain it could be assumed that they have a pulse. A DNR goes into affect if the person is pulseless and/or not breathing. So in this case, you treat him/her the same as a full code. Even than, contact the MD/RP because the decision can still be made to transfer to ER or initiate CPR in a pulseless/nonbreathing resident.

I understand what you're saying. When I was new I was always worried about maintaining compliance. I was the only nurse for 46 people. I clocked in at 1430 and had things to do before the 1600 med pass which I had to start at exactly 1500 to be done within time. So that leaves 30 minutes to make the BM list, do the daily assignments for the aids, stock the cart (because heaven forbid it already be done), and wait for the offgoing nurse to give a PROPER report/count. Yeah right. I will not accept "everyone's ok" as report either, there is always somthing to report. Our time is so strictly regimented that I don't have time to waste waiting for someone to finish their private conversation. You get a 10 minute grace period into my shift to get things together, after that you start messing up my times. I have 120 minutes to pass meds to 46 people! With the addition of fingersticks, B/P's, apicals, and answering the phone that never stops ringing I gotta go. Lagging it talking, with the exception of emergency situations, gets that offgoing nurse working a double and me going to the DON. Besides there's always something to be done like careplans, PPD's, assessments, dressing changes, etc. Busy hands make light work.

California-no