cwgrlup85

I do falls, skin tears, and bruises and any trends. Infection control resident and employees. We also discuss any new policies or anything new that we developed in our dept last quarter. We also discuss psychotropic meds tallied for the unit and if/any restraints. We also choose a resident to give a report on, particular one with current issues that may need a team effort in problem solving.

Well it would depend on what the resident it being charted on. For example a resident is on an abt for a uti, you would want to focus on: are they having any reaction to abt, are they continuing to have symptoms of uti, that you're encouraging fluids and if the resident is accepting. Ex: "Mary continues on abt therapy for uti with no adverse effects noted. Burning upon urination has subsided. Fluids are being encouraged intake 1500cc, output x6. T 98.4, p60, r 18, bp 120/60." I always tell my nurses to document as if you're painting a picture. Describe the situation or resident as if a stranger were reading the chart and you want them to know what you've observed.

I often say "I have brought you your vitamins today" or "you know how those Drs can be but we have to do as they say to stay healthy" but I work on a dementia unit. Another one that works well is "your daughter __ wants you to take them"

I have seen it work on a few geriatric residents but I have mostly seen it be ineffective. I have even heard of it increasing people's appetite to the extreme of PICA.

We have a policy where anyone on coumadin or blood thinners who hit their head be sent to er for ct, unless family refuses. Otherwise any fall with head injury notify physician and monitor for any change in condition. We monitor neuros every 15 mins x 1 hour, then every 30 mins x 1 hour, then hourly x 4 hrs, then every shift for a total of 72 hrs. That was the same policy at another facility I worked at.

Thanks! I will try these things, great advice!

It seems that in the different places I have worked getting the cna's to obtain vital signs in a timely fashion is near impossible! Their excuses are always "we don't have time" or "why can't the nurses do them all they do is sit anyways". If the cna's are having a rough day the nurses usually get the vitals, but then there are some cna's that would take advantage of that and assume the nurse will do it all the time. I have some very spoiled cna's who truly do not realize how easy they have it in comparison with your typical LTC facility. Our unit has extra staffing due to being a dementia unit, but it seems the more staff we have the less gets done! Any suggestions would be appreciated!

In our dementia classes we are taught to use therapeutic fibbing, as they call it. It is much better than trying reality orientation. Bwsides, you made her smile and seem at ease at least at that one moment in time :)

You were right. Some physicians just have a "God complex" or so I like to call it, don't ever let them make you second guess yourself.

I agree with you Nascar. We also have an attendance policy very similar to yours as well. I have even worked with staff based on individual circumstances and even given last chance agreements.

I am a director of a dementia unit in Illinois. We allow our residents to sleep in and rise on their own. We have our own kitchen stocked with cereals, bread, yogurt, pudding, eggs, pancakes, and much more. I generally have my cna's get the residents up no later than 11, considering we eat lunch at noon. Those that are up during the night are fed during those hours in order to maintain their weight. I really try to focus on our residents with weight loss vs letting them sleep in. I encourage staff to attempt different times and even with different faces to try getting the resident up without causing behavior issues. We also offer several snack times throughout the day. We also hold resident's meals if they are sleeping through lunch, and offer it again an hour later. State surveyors did not say anything about our daily routine. Just make sure the residents who like to sleep in have that on their careplan. Especially be sure to have the diabetic resident's careplan state her frequent refusals of medication and accuchecks. I would offer juice at least in the am rather than letting her go without anything. Have staff make frequent checks on that resident as well to watch for signs of hypoglycemia. Hope that helps :)

Thanks for all the words of wisdom! My administrator does fight against these and I have a hearing coming up. It just seems like it is so easy to get unemployment, at least I guess in Illinois. The working conditions are great, even the state surveyors called us "the cadillac of nsg homes" and there are only a select few I have had to terminate and they were hired before I became director. Trust me I pick and choose my new employees wisely to avoid these types of people.

Where I currently work we have a pretty strict attendance policy. I follow all the steps with verbal and written warnings, followed by a 3 day suspension and then ultimately termination. I document every discussiom with these employees as well. Yet it is so easy for these people to get unemployment! Just irks me to no end. I currently have an employee who told a staff nurse "I'm just waiting for my walking papers" and continues to have excessive call offs. I'd like to terminate her, but I truly know that's what she wants so she can go draw unemployment! Ugh, ok sorry for venting. Any suggestions or past experiences anyone would like to share?

A lot of LTC facilities avoid using them and have outlawed them for infection control purposes. Since this particular person is needing it you'll need to come up with a strict policy regarding it's use and cleaning.

I too am a new unit director of a dementia unit. I made it through my first survey recently without any deficiencies! Hopefully your staff is well seasoned and know what to expect when DPH is there. I know I have my staff to thank for our great survey results. I would focus on all the things that CapCod suggested. Then I would make a list of the things that need some attention and have frequent unit meetings on survey readiness to help prepare your staff. At least that is what I did and it does help. Some additional suggestions: make sure call lights are being answered in a timely fashion as well as door alarms being responded to. Frequent rounding on your unit will help you notice the problem areas. Maybe even a manager from another unit or department could do a "mock survey" for you. That has been helpful to us in the past as well.