geriatricRNBSN

I work in a SNF/Long-term care facility. If a resident is sent to the hospital for a week or more, they must be re-tested for TB upon return from the hospital. Many times a SNF resident who was tested 2 weeks ago for TB returns to the hospital for a week or more and returns to the facility. Is it required by CMS to re-test the resident upon return? Incubation for TB is 2-12 weeks so why test again after a short-stay (2 weeks or less) at the hospital? Any other facilities do this?

Where is the administrator in all of this. He/she should be aware. What about compliance hotline?

That is exactly what happened to me. Here is your desk. You are right to continue the quality measures reports. I don't know how you have it divided up between you and the DON but monitor these closely: Falls - interventions in place, documentation for at least 72 hours? Event notes complete Decubs - measure weekly, document thoroughly. Insulin Errors - biggie Coumadin Errors -biggie Restraints Antipsychotics Infection trends - enough equipment on hand in case isolation required. Ancillary staff knowledgeable regarding donning ppe Hospital readmissions esp MI, Pneumonia and CHF Medication errors Recerts done in a timely manner - nightmare for me. Set up a spreadsheet for recert times. Family issues Employee issues Inservices up-to-date? TBs up-to-date Licenses up-to-date One I am having serious problems with is wound identification on admission with a TREATMENT IN PLACE from day 1. Mine think the "next shift can do it". Remember, if it is not found in 24 hours, it is YOUR WOUND. Monitor the dining room. Are the residents actually being fed? Check their plates. Be sure meal documentation is being entered. BAD, BAD, BAD if it is not recorded when there is weight-loss involved. Are residents being turned. Heels floated? Enough staff to cover shifts? Check for yourself. Many times the staffing coordinator thinks the shift is covered when in fact, it is not. OMG and don't forget to make sure your QA meetings are up-to-date. Many times it is difficult to get the medical director in the bldg. Nag, nag, nag and document when you called if they are reluctant to come. Sorry this is so long, but I tried to be somewhat thorough.

I am sooooo sick of falls I could scream. I had 32 falls in a 77 bed facility last month. One resident fell oob so many times we put the mattress on the floor and she fell off that too! Caregivers cannot give good care with a resident on a mat on the floor. I believe the focus should be preventing injuries. If the intervention prevents injuries, shouldn't that be the point? If the resident rolls oob nightly onto the mat and is not injured, why count it as a fall? Problem solved to me. Ok, they roll oob bed nightly onto the mat but by george, there was no injury. Why continue to write that up as fall with never-ending paperwork if the intervention works. Our policy states a NEW intervention should be instituted with each and every fall. Well, try and think of 101 interventions. Half of them to me are mickey-mouse and retarded. Anyone else truly struggling with this or am I the only one going crazy over this? I truly think the focus should be on preventing INJURIES. I know I have an attitude tonite but I am sick of it. Just needed to rant a little!!!

Yes, we do. The nurses usually wait till around 6 am when the residents are 'rousing and some meds are being given. It is easier to assess the resident in bed. We do NOT have them do more than 2 skin assessments per day for any nurse.

I see what you mean with the DMPOA. I've found it depends on who the payor source is. If they are private pay, they are more likely to want to reduce the pharmacy bill vs. Medicaid residents' families who pay nothing out of pocket. So far, I've had good luck with those closest to 9 meds. I try to pick 2 residents a week. I will continue this.... Perhaps I should monitor the payor sources as an additional step just to see how that pans out regarding how many meds a resident gets.

What is a DMPOA - family? :-)

Do you work for a non-profit? I work for a for-profit and it's 10:1 on days, 13:1 on evenings and 20:1 on nights. Management will give me NO MORE. Period. End of discussion

We've just started our QA/PI. Others at the meeting were choosing the usual falls, staff retention, anti-psychotics etc. We've decided to take a different approach - residents with 9 or medications. Is anyone else using this as your QA/PI and if so, how are you approaching this? If you have already implemented this, how is it going? My AIM is to decrease the number of unnecessary medications to improve: Falls, Med Pass times, decrease our pharmacy expenses, decrease the pill burden for our residents and decrease adverse drug reactions. We are starting with the Pharmacy Review of Residents on 9 or more meds, starting with those closest to 9 meds vs those who are on like 26 meds. Just interested if anyone else is tackling this problem. I became interested in it when I saw my nurses doing nothing but passing meds. What measures are you tracking. I want to be thorough but not overwhelmed!