NurseMellie

That is certainly tricky. It may be both a stasis ulcer and a pressure ulcer. As Talino mentioned if there is no documentation for the previous MDS from the MD, and you have just based it on nursing judgement, it would be stasis.

I totally get the frustration piece. As RCM I have lots to juggle on my plate. I have been accused to being threatening to my staff when I have informed them of something they need to be doing or face the consequences. Most of the longer term staff u...

It is difficult to learn the MDS especially when the training is hit and miss. I often had those same types of days in the beginning of my training. I would be pulled to do an admit or work the floor so it was a bit difficult to put some of the thing...

You are covering a surgical site so is a surgical site, coding under nonsurgical would be inappropriate. You have to think of why you are doing the dressing.

Yes, it the 14day pays for days 15-30 of the day. There are graphs in the MDS manual that show what assessments pay for which days of the stay.

With a blood sugar of 75 some other intervention should most likely have been done. In most facilties that I am aware of a blood sugar less than 80 requires some kind of intervention and a follow up blood sugar check. Metformin is a long acting medic...

I have a blank calendar that I start with, I then pencil in the OBRAs which are the quarterly and annual assessments. So you have 92 days from the previous quarterly assessment to do another assessment and the follow up annual needs to be completed n...

Open the RAI manual and go to chapter 2 page 41. There is a list of what you need to remember. You have until day 8 to set your 5day ARD. You should be doing a 5 day atleast. If the resident stays less than 14 days you don't have to do an admission ...

I have a couple of different sources that I use. One is Point Click Care for our main charting system and then the Contracted Therapy's system. Between the two I set the dates. In your manual there should be a table that states when you can have your...

I have helped with passing narcs for some other nurses. It can be a pain yes, hopefully they are not working at the same time. Maybe the RCMs or MDS nurses can come help pass some of those narcotics, I know I would if needed. Many of these nurses fee...

You definitely want to address their risk of dehydration. A lot of the CAAs are redundant and repetitive but they often make you think about how to care plan an item.

I would do a 5day and discharge. You can code some of the things in the hospital before her admission. In coding some of the ADLs make sure you ask the staff very specific questions about how much assist they gave her so you get an accurate picture o...

Welcome to the nut house! A few resources are Home - Centers for Medicare & Medicaid Services, and Welcome to AANAC I think after you have probably 6 months of experience with the MDS, take a certification course if you can. You can take some of ...

I had on the job training for my position. Would I recommend courses or classes without some hands on? Maybe, Maybe not. It depends on how the classes are broken down. The ANAAC courses appear to be broken down in a way that you could start there and...

I do keep watch over the different sections; SS, dietary. It has been my experience that things don't always get marked like they should. I have had to do modifications based on others mistakes. Sometimes the CAAs are done before the CC not always, i...

Plus you have to look at the adl scores and depression scores. Those also go into determining your RUG score.

We have many separate areas that many of the DX go into for example HTN, that may be a health maintenance issue or it may even involve movement (dizziness). If the goal and intervention involve movement, I put it in the movement section or if it invo...

Documentation may be easy to come across with the skilled documentation since most of the notes include lung sounds, o2 etc. There is a big push atleast in my area to include the respiratory minutes since so many of our residents have COPD or other i...

It is definitely appreciated, I hope you said something to the staff or management bout the care you saw. Trust me it will brighten their day hearing it!

I think we all experience similar frustrations and feelings at some point in our careers. Sometimes what can help is just changing carts or units or shifts can help. When I've felt the same way you described, I usually asked for a change of scenery. ...

I'll be with you in a moment

If they are going for just a day or so, we use small envelopes that we write the meds on and what time. If they are going to be gone longer, we may send the card from the pharmacy depending on how many doses are needed. You can also use the pill boxe...

We have an admission check list we use. I look at the home medications that are sometimes listed, not always accurate though. I also look at the meds from the hospital. We have standard admission orders that we have received the OK from the MD to put...

I wouldn't recommend taking the position at this point in your career. As other posters have mentioned theres a huge responsibility level placed on your shoulders. Typically the MDS nurse makes more than some of the floor nurses, it depends on experi...

I work with lots of psych behaviors and this is a fairly common occurrence in my facility, we get a couple throughout the year. I have had only 2-3 cases where we sent them to the hospital to be detained. Most of the time, you give the aggressor a PR...