Rehab needs to get a clue

[CapeCodMermaid]

This might be something of a vent, but I am very tired of rehab people thinking they are the be all and end all of skilled care. I have rehab staff interrupt the med nurses for a variety of reasons and get ***** if the nurse doesn't drop what they're doing.

We have rehab people walk down the hall and say to the nurse , who is in the middle of a med pass, that the lady in room 15 has leg pain. They then stroll away without even making sure the nurse has heard. THEN they complain that the nurse did nothing with the information.

Really? Do any of them have a clue about the concentration needed to pass meds to 20 residents who take an average of 15 meds each?? One break in that concentration and a huge med error could occur. Our rehab manager seems to enjoy trying to throw the nurse under the bus. He only backs down when I intervene. I think I've had enough of this.

[Galaxy1]

Yes, and it is worse when nurses report on nurses. Meanwhile you wonder why the eye drops are never even opened or last forever.

The rehab aide now thinks they know more than you. Too much knowledge just creates monsters.

[Galaxy1]

I had a physical therapist tell me all these problems with a resident and it was something that should have been called to the doctor. I asked the PT if she could call the doctor because she could explain it better and also because the information will get to the MD firsthand. She did call the doctor, that was great. But this almost never happens. Or PT wants to eval someone's walking ability and they come to me and say, "Ms. X wants to use the bathroom." If I were PT I would take them to the BR. Then PT wants to watch me take them to the BR! Hmmm, thats when I ask them to leave.

[Galaxy1]

I think the story is alot deeper than just a pain med.

[jalyc RN]

i have been very annoyed with interruptions during med pass, and I've started a paper sheet communication, for people to WRITE IT DOWN, because I'm sick and tired of "so-and-so needs butt cream".

Taking that a step further, keep a pad of small sticky notes on the med carts. If anyone needs to notify the nurse of somethig, they write it on that and stick it to the med sheet. The nurse then has a reminder that someone wants a pain med, a note to pass to the CNA to take so & so to the bathroom, or a note to keep for report.

The med pass is then NOT interrupted until the nurse is ready to look at it and it is more likely to have proper followup.

[mvm2]

It is happening all over the country and (surprise) the main reason being money from another census source.

With more and more seniors choosing to age in place LTC/nursing homes are scrounging around for other butts to put in those beds if you pardon the phrase.

Even the famous Mary Manning-Walsh home here in Manhattan now offers rehab: About Us - ArchCare at Mary Manning Walsh Home - ArchCare

I'm not surprised it's all about money and census. It just sometimes feel like you will be dealing with more problems and confussion when putting the two together. Though I guess being as I never worked at a place like that myself I could be wrong.

[CapeCodMermaid, RN]

Another day, another incident with rehab. There was no one available to do an eval. Four family members very angry that they'd been promised rehab.i told them if rehab coukdn't do an eval, the nursing staff could get a walker and assist their dad with ambulation. I called the rehab manager. He told me it was inappropriate I called him in front of them. If I hadn't they would have followed me into my office. The family was getting ready to take the man home. I thought it was good customer service to show them I ( the director of nursing) took their concern so seriously I called someone who could fix the situation. The family was very pleased it was resolved. I am over these prima donnas from that department.

[amoLucia]

I need to make a comment here on something that's related to this post but I'm sure may raise somebody's ire.

I AGREE 100% that med nurses should be able to complete their med passes as UN-interrupted as poss. However, if this is expected to occur, then med nurses need to exhibit a greater sense of attention to their med pass and NOT to extraneous activities on the unit. They can't have it both ways! There, I said it!!!! I really said it!!!

Here's where I'm going to get folk upset, and I don't mean to, but...... Has anyone else noticed that SOME (NOT ALL) med nurses just seem to have all the time in the world to leisurely pass meds??? All the while they chit-chat with the maint man, joke with the hskpg staff, run off to the kitchen to pick up a quick breakfast snack (and eat it during med pass), discuss the impending stormy weather with the dietician, etc etc.

Med pass time needs to be for med pass for all the obvious, serious reasons. But a lot of times, it's not always so because of the med nurses themselves. So to some, it does look like med nurses have the time. Hence the interruptions. Hey, if all med nurses aren't on the same page and take med pass seriously, then I can see how staff in other disciplines feel it's OK to interrupt. To me, the socializing contributes to the problem.

This has not been an isolated observation. I've seen it repeatedly. Usually it's the long-timers that are most responsible. Yes, they know their residents, so their med passes can go quickly. But it's like they got their blinders on to only pass their meds!

I know this thread started out for Rehab relations with nsg, but interruptions by all the disciplines and depts occur too. By management and administration also. I've been guilty myself, altho I try not to. I don't know to what degree my observation/concern impacts on you readers out there, but I suggest you take a close look at your med pass and see if it has any effect. Might I be right?

Just my observation...

[Bruce_Wayne, ASN, RN]

I work med/surg and I only had a limited experience with LTC/REhab but I never understood why there isn't more "prep" done in LTC for things like meds. For example if a patient is on the same meds everyday why not use a pillbox to organize the meds? Yes the nurse should check the meds and pt etc before giving it but just having it laid out in an organized matter would seem to help so much. Instead of having to spend so much time every gathering things together, pulling it out of omni/carots/pixis. What if you just did it once a week and then made prn changes to the draws from there.

Also as a few others have said if a patient is in rehab and can't get the pain medication they need to participate then that is a major problem. Others have commented that it's not feasible, but that still doesn't mean it's acceptable. Something somewhere has got to change. Bring in an extra nurse to do PRNs. Pie in the sky I know.

[sallyrnrrt, ADN, RN]

atta girl capecod, I like your style, the resident would be taken care of, and family happy, and saving the admission

[mellster, LPN]

I wish there was a way to fix long term care, but I know with the current state of things there is no simple answer.

[mellster, LPN]

Sorry-posted this on the wrong thread.

[txredheadnurse, BSN, RN]

I work med/surg and I only had a limited experience with LTC/REhab but I never understood why there isn't more "prep" done in LTC for things like meds. For example if a patient is on the same meds everyday why not use a pillbox to organize the meds? Yes the nurse should check the meds and pt etc before giving it but just having it laid out in an organized matter would seem to help so much. Instead of having to spend so much time every gathering things together, pulling it out of omni/carots/pixis. What if you just did it once a week and then made prn changes to the draws from there.

Also as a few others have said if a patient is in rehab and can't get the pain medication they need to participate then that is a major problem. Others have commented that it's not feasible, but that still doesn't mean it's acceptable. Something somewhere has got to change. Bring in an extra nurse to do PRNs. Pie in the sky I know.

The major reason meds can't be prepoured in a SNF is the regulations forbid it. There is a degree of assessment that should be happening during med pass so that meds can be withheld, PRNs offered etc. Also many patients during their skilled portion of admission have frequent medication changes.

As to why it can be difficult to always medicate for pain prior to rehab there can be a laundry list of reasons for not always being successful to medicate pre rehab to include residents themselves still being in the process of getting dressed, fed, toileted, etc. so that the med pass nurse has to either wait for them (which is very inefficient and results in more delays) or has to come back to them as the remainder of the pass permits. This is why rehab needs to work with nursing so that patients not requiring pain meds prior to therapy can go first and the other patients can be worked with after the med nurse has had a chance to medicate them.

PRN nurses sound wonderful but in reality if there is one cart for a hall (which is the norm for a 30 person hall) then two people working out of it is a recipe for disaster.