Resident re-education to call bell

[gabrielle76]

Hello fellow nurses!! Here is my post, i will try and keep it breif.

Background is, Im a RN supervisor working for a agency while attending school for my BSN and Masters. This is my weekend on and I have to say....im quit annoyed so ill try and not rant.

LTC facility, all LPNs (whilch is fine) i get a call to assess a resdient's right bruised leg. Resident is know for self transfers and turning off chair alarm so that she may do so unattended. Resident with know hx of "mild dementia" but could recall trying to transfer self but not if the bruise was caused by it or not. The bruise to shin lines up perfectly with residents metal frame on bed, and yada yada the I&A is filled out and completed.

Here is the thing, documented is that this person is aox2 with intermitten confusion. I wrote intervention and note that resident was reoriented to call bell and that she could express what the call bell was used for correctly. This facility (floor nurses) are trying to state that this facility does not allow reeducation of a person with "mild dementia" but then wrote in her careplan that resident is aox2 and could name staff,find her own room, recongnize family, ADLs all done alone, and make decisions for activities....but you cant write that you reeducated her on a call bell!!!! WTHeck.....i feel like im in lala land. I will agree that she does have some confusion, but how can you write all those other things and then not educate her!!! really....i must be missing something...im only agency here, so im waiting for there DON to get here tomorrow and I can try and get some answers about this.

They have a new RN here who redid my I&A!!! it was not handed in and completed it was waiting for that wings nurse to finish her part....but the RN told the wing nurse that she would redo it because of this education peice....UGHHHH

am i the only one that see's it cant be done both ways.....you have to educate!!!!

thanks for listening! feedback always welcome!

[Pompom]

If she redoes your documentation isn't that fraudlent charting on her part? I would leave my documentation as it is, if they don't like the truth it is time to change jobs.

[brigid22]

If she's able to figure out what her chair alarm is for, and is able to turn it off so that she can transfer unassisted, then you should be able to to re-educate her to her call light use.

On mild dementia, with alert and oriented x 2, in my experience, we have done call light re-teaching as an intervention. It doesn't always stick, but it's done and it's been an acceptable intervention.

And I think the only way that they could hand in the form with the new nurse doing the form would be to staple it to yours with your initial assessment. Otherwise, it crosses over into fraudulent charting and an assessment she didn't make.

[nerdtonurse?, BSN, RN]

While your equipment is probably different, what I've done with "escape artists" is tape the box to the back of the chair, and then tape over the button (or wrap it in kling). They may have to pick at tape for a few minutes to turn it off, but that increases the likelihood that someone will come in and notice. I've also put them in a chair at the nurse's station.

Regardless, I'd document like crazy, because when she falls and gets a closed head injury, you need to be covered. We didn't really have good tools for folks like this where I used to work -- we'd put them in chairs at the nurse's station, and the unit secretary wouldn't get anything done all shift because they'd be running over to the pt's chair every 5 minutes getting them to sit back down, stop picking at the IV, put their gown back on, etc. Now in ICU, I have vent protocols, and safe treatment protocols so I can keep the pts from injuring themselves. It doesn't keep the demented patients from screaming down the house and keeping everyone else awake, unfortunately.