standards of practice

RNPATL, DNP, RN · Dec 28, 2004

I'm currently reviewing some of our policies. Some basic nursing skills are being reviewed and I am finding discrepancies between nurses. for example. Our current policy on IM administration does not say anything about limiting the amount of med injected i.e. 3ml limit. In nursing school, I was taught that you can only give 3ml per injection. So, if giving Rocephin and it is reconstituted to 5ml, we had to give it in 2 shots. I graduated in 1987 and some of the nurses that graduated near me agree with this but the more recent grads said they never heard that. Any opinions? Also, does anyone know where I could locate "Standards of Practice". I perform risk management for the facility also and need some guidance for Standards of Practice. I was informed that if a Resident falls, you need to assess the Resident, including vital signs every shift for 3 days. What do others do?
Thanks in advance

I certainly agree with the 3cc limit for IM injections. Anymore than 3cc can be and is very painful for the patient. In relationship to standards of care, it might be helpful for you to look at your State's regulations relating to falls, weight loss, etc ..... from what I remember, the facility must follow its own policy in relationship to falls. For example, if your policy states that you will assess neuro and vital signs for 72 hours post a fall, then that is the standard you are held to. I am not certain that the regulations actually define this. I do know that most States define their standards by stating that the facility "provides care that is reasonable give the resident's overall condition." By reasonable, the State leaves it open for a surveyors opinion. So, my advice to you is to review your policies and make sure your nurses and aides are following them. In addition, I would speak to other Director's of Nursing from your area and ask them what their standards are in relationship to falls, weight loss, etc and try to match as this would indeed represent a community standard.

Hope this helps.

Antikigirl, ASN, RN · Dec 29, 2004

At our facility we put falls on 'alert charting', which is vital signs q shift and a general notation in charts q shifts about pain levels and activities. However, I work in assisted living, so caregivers do much of this work, and a nurse oversees when there is a probelm.

And boy the paperwork! Seems like more goes into the paperwork to prove we did something than actually doing something! We have the IR of course, which is very long. Then we mark in a log the fall and if there was injury so we can track falls. The the nurse does an initial assessment with charting, then we must call the family, fax the doctor, and write any injuries to look for such as skin tears on the MAR for caregivers to monitor and alert the LN (we write parameters like 'alert LN if any increase in redness, swelling, drainage, or pain.).

At the end of each shift us nurses go to every service area and check the charting to make sure that the 'alert charting' has been done, and that implementations are being done (ie, a look to see if their pain meds are working...many times I find they aren't via the notes...then I have to fax MD, try to solve all this with maybe 20 minutes left of shift...LOL! Yeah, I never get out on time!).

As far as injections..I tend to remember that 3mL limit and think that is a good way to go (although a patient may not till you explain why!). I haven't had to give over 3mL in a long long time...so this is a great reminder!