Treatment supply storage

[Apentti]

I work in a LTC facility (SNF) and have been working on getting locked treatment cabinets in each patients room for improved accessibility to supplies for bedside treatment. I had everything ordered and ready to proceed, when a new nurse consultant stepped in and put a stop to the whole project. She claims locked cabinets in patients rooms are a violation of CMS regulations, but couldn't cite why or give any evidence of this. All she could come up with is that the patients could jimmy or break the locks and tamper with supplies. What?!? Does anyone know the actual guidelines in place for storage of treatment supplies in a SNF? I really can't see any reason having locked cabinets could be a violation. Hospitals have them, other SNFs I've worked in have them. Any input is appreciated so I can effectively oppose this.

[klone, MSN, RN]

I would request that she cite what she is saying. Per CMS, if there are medication supplies in a patient room, they MUST be locked.

[MunoRN, RN]

CMS doesn't prohibit patient supplies from being in the room, they also allow medications to be kept in the room although they must be secured depending on the medication and the setting, although they do specifically allow some medications to be kept at the bedside such as inhalers, creams, etc.

[JKL33]

It is very possibly more an issue of not wanting to have all that inventory out in rooms, which may or may not be used in any given room. Those kinds of cabinets tend to accumulate things and may eventually contribute to waste of supplies - - or so I've been told. They tend to be stocked irregularly and with little regard for what belongs in there and what doesn't. Then there is the issue of things expiring and yet hanging around in cabinets for another year or two.

Perhaps you could talk with this individual and let him/her know that there is no CMS regulation that prohibits this and then see if there is another reason for concern. If it has to do with any of what I wrote above, it's easy enough to make a standard plan for what will (and won't) be kept in the cabinets and who is responsible for stocking them and checking them for outdates, etc.

[Apentti]

Thank you for your input. The plan was to store items specifically ordered for and billed to patients such as wound care dressings, topical agents containing medications, topical prescriptions. Only the nurses would have access. And I would monitor the usage for effectiveness appropriateness and avoiding waste

[JKL33]

It sounds like a good plan! Do you think someone decided against the financial layout for the cabinets themselves?

[amoLucia]

Some years ago, I remember a similar problem in my NH/SNF. We were suddenly prohibited from storing quantity supplies in pt rooms. Had something to do with the concept that the room was the PT'S HOME and that storing FACILTY equip in the PT'S HOME for the convenience of the FACILITY was inappropriate. It was taking up valuable 'real estate' room that normally would be avail for each pt in his little facility space.

We were dedicating the open top shelf of the pt closet for supplies and the State put a stop to it. That top shelf did open up extra storage space esp for the cognitive long-term resident who had all their personal items to store. We had GT stuff and wound care stuff and didn't seem to have a problem with it.

It makes sense to me that I personally wouldn't want my municipal Township to park its snow plow in my driveway.

Residents are paying for the space in their HOMES so they shouldn't be required to 'donate' space. that was kind of the understanding that we had at that time.

[Apentti]

Interesting. My argument to that would be that these supplies (tube feeding, wound care, prescription items) are there property. I guess in your case, I would try to come up with some sort of consent/refusal form to have the residents decide if they want to allow in room storage.

[Apentti]

No, all the supplies are already purchased and sitting in storage in the maintenance department with staff time budgeted in for installation.

[amoLucia]

State felt that a home environment TRUMPED facility convenience. It was their HOME. Signing a consent was not an option. Pts could be considered as having been 'gently coerced into'. And then there'd be competency issues and POA issues.

What about something that was already BILLED in ADVANCE but not used? Happens all the time when GT formulas and wound care supplies and other orders are changed. Items discarded/lost because of expiration, contamination, or theft, or change would have to be replaced. At best, that could be considered wasteful and EXPEN$$IVE. I'd worry about 'private pay' complaints. And then that might be thought to be 'double dipping' and considered a Medicare/'caid/insurance scam.

I'm playing 'devil's advocate', but in hindsight, I support the position that lets the residents have their space. As I remained longer and longer in LTC, I became more & more a Resident Advocate. They have so little independent input into their institutionalization.

Itty Bitty Nursing Home is the resident's HOME. To YOU, it's just your workplace, and at the end of the day, you get to leave and go home to your home. And you put your stuff away in the space you have.

[Apentti]

What state are you in?

As far as billing in advance and not completely using a product due to order changes, I always send unopened unused product back to the pharmacy or supplier for reimbursement. And I was told that as long as the product is sealed, it can be removed from the resident room and put back into general supply. Perhaps I'm wrong.

I'm in Wisconsin and if Wisconsin regulations say we can't yhen I won't, I would just like to see the actual guidelines stating so in order to know what I should be doing.