I just started my new job as a MDS nurse with this facility 3 weeks ago (Have 15 years MDS experience) and this morning I was called into the DON's office and given a written warning over a care plan that had not been changed to reflect this particular patient had had both legs amuptated back in September, so another MDS had been done since then AND another care plan, but was not updated to reflect this change, nor was a significant change in status done.
I signed it, stated I understood, and just went back to the office and cried. Maybe I'm making too much out of it, but I fail to see why it is my fault that this care plan had not been updated for 5 months.
I guess I just needed to vent. Moving on and trying to stay out of trouble.
Specializes in Clinical Documentation Specialist, LTC.
Because you were under duress
This is why you came to us - to help re-orient you to the appropriate action.
And I very much appreciate it. It really helped a lot to type it out. I will accept a write up gracefully if I know I am solely at fault, but it seems to me the nurses who missed it months ago should be held accountable as well. I don't wish anyone any trouble at all, but fair is fair you know?
Yes, I signed it like an idiot. I was basically told "It's your problem now. You inherited it." I do understand their logic. I really do. I just don't understand why it's just now an issue when it should have been addressed over 5 months ago.
They were two months behind when I started, and this particular MDS is just now due, so although I have only skimmed through the care plan, I have opened the MDS in the system and have interviewed the resident. I just don't understand how it wasn't care planned the day he came back from the hospital after having both legs amputated. The nurse who had him, the DON, the Unit Manager? Why wasn't a significant change done then by the other MDS nurse? Why wait all these months? I'm just trying to wrap my head around the reasoning.
Welcome to MDSLand....
As far as those legs being amputated, may or may not be a significant change- not enough info is at hand. (For instance- someone who hasn't walked in years or maybe is end stage of life?). But as far as it being careplanned or not- the day you walk in the door is the day you own that whole system. They have to blame 'someone', and the last MDS person isn't around to blame!... Nothing like walking into a SNF with a chaotic MDS and care plan mess, eh?
If they were 2 months behind to begin with, the expectation can't be that it is all caught up in a couple of days. Also sounds like you were in the process of working on this file. So unless you signed it off as completed, I am not sure why they would make such a huge deal about this. Did you sign the care plan?
Instead of re-hashing with the powers that be, I would most definetely have conversation about how to move forward with the priorities that the facility has in mind. I would think you can't complete a care plan without an interview or an assessment. Both of which you completed. However, if they don't want you to document until you have completed all the steps to the care plan, and document everything at once, they need to say that.
I am highly curious how this all came to light. Did administration do chart reviews for an upcoming audit or something? Seemingly, they didn't care enough to let this care plan go un noticed for 5 months, and who knows what messes you have encountered in the charts. But they need to tell you that. Then you can be more mindful of the fact that the charts are being audited, so each one needs to be completed same day.
Shady facility. You have a crappy DON on your hands. She should have caught that when she was doing her chart review, so she is the one who allowed the former RCM to screw up.
Specializes in Clinical Documentation Specialist, LTC.
Surveyors had just left a few days before I started and they got tagged on some care plans (otherwise a good survey) so the DON and unit managers have been auditing charts. Prior to the audits, the care plan hadn't been updated for six months and still addressed multiple wounds to the resident's lower extremities, which were obviously resolved post amputation. According to the care plan signature sheet, the care plan hadn't been reviewed by the IDT since August.
When I came on board and started getting them caught up they were two months behind with MDS in spite of having another MDS nurse. Her reason for not helping keep them updated until another MDS nurse was hired was she "didn't have time" because she "does Medicare." Out of 98 residents, there are only 8 part A right now which leaves 90 long term care (or Medicaid and Part B) residents. The capacity is 100. I used to do the Medicare Part A patients for another home and never had under 15 at one time, yet I was able to keep them current and help the other MDS nurse stay caught up. Anyway, as I am going through the charts and getting them caught up, I am finding care plans that have not been reviewed or updated since August, but not a thing has been done until now. I just can't understand why the other MDS nurse is not being held accountable in any way. She's been there for four years!
Another thing, since I am a LPN, the RN MDS nurse has to sign completion, but complains because she is having to sign them late. Really??? They should have been kept up to date in the first place, then that wouldn't be a problem! They had two pages full that were due two months ago! What does she expect??? The good news is, I am now caught up as of today. I have been working feverishly at it since the 17th of February and am finally caught up! (I spent from the 11th-14th in orientation).
Specializes in Clinical Documentation Specialist, LTC.
I just feel bad for you and the whole situation. I think you are being treated unfairly.
Thank you. My heart tells me it's unfair, but deep down I know there's not a thing I can do about it. They went straight from verbal corrective counseling to a category two written warning. I had never met the resident in my life, yet was expected to know everything about him.
Sounds like some game playing--so be mindful of this going forward. Instead of saying "your priority is the care plans, hence why we were dinged in surveying" they chose the passive aggressive route of "lets write her up so she will be so parinoid that she will get all of them done like yesterday!!"
That being said, just be really mindful that your priority may not be the faciities. I would be sure to follow up with the audited charts ie: "Are you finding that the charts are how you prefer them?" You have been at this gig for a long time. So you could probably do this in your sleep. I would not own up to a mistake that is not your own, however, go forward knowing that this facility keeps an MDS nurse who does little, that although the DON audits she makes no changes, and be careful as it is unclear what the motivation will be on any given day.
And make sure that you put your eyes on people--even if it is 20 people a day. That way you will know for sure that the care plan is up to date. I would not go off of the charting notes, as seemingly it is unclear if the care nurse puts her eyes on the patients either.
LTCNS, LPN
623 Posts
And I very much appreciate it. It really helped a lot to type it out. I will accept a write up gracefully if I know I am solely at fault, but it seems to me the nurses who missed it months ago should be held accountable as well. I don't wish anyone any trouble at all, but fair is fair you know?