-----Original Message-----
From: Holly Sox, RN, RAC-C [mailto:[EMAIL PROTECTED]
Sent: Thursday, November 06, 2003 1:09 PM
To: [EMAIL PROTECTED]
Subject: Survey Preparation run Amok
Hi Group!
I have a few questions for the group, all stemming from our survey prep
process, which (as the header states) has taken on a life of its own.
1) Our administrator (and his administrator guru who is helping us with this
process) asked me to find out if there is a regulatory requirement (either
federal or state) for annual physical exams. I have not heard of this. The
only requirement I have seen is that the "resident must be seen by a
physician at least once every 30 days for the first 90 days after admission
and at least once every 60 days thereafter."
So, to any of you folks who are more knowledgeable than I, is there any
requirement for an annual physical to be done, or is this just considered as
part of the every 60 days physician visits?
I'm from Maryland ans the State has their regs but we have our which is H/P
within 72 hrs of admission. As most of you know we all are getting sicker
and sicker people. Longer than 72 hrs put us at risk
2) We have a married couple who reside in a room together. These people are
as nice as they can be, but their hygiene and general cleanliness are very,
very poor. The husband chews tobacco and spits anywhere the mood strikes
him. He has some vision impairment, so it may be that he has difficulty
"aiming" for a particular container. They are very resistant to bathing and
get upset when housekeeper straightens their room or does any type of
cleaning.
We can deal with most of this, but the tobacco juice is becoming a real
hazard. We are worried that one of them (or an employee or other resident)
will slip and fall, and it is just nasty in general. Has anyone else faced
this situation? Can we require him to only chew tobacco outside the facility
(ie, the way we restrict smoking to certain outside areas)? Or can we
designate a container in his room and tell him that if he is unable to
confine his expectoration to that container he will not be allowed to chew?
Gosh, I thought we were the only one plagues with sightless, tobacco
spitting seniors. We even have carpeted rooms! We have made the tobacco
situation a interdiscipliary problem. We are a smokeless facility not a
tobacco free facility. yuck is an understatment.
3) (Last but certainly not least) My biggest concern is that today we were
informed that ALL records other than MDS will be thinned q 3 months. We are
going to have no information on the charts that is older than 3 months,
including physician progress notes, ancillary department notes, etc. The
only things that will be left longer than 3 months are the required 15
months MDS, the care plan, and rehab information.
We keep the original MDs the last full and Q even with thinning.
Care plans are kept in a separate folder for viewing of staff.
When I expressed my concern about this, I was immediatetly shot down. I
said that there are MDS items with a 6 month look back, and so how was I
supposed to know if there were falls 6 months ago, and 6 month wt loss, etc.
The answer was that there is a Falls log kept by the ADON, and I could get
my information from there. (Even though this is not part of the medical
record and there is no guarantee that all falls make it to the log.) Weight
records are kept in a weight book on the unit, and therefore I can get
weight information from the weight book.
I am pretty sure their minds are made up, but just wanted to ask what y'all
think of this. (Dolores???? ) I just don't see how taking everything off
the charts that quickly will be beneficial, and I can see all sorts of ways
for it to be harmful. Am I overreacting??
Thank you all, and have a great day.
Holly
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