I am not sure about the chewing tobacco, we did explain our
concern to the one res. I had about his chewing, he now has a designated
spitting container, and has not made a recent mess, but may be asked not to do
it in the facility. I don't know if all states are the same, in Kansas, it
is a yearly physical, and the res. is to be seen at least every 90 days by the
doctor or nurse practitioner, and at least once yearly. If I were you I
would call and visit with your state RAI person and see what she says.
As far as thining out the medical records every 3 months, I
personally don't see a problem. Before you get to upset, let me
explain. I work in an intermediate facility, we do not do skilled care, so
many of our res. about 6 have been here for over 10 years. We have always
thinned out our charts every 3 months, if we didn't we would not be able to lift
our chart. I know that it makes it more work, but I just go to our medical
records office find the overflow chart, and look up what I need to do.
Know I am responsible for tracking the falls, psychotropic meds, consults, skin
breadown is kept indefinately in the chart, but we also have a seperate notebook
that keeps that data in also. I also do know when they are going to thin
out the charts, and what I do is look at who is coming up on my mds schedule,
and then look at the chart to see if there is something that I might need.
I am lucky, I only have 45 res that I am responsible for, so I can do this a
little more easily then some with 100. I get behind sometimes, and for an
compulseve type personality that bites.
I guess what I am saying is look at the whole picture, keep a
notebook to track down what you are doing, how long it takes to do what you are
doing, and then visit with the powers that be. If you don't have people
who are in your facility for very long, it maybe a hassel. Just my 2 cents
worth.
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?
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?
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.
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??
