Thank you Shellie, and also everyone else who has responded on
this one. I think part of my pique was related to feeling shot down and as
though my concerns were completely irrelevant. After calming down, I can
see it that way. It's just frustrating to be responsible for 118 residents
in 2 different buildings, 15-20 medicare census and also coordinating admissions
process... then changes get made that make it just a little more difficult for
me to do my job.
Oh well, however nice it would be if the world revolved around
me, it is not to be so.
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??
