RE: Survey Preparation run Amok

[Deanna J. Ogle]

Title: Message

My input is below in blue.   Deanna   -----Original Message----- From: Holly Sox, RN, RAC-C [mailto:[EMAIL PROTECTED] Sent: Thursday, November 06, 2003 10:09 AM 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 can't address that. It may be a state specific requirement.   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?    I agree with Brenda's suggestion to document and care plan all interventions that have been tried. Also, have you considered having him sign a contract that he will only spit in the designated container and what the consequences are of not following his agreement? If he is cognitively intact, that might help, especially if you have to go to the next step of only allowing him to chew outside or in a specific location. We did that a couple of years ago with one of our residents who had some behavioral issues and it worked for a while. It made it easier to go to the next steps and documented what steps were taken before more stringent restrictions were imposed.   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?? Thank you all, and have a great day.    Holly     Our charts are thinned but not on a blanket basis. We thin some areas and only leave the last 3 months in the active chart and other sections we leave 6 months in the chart. We thin the prog notes, telephone orders, med and treatment sheets and flow sheets to 3 months but we thin the labs and dietary to 6 months. We keep the most recent H&P and hospital info in the database section and the info from prior stay goes to the split chart. The thinned info is put into the split chart and medical records can pull it for us if we need it. We keep a log of all falls and other incidents for the facility and we can refer to that if needed. I also keep my prep sheets for completing my MDS's in a folder for a quarter so I can refer to events of the previous quarter if needed, esp. falls. It also helps if anyone has any questions about why I coded something on the MDS. I referred to them several times over the past few days when we had state MDS folks in for a case mix audit. We did very well, by the way. We also only keep the most recent MDS on the "official" chart in the rack. The others for the past 15 months are in binders at the nursing station, where they are available 24/7 for anyone who needs them. Our charts were getting so overloaded, especially with our folks who go back and forth to the hospital that we had some staff members with problems with shoulders and carpal tunnel from lifting the heavy, oversized charts in and out of the chart rack.   I hope this helps some.   Deanna J. Ogle, RN Care Manager St. Francis Extended Health Care 3121 Squalicum Pkwy Bellingham, WA 98225 (360)734-6760, ext. 322 [EMAIL PROTECTED]