RE: Getting orders on care plans

[Onken, Julia]

Title: Message

Terri,

"failed to modify the careplan when there was a change in clinical condition/status". 

     I think the citation is probably more about failure to identify and trigger a significant change of status, rather than the fact that she was started on lasix.  It sound to me like there was a condition that the resident developed that required the use of a diuretic for treatment.   

     Here are some of the questions that I would ask myself:  "Is there a new diagnosis to support the use of the diuretic?"  "What happened to her health status prior to beginning the diuretic?"  "Is the fact that she is not consuming enough a change since her last asessment?"  "What needs to be accomplished by the staff related to the use of a diuretic...are labs being monitored...are fluids being encouraged....how does the staff know what needs to be done if the plan of care does not include these things?"

     Your challenges now are to determine what need to be done to correct the problem for this resident, and what process are you going to put in place to assure that it doesn't happen again? 

     As teh RAI coordinator, I meet with the unit staff on each unit on a weekly basis to go over the quarterly reviews of the care plans, etc.  At that time, we also discuss acute problems that have come up during the past week, note it on their plan of care and then discuss it again in a couple of weeks to be sure that it has resolved. 

I have considered the possiblity of an "Acute problem" care plan for each resident that identifies new, hopefully short term, problems with reviews approximately 2 weeks after noting the problem so that we can determine whether or not it is "easily reversible" and then determine the need for further assessment.  This seperate care plan would mean that the need to revise the entire plan of care for one problem woul no longer be necessary.

Just some thoughts,

Julia A. Onken, R.N.  LTC Nurse Manager

Goshen Care Center

2009 Laramie Street

Torrington, WY  82240

Phone (307) 532-4038  ex. 3044

Fax (307) 532-3800

 

   

-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of T Prit
Sent: Thursday, February 19, 2004 12:04 PM
To: [EMAIL PROTECTED]
Subject: RE: Getting orders on care plans

Holly:

The surveyor states that we "failed to modify the careplan when there was a change in clinical condition/status".  It turns out the woman did not consume enough and was at risk for dehydration and this was not careplanned along with the diuretic.  Also, it had been 2 months since the doctor wrote the order starting the diuretic.  I really only look at careplans quarterly when I do the MDSs.  So... how I try to resolve this problem?  Like I said before, the RN supervisors are having a fit because they don't have time and at this time I can understand because they are having to be pulled to the floor to push the med cart and do treatments.  They're even having to work midnights.  Of course, surveyors don't care about those things.  Terri

Holly McGran <[EMAIL PROTECTED]> wrote:

I have a question - was there more to the issue other than just not having the lasix on the RCP - my gosh you could literally rewrite your medication record - we only put meds on our RCP when they relate to a problem or create risk i.e psychotropic for behaviors or the risk they pose to falls. I will admit we have a lot of lasix on the RCP because it usually relates to edema which poses skin issues and also the impact it has on bladder continence and sometimes safety if they are trying to get to the BR.... but, could you elaborate on the deficiency a little more?
Holly McGran

> -----Original Message-----
> From: Wendy Connor [SMTP:[EMAIL PROTECTED]
> Sent: Thursday, February 19, 2004 12:48 PM
> To: [EMAIL PROTECTED]
> Subject: RE: Getting orders on care plans
>
> So when do the nurses actually look at the Care Plans. Our MDS Coordinators review the CP every Quarter. It is the responsibility of the staff nurses to up date the CP's between MDS'.
>
> -----Original Message-----
> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Richardson, Christine
> Sent: Thursday, February 19, 2004 12:42 PM
> To: [EMAIL PROTECTED]
> Subject: RE: Getting orders on care plans
>
>
> In our facility the MDS cord. gets copies of all the orders and its up to us to update the care plan
> CAR
>
> -----Original Message-----
> From: T Prit [mailto:[EMAIL PROTECTED]
> Sent: Thursday, February 19, 2004 11:38 AM
> To: [EMAIL PROTECTED]
> Subject: Getting orders on careplans
>
>
> Hey group: We recently had survey and we got a tag on careplan and assessment because the careplan was not updated due to the fact that a resident was started on a diuretic. The nurses say that they are not able to put new orders on the careplans at order times because they don't have enough time. The question is what do your facilities do to see that new orders are put on the careplan in a timely matter? Any suggestions are greatly appreciated. Terri
>
>
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