----- Original Message -----
Sent: Thursday, February 19, 2004 5:32
PM
Subject: Re: Getting orders on care
plans
Kristen,
I agree with you 100%. At my first
facility, we got several citations for the same issues, as well as orders not
being followed. We instituted a check sheet that was required to be
completed for every new order, which included notifying the family, copy sent
to pharmacy, labs/diagnostics set up, and care plan addressed. We
inserviced all nurses about the care plans, and they did a really good job
with following through. The check mark for "addressed on care plan"
meant that either a care plan was already in place for this (ie, same
medication but different dose/times/etc, or a new recurrence of UTI in someone
with the hx) or that the nurse had added it to the cp.
At my current facility (for the next 15 days), we
have the culture that the care plans are the property of the MDS nurse. I am
supposed to follow all new orders (yeah, I just LOOOOOOOOOVE those pink
copies) and 24 hour report sheets and keep up with 118 care plans. I would be
willing to bet that not one licensed nurse on staff besides myself has ever
looked at a care plan in that facility.
Stay on the soapbox and preach it, Kristen.
Holly
----- Original Message -----
Sent: Thursday, February 19, 2004 12:55
PM
Subject: RE: Getting orders on care
plans
I
have been MDS Coordinator at this facility for 5 1/2 years. But, before I
came they had a policy of MDS coordinator getting copies of orders, and the
MDS Coordinator was the only one allowed to change the care plan. In my
opinion this was ridiculous!! Luckily, it changed before I came on, because
they got a deficiency because the MDS coordinator had a HUGE pile of order
slips which she hadn't had time to look at or care plan, she was also
several months behind on CP's and RAP's!! This is why they had changed this
process here. They ended up with >30 deficiencies. And I honestly feel, a
lot of this could have been prevented if they had just had charge nurses
update careplans. A sample of deficiencies: care plans not followed (how
could they be they weren't even accurate - who knew what to do??) Care
plans not updated. MDS not signed by RN coordinator. MDS not timely . . . I
could go on and on. This was in 1997. I strongly believe having a policy
that MDS coordinators are the only ones who update the CP's is setting
a facility up big time. OK I'll get off my soapbox now.
Kristen
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'.
In our facility the MDS cord. gets copies of all the orders and
its up to us to update the care plan
CAR
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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