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Honey, it just keeps getting worse and worse.
Last Friday, after working 12 days straight, 8-9
hours every day, I was pulled to the floor to work from 230 until 7 pm. I
left some RAPs unfinished, with a note to the DON that they would be late
due to me working the floor. She called me at home on Sunday to lecture me on
integrity, and said that I should have stayed even later on Friday in order to
finish everything on time. oh yeah.
Her lecturing me on integrity is about like me
lecturing someone on Alpine skiing. It's just not even in her solar
system.
Ever seen The Lion King? Remember when
the hyenas are all saying "Mufasa" and shivering over and over?? That's
what I feel like just thinking about the place.
HS
----- Original Message -----
Sent: Thursday, February 19, 2004 6:32
PM
Subject: Re: Getting orders on care
plans
Sure are glad you're getting out of that place! No
wonder the care is so scary!
----- 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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