|
Quite honestly, Lisa, I think it would be worse at
this point. The nurses and CNAs in this facility have had no actual
leadership in so long, that they all just do whatever they want right now
anyway. I think that if we were to put the problem to them in this way,
one of 2 things would happen:
1) They would insist that there is no problem,
because "We have never gotten cited for this before"
2) It would immediately dissolve into a (very
loud) chorus of "There goes management again, expecting us to solve everything
for them"
You know how some kids get when they have never had
boundaries? They push everything, and interpret any negotiation as a sign
of weakness? That's what this staff is like at times. And I really
believe that what we/they need is a strong, fair, consistent leader with clear
expectations and rational consequences.
It's just figuring out how to get there that is so
tough.
HS
----- Original Message -----
Sent: Monday, April 05, 2004 11:05
PM
Subject: Re: ?Regulation re Shift Change
MAR Review
Holly,
Have you tried taking it back to your nurses?
Get them together and explain the issue and then ask-how do
you guys propose that we can fix this problem?- they are the ones who need to
be more responsible-give them the problem and expect them to come to a
conclusion on how to fix it.
Most times, I find that if I figure out a solution they will
find ways to gripe and complain about it-so, turn it on them to figure out and
fix.
Just an idea.
Lisa
----- Original Message -----
Sent: Monday, April 05, 2004 6:44
PM
Subject: Re: ?Regulation re Shift
Change MAR Review
As most of you are aware, my facility has come
through some unreal difficulties recently. I believe we are on the
right path, and this administrator really seems to want to make the right
things better.
We have had an abysmal record with our pharmacy
reviews, and the administrator, pharmacists and I spent 2 hours this am
brainstorming ways to improve our compliance. One of the biggest issues is
holes on the MAR and documentation errors. What he is proposing
is a shift-to-shift compliance check off that will involve the
oncoming nurse going thru the MAR books to check for any holes or missing
PRN documentation, prior to accepting the keys. Hopefully, this will reduce
(or eliminate???) the problem. We do have some good nurses, but a
culture of mediocrity and half-arsed compliance has developed. It's a hard
attitude to overcome, but I am one determined nurse manager.
Wish me luck.
HS
----- Original Message -----
Sent: Monday, April 05, 2004 3:25
PM
Subject: RE: ?Regulation re Shift
Change MAR Review
There is no regulation in regard to this
policy. It is overkill and the administrator is stomping on
standards of practice. His he or she going to require a witness as
you perform each task to ensure it is complete and have the witness sign
off on it? What prompted the policy?
If your administrator claims to be quoting
a reg, it would be reasonable to cite the reference in the policy. Ask
the Admin for the exact reference.
Nathan
----- Original Message -----
Sent: Monday, April 05, 2004
11:27 AM
Subject: RE: ?Regulation re Shift
Change MAR Review
I don't think that there is a federal reg like that. Look at
F333, under "Determining Medication Error" (pp-135.4 in the 2003 Pink
Book). If he is concerned with the number of "blanks" on the MAR, it
specifically addresses blank spaces.
Okay, Gang,
Help me out again, please. My
administrator has brought me a draft policy regarding requirements
for shift change MAR review and accountability. He quoted a
regulation as follows, but is uncertain as to where this is located.
"At each shift change, there shall be a
documented review of the MARs by outgoing staff members that they
have properly administered medications in accordance with orders by
physician or other authorized health care providers and have
documented the administrations. Errors/omissions indicated on the
MARs shall be addressed and corrective action taken at the time. The
director of nursing shall be notified and other persons as set forth
in the policies."
Is this from Certification Regs?
Licensing? His imagination??
Thank you in advance.
HS
Holly F. Sox, RN, RAC-C
Clinical
Editor
This message is intended for the sole use of
the individual to whom it is addressed, and may contain information that
is privileged, confidential and exempt from disclosure under applicable
law. If you are not the addressee you are hereby notified that you may not
use, copy, disclose, or distribute to anyone the message or any
information contained in the message. If you have received this message in
error, please immediately advise the sender by reply email and delete this
message.
|
