One timely topic that is both difficult to comprehend and discuss is drug diversion in long-term care. Long-term care leaders must have a solid system in place with policies and procedures, education, oversight and monitoring on an ongoing basis, as shift-to-shift counting alone will not suffice in identification of diversion.
It is critical to have a solid system for discharge planning that begins even before the resident is admitted to the facility. Individualized, resident-centered discharge planning will provide a solid system for quality transition and a crucial component of care at the preadmission assessment process.
Adequate preparation, communication of expectations and ongoing monitoring is certainly essential for our certified nursing assistants. Holding them accountable for their assignments, proper technique and interpersonal skills should be a given, yet many times nurses and managers will complain that over the years we have gone from the “nurse is in charge” to the “tail wagging the dog.”
Today more than ever, we hear about the importance of PROACTIVE approaches to prevent as many unfavorable events as possible. One of the key essential proactive approaches that we can implement is to PREPARE our charge nurses for success! There are times, when new nurses start their position that the orientation or teaching period is cut short because they are “doing just fine” and they are “needed” to take a shift by themselves.
Over the years, long-term care has seen many changes. The environment is entrenched with the need to understand the history and the reasons for all of the change! How does a new LTC professional keep their head above water while desperately attempting to maneuver the waves and rip tides?
CMS recently made changes to surveyor guidance on feeding tubes. Nursing homes must look at their policies, documentation and education practices in order to assess whether a feeding tube is appropriate.
Have you reviewed end-of-life care plans with your staff? The Centers for Medicare & Medicaid Services recently made changes to the surveyor guidance for End of Life in Appendix PP of the SOM. This was to provide clarification to nursing home surveyors when determining compliance with the regulatory requirements for End of Life.