Ah, spring (cleaning time!)
Jacqueline Vance, RNC, CDONA/LTC
Spring is in the air. Well, sort of. As this is being posted, I am looking at freshly fallen snow in Minnesota. But, I have the HOPE of spring! A time when all things can be made new.
Sometimes we get so stuck in the mud of winter, get so despondent that we forget that spring is right around the corner.
Of course, I am talking metaphorically. A meteorologist I'm not. And, frankly, don't want to be because I've got this control issue thing and I like to be right most of the time!
But often we forget that we can make changes — heck, even be the change.
There is so much that we do that doesn't make sense, wastes time, has nothing to do with the regulations. But we do it and get mired down in that mud.
Take, for example, neuro checks after an unwitnessed fall [even — gasp! — when the resident is cognitively intact and tells you they didn't hit their head.) The regs don't dictate that you have to do neuro checks and how often. But we have these archaic policies and procedures that say we need to do them every 15 minutes for so often, then hourly, then every four hours, etc.
In most cases, it just wastes time. No studies are available that demonstrate the usefulness of performing regular neuro checks in LTC settings. And there is no evidence that supports observing patients for a fixed period of time after a fall.
A “spring” thing to do would be to change to a process that is clinically relevant and doesn't waste time. Like routine monitoring/assessment and documentation (two times per shift post fall for three days), with increased mindfulness that the patient has recently fallen, and any signs and symptoms associated with a fall.
Things such as relevant post-fall clinical findings, like, maybe vital signs, pain, swelling, bruising and changes in function or cognitive status as well as the absence of significant findings, “pertinent negatives,” to demonstrate that the patient is being monitored appropriately.
So maybe some good spring cleaning would be to throw out some archaic principles and practices and other routine stuff that doesn't make a whole lot of sense. Just ask: Why are we doing this? And if all you hear are crickets, maybe it's time for a change!
Just keeping it real,
The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, an APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.