Plan of Correction CNA NCU 2014

Objectives At the completion of this presentation the staff will be able to: Verbalize how often restraint reduction is completed. State the degree that the head of the bed should be elevated. Identify who is responsible for hourly rounding of HOB evaluation. State when to call the MET team State when to call a code.

Restraint Reduction Before implementing restraints, alternative methods must be attempted and documented in the residents plan of care and on the restraint assessment prior to implementation of restraints. The physician will obtain informed consent from the resident or resident representative. The RN/LVN will obtain a physician order for the appropriate type of restraint and the timeframes for use and release Restraint use will be reflected in the resident’s plan of care.

Restraint Reduction A restraint reduction attempts will be completed on all residents who are physically restrained. The attempts to reduce physical restraints use will be completed on a quarterly basis. Documentation of the restraint reduction attempt will be done on the Physical Restraint Assessment form and on the Subacute Interdisciplinary Team (IDT) Conference Meeting form. The Social Workers will complete a weekly audit using the Physical Restraint Log.

GI & Head of Bed (HOB) When resident is receiving Continuous Enteral Feeding Via G or J Tube: Place resident in a high-Fowler’s position elevating the head of the bed at least 30-45 This will prevent pulmonary aspiration. NOTE: The head of the bed may be flat during direct resident care. Examples include, but are not limited to: turning, bathing, incontinent care, and treatment administration

HOB Monitoring Hourly rounds will be made on all residents to ensure that all head of the beds are elevated. Make sure that the bed height is at the lowest level when checking the head of bed elevation. You will know that the head of the bed is at the proper angle by noting the mark on the wall at the head of the bed. Bed Lowest Level

HOB Monitoring All staff will be responsible for documenting hourly HOB rounds TIME DATE: NOC SHIFT 2400 0100 0200 0300 0400 0500 0600 DAY SHIFT 0700 0800 0900 1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000 2100 2200 2300

Routine Medical Changes/Need to Alter Treatment Significantly The nurse in charge is responsible for notification of physician and family or legal representative prior to end of assigned shift when a change in a resident’s condition is noted Document resident change of condition and response in Nursing Progress Notes, on 24-Hour Report and update resident care plan as indicated. All nursing actions will be documented in the licensed progress notes as soon as possible, including assessment, notifications, actions taken and resident’s response. A minor change in physical, mental or psychosocial status with the potential need to discontinue an existing form of treatment or to commence a new form of treatment. All signs and symptoms of the condition change will be communicated to the physician promptly.

Routine Medical Changes/Need to Alter Treatment Significantly The nurse in charge is responsible for notification of physician and family or legal representative prior to end of assigned shift when a change in a resident’s condition is noted Document resident change of condition and response in Nursing Progress Notes, on 24-Hour Report and update resident care plan as indicated. All nursing actions will be documented in the licensed progress notes as soon as possible, including assessment, notifications, actions taken and resident’s response. A minor change in physical, mental or psychosocial status with the potential need to discontinue an existing form of treatment or to commence a new form of treatment. All signs and symptoms of the condition change will be communicated to the physician promptly.

When to Call the MET Team Respiratory distress, threatened airway, change in breathing pattern Acute change in systolic blood pressure less than 90 mmHg Acute change in heart rate less than 50 bpm or greater than 120 bpm Acute increase in oxygen demand or acute change in level of consciousness Failure to respond to treatment

When to Call a Code Blue When a resident is found in a life threatening situation (examples: on-responsive, no respirations, no pulse, etc) a Code Blue is called. The Code Blue is called by dialing 3000 Basic Life Support (CPR) is immediately initiated CPR continues until further help arrives Assist the Code Blue team as needed

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