1. Plan of Correction CNA NCU 2014

2. 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.

3. 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.

4. 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.

5. 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

6. 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

7. 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

8. 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.

9. 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.

10. 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

11. 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

12. Thank You