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Resident Care Powerpoint

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Transcript

  • 1. Medical Care, Nursing, and Rehabilitation
  • 2. Attending Physician
    • A generalist or family practitioner in the community
    • Patient has the right to choose his or her attending physician
    • But, the physician must agree to deliver care and to comply with regulatory standards and the facility’s policies
  • 3. Unique Aspects of Medical Practice
    • Physician visits are infrequent, but must comply with regulatory standards
    • Nurses render most of the care in accordance with physicians’ orders
    • Shared communication and collaboration between physicians and nurses
    • Physician is involved in multidisciplinary teamwork
    • Referral to specialized services when needed
  • 4. Medical Director
    • Every facility must have one
    • A part-time position (2 to 4 hours per week in an average size facility)
    • Reports to the administrator
    • Key personal traits
    • Knowledge of geriatrics
  • 5. Areas of Special Focus in Geriatrics - 1
    • Comorbidities
    • Complications resulting from chronic diseases
    • Negative drug interactions
    • Response to treatment may vary from that in younger patients
    • Separating treatable symptoms from changes that commonly accompany aging
  • 6. Areas of Special Focus in Geriatrics - 2
    • Hydration and nutrition
    • Possible impaired metabolism
    • Loss of skin turgor
    • Psychological disorders
    • Palliative care
  • 7. Separation of Functions
    • The consulting role of the medical director must be separate from his or her practice as the attending physician even though the latter provides important insights into patient care
  • 8. Anti-kickback Legislation
    • Prohibits gifts or favors in exchange for patient referrals (see p. 143)
    • Particularly when the medical director attends to a large number of patients in the facility, patient referrals by the facility may be construed as a favor in exchange for consultancy fees
  • 9. Medical Director Roles
    • Oversight
    • Advisory
    • Teaching
    • Representative
  • 10. Organization of the Nursing Department Administrator Resident Assessment Coordinator Medical Director DON ADON Medical Records In-Service Director Charge Nurses CNAs Staff Nurses
  • 11. Main Responsibilities of the DON
    • Staffing
    • Training
    • Patient care
    • Policy
    • Administration
  • 12. Ensuring Consistent Quality
    • Develop policies, procedures, and practice guidelines
    • Use them for reference and training
    • Review and revise these protocols
  • 13. Resident Assessment
    • First step in the delivery of patient care
    • Serves two main purposes:
      • Evaluate each individual patient’s strengths and needs
      • Track important changes in the patient’s condition
    • Multidisciplinary
    • To be completed or coordinated by an RN
  • 14. RAI
    • Resident Assessment Instrument (RAI)
      • Minimum Data Set (MDS)
      • Resident Assessment Protocols (RAPs)
      • Utilization Guidelines
  • 15. MDS
    • Focuses on a core set of screening, clinical, and functional status elements
    • Triggers = risk factors
    • Revealed during the assessment process
    • Triggers call for additional review and assessment using RAPs
  • 16. Care Delivery Sequence
    • Assessment
    • Plan of care
    • Delivery of care
    • Evaluation of outcomes
  • 17. Plan of Care
    • Driven by assessment
    • Incorporates approaches for addressing problems and needs:
      • what the resident can do
      • potential for improvement
      • action and interventions from staff
    • Progress goals
  • 18. Infection Control
    • Goals:
    • To protect residents, staff, and visitors from contracting infections
    • Prevent the transmission of infection
  • 19. Components of an Infection Control Program
    • Policies and procedures
    • Screening
    • Infection control practices
    • Surveillance
    • Education
    • Control of infectious outbreaks
  • 20. Falls: Contributing Factors
    • Intrinsic (medical)
      • Effects of drugs
      • Cognitive impairment
      • Visual impairment
      • Frailty
    • Extrinsic (environmental)
      • Poor lighting or glare
      • Wet floors
      • Loose objects
  • 21. Fall Prevention
    • Evaluate risk factors
    • Teach new residents how to safely navigate within the room
    • Strength training and transfer skills
    • Nursing supervision and monitoring
    • Drug management
    • Environmental safety
    • Focus on chronic fallers
  • 22. Pressure Ulcers: Main Causes
    • Sitting or lying in one position
    • Friction against the skin
    • Prolonged exposure to moisture, such as from urine or feces
    • Poor caloric and protein intake
  • 23. Pressure Ulcers: Predisposing Factors
    • Neurological disease
    • Cardiovascular disease
  • 24. Pressure Ulcer Prevention
    • Proper nutrition and hydration
    • Proper bed-making
    • Proper patient positioning and repositioning at least every two hours
    • Pressure relief
    • Keep the patient clean and dry
    • Skin inspection and care
    • Mobility
  • 25. Legal Use of Restraints
    • To be used only when medically necessary
    • Use must be temporary
    • Under physician orders
    • Close supervision by nursing staff
  • 26. Managing Urinary Incontinence
    • Focus should be on transient (reversible) causes such as UTI, delirium, pharmaceuticals, etc., and more serious conditions such as bladder cancer
    • Treatment of underlying causes
    • Voiding schedules, staff assistance, exercises
    • Catheters to be used only when other measures have failed
  • 27. Pharmaceutical Management
    • Consultation from a licensed pharmacist
    • State law governs dispensing and labeling
    • Locked storage
    • Among other oversight functions, monthly review of each patient’s drug regimen
    • Negative drug responses
    • Emergency medication kit
    • Safeguarding of controlled substances
  • 28. Reduction of Psychotropic Drug Use
    • Use is governed by law (OBRA-87)
    • Specific conditions indicating use must be documented
    • Gradual dose reduction whenever appropriate
    • Evaluation of underlying causes for behavioral problems
    • Nonpharmacologic approaches must be tried first
  • 29. Rehabilitation
    • Main goals:
    • Restore or improve function
    • Maintain residual function and prevent further decline
    • Enable adaptation to functional deficits