Medical Care, Nursing, and Rehabilitation
Attending Physician <ul><li>A generalist or family practitioner in the community </li></ul><ul><li>Patient has the right t...
Unique Aspects of Medical Practice <ul><li>Physician visits are infrequent, but must comply with regulatory standards </li...
Medical Director <ul><li>Every facility must have one </li></ul><ul><li>A part-time position (2 to 4 hours per week in an ...
Areas of Special Focus in Geriatrics - 1 <ul><li>Comorbidities </li></ul><ul><li>Complications resulting from chronic dise...
  Areas of Special Focus in Geriatrics - 2 <ul><li>Hydration and nutrition </li></ul><ul><li>Possible impaired metabolism ...
Separation of Functions <ul><li>The consulting role of the medical director must be separate from his or her practice as t...
  Anti-kickback Legislation  <ul><li>Prohibits gifts or favors in exchange for patient referrals (see p. 143)  </li></ul><...
Medical Director Roles <ul><li>Oversight </li></ul><ul><li>Advisory </li></ul><ul><li>Teaching </li></ul><ul><li>Represent...
Organization of the Nursing Department Administrator Resident Assessment Coordinator Medical Director DON ADON Medical Rec...
Main Responsibilities of the DON <ul><li>Staffing </li></ul><ul><li>Training </li></ul><ul><li>Patient care </li></ul><ul>...
Ensuring Consistent Quality <ul><li>Develop policies, procedures, and practice guidelines </li></ul><ul><li>Use them for r...
Resident Assessment <ul><li>First step in the delivery of patient care </li></ul><ul><li>Serves two main purposes: </li></...
RAI <ul><li>Resident Assessment Instrument (RAI) </li></ul><ul><ul><li>Minimum Data Set (MDS) </li></ul></ul><ul><ul><li>R...
MDS <ul><li>Focuses on a core set of screening, clinical, and functional status elements </li></ul><ul><li>Triggers = risk...
Care Delivery Sequence <ul><li>Assessment  </li></ul><ul><li>Plan of care  </li></ul><ul><li>Delivery of care  </li></ul><...
Plan of Care <ul><li>Driven by assessment </li></ul><ul><li>Incorporates approaches for addressing problems and needs: </l...
Infection Control <ul><li>Goals: </li></ul><ul><li>To protect residents, staff, and visitors from contracting infections <...
Components of an Infection Control Program <ul><li>Policies and procedures </li></ul><ul><li>Screening </li></ul><ul><li>I...
Falls: Contributing Factors <ul><li>Intrinsic (medical) </li></ul><ul><ul><li>Effects of drugs </li></ul></ul><ul><ul><li>...
Fall Prevention <ul><li>Evaluate risk factors </li></ul><ul><li>Teach new residents how to safely navigate within the room...
Pressure Ulcers: Main Causes <ul><li>Sitting or lying in one position </li></ul><ul><li>Friction against the skin </li></u...
Pressure Ulcers: Predisposing Factors <ul><li>Neurological disease </li></ul><ul><li>Cardiovascular disease </li></ul>
Pressure Ulcer Prevention <ul><li>Proper nutrition and hydration </li></ul><ul><li>Proper bed-making </li></ul><ul><li>Pro...
Legal Use of Restraints <ul><li>To be used only when medically necessary </li></ul><ul><li>Use must be temporary </li></ul...
Managing Urinary Incontinence <ul><li>Focus should be on transient (reversible) causes such as UTI, delirium, pharmaceutic...
Pharmaceutical Management <ul><li>Consultation from a licensed pharmacist </li></ul><ul><li>State law governs dispensing a...
Reduction of Psychotropic Drug Use <ul><li>Use is governed by law (OBRA-87) </li></ul><ul><li>Specific conditions indicati...
Rehabilitation <ul><li>Main goals: </li></ul><ul><li>Restore or improve function </li></ul><ul><li>Maintain residual funct...
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Resident Care Powerpoint

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Resident Care Powerpoint

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