resident care powerpoint
TRANSCRIPT
Medical Care, Nursing, and
Rehabilitation
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
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
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
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
Areas of Special Focus in Geriatrics - 2
• Hydration and nutrition
• Possible impaired metabolism
• Loss of skin turgor
• Psychological disorders
• Palliative care
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
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
Medical Director Roles
• Oversight
• Advisory
• Teaching
• Representative
Organization of the Nursing Department
Administrator
Resident Assessment Coordinator
Medical Director
DON
ADONMedical Records
In-Service Director
Charge Nurses
CNAs Staff Nurses
Main Responsibilities of the DON
• Staffing
• Training
• Patient care
• Policy
• Administration
Ensuring Consistent Quality
• Develop policies, procedures, and practice guidelines
• Use them for reference and training
• Review and revise these protocols
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
RAI
Resident Assessment Instrument (RAI)– Minimum Data Set (MDS)– Resident Assessment Protocols (RAPs)– Utilization Guidelines
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
Care Delivery Sequence
Assessment
Plan of care
Delivery of care
Evaluation of outcomes
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
Infection Control
Goals:
• To protect residents, staff, and visitors from contracting infections
• Prevent the transmission of infection
Components of an Infection Control Program
• Policies and procedures
• Screening
• Infection control practices
• Surveillance
• Education
• Control of infectious outbreaks
Falls: Contributing Factors• Intrinsic (medical)
– Effects of drugs
– Cognitive impairment
– Visual impairment
– Frailty
• Extrinsic (environmental)– Poor lighting or glare
– Wet floors
– Loose objects
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
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
Pressure Ulcers: Predisposing Factors
• Neurological disease
• Cardiovascular disease
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
Legal Use of Restraints
• To be used only when medically necessary
• Use must be temporary
• Under physician orders
• Close supervision by nursing staff
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
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
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
Rehabilitation
Main goals:
1. Restore or improve function
2. Maintain residual function and prevent further decline
3. Enable adaptation to functional deficits