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Hand-in-Hand Teaching Guide to key in Arkansas Department Of Human Services Long Term Care Application For Assistance 2008 Form

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Arkansas Department Of Human Services Long Term Care Application For Assistance 2008 Form Demand Assistance

hello my name is Maria Welsh and I'm the.corporate vice president and Morningside.ministries for community and corporate.education and I also work with mmm learn.org and that's who is providing this.presentation for you today.we talked about survey readiness when we.work in long term care and I want you to.know that survey readiness should be.everyday readiness is what we ought to.be calling it I'm a real realist I want.you to know I've been in the field for a.long time and I understand how hard an.industry it is that we work in so the.program that I'm going to give you today.I hope is very real-world and very.meaningful I know that when surveyors.come in the house we get very nervous.and I know that we get very uptight.because it does have a great impact on.us and on all of the staff but I want.you to know that what we should be doing.is just basic common sense on most.things that we just need to be looking.at making sure that we're taking care of.it so this is a very quick I want to.kind of walk you through your facility.and help you look for things to make.sure that you're not getting.deficiencies for things that just don't.make sense that they're very simple but.very important and meaningful things so.I'm going to start with just a brief.brief walk with you one of them I want.to talk about is an infection control.issue and these are some of the things.as a consultant and as I've worked in.different facilities throughout my years.of things that I always pick up on and.one is an ice chest that has the scoop.inside the ice okay we know immediately.that's going to be an infection control.deficiency any water that is in a.picture on a med cart must be dated must.have the time that the water was put in.it and the initials of the person that.prepared the water and this is just for.a regular med pass so make sure that.that's being done sharps containers.these are infection control these are.OSHA hazards when they hit the line for.the number of needles they need to be.changed so watch those sharps containers.all the times do you know that you have.only a certain number of inches from the.roof where you can have boxes and almost.all of us put red tape up all the way.around but we don't always tell.employees that we can't have things too.close to the sprinkler heads so we have.a distance that has to be maintained and.if you're in a different state I want.you to check your own rate.lesions on this but I want you to be.very careful that we never have things.over the level of where you should mark.off the piece of red tape or no items.above this line break oh refrigerators.have to have a temp log on them if they.have employee items in the fridge and.even for I'm sorry for all refrigerators.let me take that back have to have a.temp log on them even employee.refrigerators should have that for our.own safety but for sure for the.residents it must be checked every day.and signed off with what was the.temperature not just a signature but.what was the temp want to think about.any irrigating equipment any saline in a.room anything like this has to be dated.once it's open it has to be dated should.think about you if you have some people.call them crash cart to your emergency.carts AEDs now are required to be.checked we want you to have a log to do.that make sure when you're walking.through that that log is just updated.and done never machines when we have.nebulizer machines at the bedside we.know that any equipment with that if we.have a mask a cannula anything that's.there that deals with oxygen has to be.kept in a bag labeled with the person's.name the date that it was changed.especially maybe put in just a little.piece of tape around it on the date that.the tubing was changed and initialed and.the time that that was done we want to.look at every closet no closet can have.any things stored directly on the floor.boxes must be up off the floor so we.might have pallets or you might have.plastic little pallets that you use but.you can't have boxes directly on the.floor and people do that all the time.it's one of the most common things that.I see all personal items of a resident.has to be labeled with their name the.room number preferably and then again.just make sure that the toothbrush has.the person's name on it I walk through.one room sometimes and I see a.toothbrush laying on the sink and.there's two people in the room I don't.know whose toothbrush that is we want to.make sure that all of our trash.containers don't have.anything overflowing and that every.restroom that we have has plenty of.paper towels an adequate amount of soap.easy to walk in and check that you can't.have items lined up on both sides of the.hallway we have to make sure that we.have a good exit in the event of a fire.so we need to make sure that a linen.cart if it's out a bucket if it's out.the med cart a machine for blood.pressure take anything that you have.should be on one side of the hallway.this is good information for a new.employee who's just come to long-term.care for the first time if you have.isolation precautions and you have the.equipment outside the room with gowns.gloves masks all that the room still.must have a sign on the door that.reflects that their isolation.precautions and to see the nurse at the.front desk before entering the room.shower chairs wheelchairs any items that.residents are using have to be clean.clean clean when I go through and I see.mesh on a shower chair and there's.mildew on it I have to tell you that is.an infection control first of all just.plain ugly but it's an infection control.hazard wheelchairs cannot have food on.them they can't have strings in the.wheels walkers are the same thing for.people they need to be cleaned and I.know this is hard to get done but it's.an infection control hazard and a safety.hazard to have threads in the wheels so.let's talk about never seeing linens on.the floor this is a training issue for.people linen can never be placed on the.floor.under any situation if there's oxygen in.a room there has to be a sign that there.is oxygen going on in that room that.there is oxygen and to use caution for.oxygen let's talk for a minute about.oxygen tanks oxygen tanks all have to be.stored separately if they're full or.they're empty and have to be.appropriately marked and I hope this.slide helps you a little bit with that.if it's a single cylinder it must still.be contained or chained to a wall all of.you have different ways of doing this.but you can't have a loose oxygen tank.that's like a torpedo.another thing about oxygen tanks.that you need to make sure that these.are not left out and about in a room I.recently was walking through a facility.and saw in a restorative a rehab area an.oxygen tank in there but no sign that.there was oxygen in the room so it.doesn't matter where the oxygen goes the.room has to have a signage that there is.oxygen going on let's see what else I.can share with you.hydration cards oh my gosh for some.reason people don't think hydration.cards need to be cleaned daily these.really need to be scrubbed down because.that is a major infection control hazard.microwaves are the same thing the.interior of a microwave must be cleaned.ice-chest you should have a routine for.how is the ice being taken out how is it.being cleaned and this is done on your.individual facility protocol who would.think about blood pressure cuffs as.being infection control hazards but they.are we know that we don't take a blood.pressure cuff into an isolation room but.on the other hand I see blood pressure.cuffs that are attached to machines that.are filled with lint and they're not.clean they need to be replaced those are.very very most often we can wipe some.down but after they're all filled with.lint you don't have a good attachment.infection control hazard car lights have.to be with a resident at all times.within their reach and many people.forget and don't know in long-term care.even if someone is in a comatose state.they still must have a call light within.reach they must have their water unless.they are on fluid restrictions available.to them it needs to be fresh their water.container should have their name on it.and we should know when it was changed.out people should be offered whether.they want ice water just fresh water but.it must be within reach of the resident.at all times and we're always talking.about hydrating our residents so we want.you to make sure that we've done that.oxygen concentrators require signage as.well that there's oxygen in the room and.if you have an oxygen concentrator that.has filters that have to be changed the.little spongy filters you need to have a.protocol in place for that it's one of.the first things surveyors look for.because you are.setting someone up for infection this is.an infection control hazard and that's.the tag that you're going to take that.on supply room again even though it's a.supply room no boxes on the floor.overhead table should be clean they.should not have a million empty.medication containers on top of them if.a resident has hand cream or other.things on it write their name with a.sharpie on top of it that's indelible so.that we know who it belongs to.again I keep seeing notes here med carts.must be claimed do you know what they.look for when they look at med carts.loose pills in the bottom of the drawers.that says to me that's a problem in.itself and we're going to spend just a.minute and talk about some.pharmaceutical or medication.administration issues very briefly but.just remember that make hearts.themselves must be cleaned down and very.clean bottles of hand sanitizer is hand.sanitizer should not be left all over.the facility those should be either.hanging on the wall or in controlled.areas people with dementia may not know.and could drink the hand sanitizer so we.want to make sure that those are just.left around HIPAA violations are another.thing we cannot leave assignment sheets.out on the top of counters we cannot.leave computer screens up that people.can read any information or learn.anything about who's in our facility.what is their diagnosis what are their.needs we don't need for somebody to be.reading about somebody's BMS remember.this is confidentiality at its best so.walk around and see if you see any HIPAA.violations take a walk yourself with.your staff and see if you can identify.things to improve on see what else I.want to just share with you I would make.sure of course that there are hair nets.available when you walk into any kitchen.area or food service area and that.people understand that all hair has to.be underneath the hairnet not just.partial not sitting around on the top of.their head to protect their hairdo if.you have a beard you have to wear the.same kind of coverage to cover up so.no hair is getting in the food water.pitchers and as I said need to be.changed out but the most important thing.is that they are available to people and.then start looking if you have community.showers and even individual showers the.things should not be left in the showers.personal items all clothing all linens.everything has to be removed each time.somebody goes in a shower so we're going.to stop for just a second I'm going to.move over and talk for a second about.some medication tips for you and these.are pharmacy related survey citations.that you can just avoid and I want to.run through them very quickly so if.you're a med aid.you're a nurse these are some things to.think about you need to check medication.carts refrigerators med room cabinets.for an expired insulin TV and house.stock items those are the most often.forgotten we look at other things in the.drawer but remember to look at those.make sure that all insulin vials are.dated when they're open some insulin.vials and other multi-dose vials.generally expire in 28 days after.opening there are two that don't that.are good for 42 days and if you want.I'll put up this program right as part.of the paper clip so you can have all.that verify that all the TB test files.are dated when opened because the TB.test files are only viable for good for.30 days so remember 30 days for TB.secure your house stock medications only.licensed personnel may access them and.then refrigerators where vaccines are.stored the temperature should be.documented twice a day let's talk for a.second about EFT at 3:29 I hate getting.into those numbered tags but these are.unnecessary drugs you should be.documenting non-drug interventions prior.to administering PRN psychoactive meds.non-drug interventions should be listed.in a residence care plan these are great.tips because they're the right thing to.be doing for our residents labs have to.be drawn as or.and the results have to be readily.available you have to have enough.documentation to support the use of an.ANA of a antipsychotic medication in any.dementia resident and behaviors must be.a danger to the resident or others care.plans for psychoactive medications have.to reflect the target behaviors or the.PRN usage so these are everything kind.of rolling in together and I know I'm.going through this quickly I'm always.willing to answer questions info @mm.learn organ medication regimen review I.have to tell you that pharmacy.recommendations we all have pharmacy.consultants coming in they have to be.turned around within 30 days as the.expectation of a surveyor and it's an.expectation of why we're even doing this.so make sure when the pharmacy.consultant comes in and gives you.recommendations we get these out and we.get the doctors to return what they want.to do within 30 days and they should be.acted on immediately in some cases by us.so we need to look at that so let's.finish up with EFT AG 333 medication.errors on a med pass make sure again.there are no loose pills at the bottom.of the medication card drawers be sure.to follow the manufacturer.recommendations when administering your.proton pump inhibitors these should be.many times administered before eating.we have other recommendations of.medications that should be given two.hours before meals one hour before meals.at bedtime and yet we see some of these.things being given to people in the.morning and wonder why they're so.anxious or why they're so sleepy during.the day you have to follow those PR and.Controlled Substances have to be signed.out on both Tamar and a proof of Use.sheet so make sure even the PRN meds and.nurses should be able to explain to.anybody our control substance.reconciliation process so there are so.many things to learn in the long-term.care industry so many issues that.continue to come up over and over for us.so all I can say to you is we're going.to continue.bring you everyday readiness and survey.readiness to just prompt us to think.differently if you're a new employer.you've been doing it for years to remind.you these are important considerations.thank you for spending these few minutes.with me and I hope this helps.

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