Long-Term Care Survey Alert

Published on Sat Jul 21, 2007 PDF

2 examples illustrate improved outcomes for residents.

Nurses who spend less time at the med cart have more time to apply their skilled nursing assessments and interventions in ways that pay off for residents and the facility.

Case example No. 1: One resident with dementia had high anxiety and developed behavioral symptoms when he had a change in routine. For example, if he had to leave the unit for a doctor's appointment, his anxiety and behavior would escalate to the point that it upset the whole unit, notes Carol DuMond, RN, MS.  Dumond is assistant director of nursing for St. John's Home in Rochester, NY, which has consolidated med passes, resulting in more time for nurses to devote to patient care.

One day the resident needed to go to a dermatology appointment at the clinical suite downstairs. Since the nurse's med pass only lasted 30 to 45 minutes in the morning, she had time to take the resident for a ride in a wheelchair to the clinic, "visiting with him" the whole time, says DuMond.

The resident viewed the trip as an enjoyable outing with the nurse rather than a trip to the doctor. And the nurse's intervention saved staffing time overall because the resident didn't become agitated about going to his appointment, relays DuMond.

"If we'd just said to the [resident], 'It's time for your appointment, let's go,'" the resident would likely have become upset and yelled, she notes. "And his outburst would have changed the spirit on the unit," upsetting other residents, who then require more attention.

Case example No. 2: A resident needed care for end-stage cardiac disease. "Because the nurse wasn't spending all day passing meds, she would do morning care for one resident a day in order to get to know the person and do a thorough assessment," says DuMond. As a result, the nurse realized that one resident with cardiac disease became very short of breath when taking a few steps into the bathroom. So she discussed her observation with the physician, who ordered medication to ease the patient's respiratory rate, says DuMond.