AANEX - American Association of Nurse Executives

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Care Planning
It is my understanding that if a resident goes out to an acute hospital and returns to the facility with no change in condition, I would not have to do a comprehensive assessment and care plan. I would just be required to do a short form 5 and 14 day assessment. Is this correct? 4/7/2008
What are the regulations regarding care plan meetings? Is one required for every medicare assessment? 2/20/2008
During a recent survey, our facility was questioned by surveyors regarding our process for working the RAPs. We were told that our documentation was not comprehensive and did not reflect critical thinking. What should be documented in the RAP review? 1/23/2008
Case Mix
Specialized therapy did not initiated treatment of a resident as ordered after admission to the facility. As a result the resident has been receiving only skilled nursing services for 8 days. Rehab now wants to pick him up starting the 9th day.The 5-day assessment is already scheduled. What's the best thing to do as far as the assessment switching from nursing RUG to rehab RUG? . 4/18/2008
If your facility has Medicare and Medicaid reimbursed residents mixed do they both affect the case mix index for your state or, does only your Medicaid residents affect this reimbursement? 4/7/2008
According to my consultant, when a person comes out to RH in the mds when there are extensive services, it will always default to RMX (which actually pays more than the RH that it would have been). My consultant says it is just one of those things that we don't know why, it just is. 2/22/2008
Clinical Issues and Resident Care
I am looking for examples of documentation that you would send with a resident going to and from dialysis to better communicate with the staff of the dialysis unit regarding the resident's condition. 5/1/2008
Boggy heels with any discoloration (maroon or purplish in color) can be a deep tissue injury or may be unstageable. Do I code this type of pressure ulcer as a Stage IV on the MDS? 4/25/2008
What processes of care should be considered by the nurse executive when evaluating the effectiveness of pressure ulcer prevention and treatment? 4/25/2008
Are wet to dry dressings still used for wound debridement? 4/22/2008
If PT writes an order for a resident's transfer and ambulation to be 1-2 person assisted and nursing disagrees and states the person is definitely a 2 person assist shouldn’t 2 people be utilized for transfer and ambulation? Should an order ever be written 1-2 assists or should it be more specific, 1 OR 2 assists? 4/15/2008
How should a Kennedy Terminal Ulcer be coded on the MDS? The skin is currently intact but the area directly over the coccyx is dark red and has the "butterfly" shape to it. 4/14/2008
What is an appropriate diagnosis supporting the use of an indwelling foley catheter? We were told urinary retention was not appropriate because it ‘can be fixed’. 4/14/2008
We are trying to eliminate continous tube feedings during the day shift when possible in order to provide our residents freedom from tube feeding pumps and equipment. How have other facilities handled this? 4/9/2008
If we use a lap buddy for positioning of a non -mobile person is this considered a restraint? We use it because she has a tendency to lean forward and has fallen on past occasions. 3/17/2008
Is it a CMS requirement that residents receive education related to vaccinations at admission? 3/10/2008
We are using hand mittens at night to prevent a resident from scratching open wounds on her legs. Are the mittens considered a restraint? 2/20/2008
Does the admission History and Physical count as a physician's visit? 2/1/2008
Is there a pain intensity rating scale that corresponds to Section J on the MDS? 1/24/2008
What is all this talk about automated external defibrillators and should we get one for our facility? 1/16/2008
I have been hearing a lot of information about the increase in invasive MRSA over the past few years. Is this true and is there something more specific that we should be doing as healthcare workers? 1/8/2008
I am the Administrator of a small rural facility. My staff is being pressured by a family member to restrain his mother in bed to prevent her from falling. If we don’t restrain the resident, won’t the family sue us? Who is liable if we don’t restrain her? 1/8/2008
We are attempting to eliminate the use of physical restraints in our facility. Some members of the care team have voiced concerns related to a perceived increase in the cost of care. Do costs increase when restraints are reduced? 1/8/2008
I recently read an article about an elderly woman who wandered away from a nursing home on Thanksgiving morning and was struck and killed by a car. The resident was wearing an alarm bracelet and still managed to leave the facility unnoticed. Our facility uses an alarm bracelet system as well. What can I do to significantly reduce the risk so that a similar tragedy does not happen to one of our residents or to our facility? 1/8/2008
In the past our facility policy was to routinely conduct urine cultures for all residents with indwelling catheters. Now I am told that we do not want to identify and treat bacteriuria rather than actual urinary tract infections. What is the difference between these two conditions? When should a urine culture be obtained? 1/8/2008

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FAQ's

Regulatory, clinical and current practice answers at your fingertips with our Frequently Asked Questions.