New York State Attorney General Elliot Spitzer announced this week the arrest of nine nursing home employees, including six CNAs and the facility Medical Director. A hidden camera was placed in the room of a resident for a five week period, where it observed:
-Resident did not receive restorative therapy twice per day as ordered
-Resident was not turned every two hours as ordered
-Resident was not toileted every two hours as ordered
-Resident was not assisted with feeding at every meal as ordered
-Resident did not receive medications consistently as ordered
-Resident was not visited by the physician as documented
AS ORDERED. When was the last time you looked at your residents' monthly order sheets? Do you know the types of things that are being ordered? Are you comfortable with the frequency that some of these things are being ordered?
Nurses and physicians will sometimes write orders without any consideration of facility constraints. I have seen orders and careplans written to deliver some type of care "every fifteen minutes." The chances of consistently fulfilling these orders is zero. There are certainly times when an order like this is realistic and/or necessary for an acute situation. The problem is that these orders are written without a stop date or a defined time frame. As facility leaders, it is our responsibility to consistently evaluate the scope of services that we have committed to offering. A time is coming when surveyors will use their calculators as primary tools of their trade; calculating the total hours of restorative ordered per day in the facility divided by the number of restorative hours on your schedule.
Defined staffing levels are certainly a possibility in future versions of our regulations. Do you know how much care your nurses and physicians have committed you to providing?