A) A family member recently arrived to feed a resident at supper, encountering the overpowering smell of urine in their bedroom.
They asked the nurse on duty for help to clean up. Incredibly, she not only did not co-operate in finding someone to remove the stench but also to their request for some cleaning supplies to do it. This "attitude" is unacceptable. Who is responsible for clean ups?
Ans: If this situation occurs before 3:00 PM the cleaning staff normally will be called to clean up. After 3:00 there is no cleaning staff for individual floors,but a building cleaner should be present until 6:00.
In this case (after 6:00) it was the responsibilty of the NURSE to clean up the mess as requested.
(Most nurses are aware of this.)
She's violating the resident's rights (and her job description) by refusing.You're corrrect, this attitude is unacceptable.
B) Whatever happened to that QI RN position created last year to implement “quality improvement initiatives” that were going to “Improve quality of care for residents and their families” and 'promote a culture of teamwork and innovation”
and provide “Education and open communications” as well as “Leverage strengths of 4 homes- utilizing national standards and best practice guidelines”.
Ans: We're awaiting the results....
With some research we discovered these 5 (1 QI nurse /residence,1 manager) positions were created as a result of the April Auditor General's report. Funding is coming from MOH (now MLTC), hence a temporary position. Even more recently we discovered one of the issues that will be addressed is the response time to complaints. This we can relate to!
C) In January we noticed the office doors on our floor were now closed at night after the residents had gone to bed. Formerly they were kept open,for obvious reasons -you cannot hear if residents are in trouble. Management was asked the following:
...the office doors now on most floors are closed at night after the residents have gone to bed. How can staff hear anything that might happen on the floor?
Here's their reply :
"The following process are in place should a resident need assistance:
-Rooms are equipped with a call bell system
-The office on each floor is equipped with visual monitoring systems, giving a visual access to each corridor.
-Staff perform rounds to monitor and account for all residents.
-Doors may be closed for specific reasons such as confidential conversation and confidential charting on the resident electronic data base."
We expected management to know that a) less than 30% of residents know how to use a call bell,(or even have access to it), b) visual monitoring systems (cameras,monitors) in corridors won't do much for residents in trouble in their room, c) it takes 5-15 minutes to bleed out, i.e hourly rounds won't help much,even it they actually happened (we now know "hourly rounds" claims are a myth) d) as far as confidentiality is concerned- we did specify AFTER the residents were in bed (maybe some residents have mega acute hearing here?)
Ans: You neglected to mention that the question "how can staff hear" was never answered...
Placing residents in a situation that threatens their safety is contrary to the Legislation designed to protect our very vulnerable residents. Management has told families it's a fire code issue- but there is nothing in the fire code mandating closed office doors. We can't stress enough the need to a) use the complaint forms,and b) call the MLTC. They will "educate" management on these issues. Remember...Management reacts to MLTC inspections.
D) Re: your "closed office doors" comments (C above): Recently a resident fell just outside the office (equipped with a glass wall to provide visual monitoring of area) and,despite there being staff inside, nobody came out to help . Here,too,the office door was closed.The resident lay there on the floor several minutes.(And this was mid-day.) The management response you published is troubling.No resident on our floor can use the call bell system. The visual monitoring system mentioned was obviously of no help, despite it monitoring the corridors.Conclusion: closed office doors are are threat to residents' safety. Confidentiality issues? That's a bit of a stretch. Does a confidential conversation last a whole shift?
Ans.Thanks for stating the obvious. As some have observed, closing office doors, particularly at night after all residents have retired, "is like dispensing drugs with your eyes closed".
E) Thanks for this site. Why is there such turnover of staff here?Too many new staff faces (especially evenings, weekends, etc.) We're a 100% dementia floor. Dementia units especially need staffing stability. The personnel change so often here it's dizzying. Is nobody capable of scheduling for results? Now we're getting nurses who don't know which PSW takes care of which resident (another reason to post staff schedules!).
Ans: It's an ongoing issue here. Currently (Jan 2020)The day shift is now pretty stable,the night has new staff that are sticking around too.
F) We witnessed an RPN simply walk away from a resident in severe distress during mealtime (aspiration -he was choking) The private caregiver became hysterical. Nurse's response to cries for help? "I have to do my meds" and walked away! This was unbelievable. (A family member took control and removed resident from the room.)As a result we now are left wondering about nursing staff here and their training to handle situations like these. Most seem capable, but after this incident... This is the first emergency situation we have witnessed. To compound our concerns management has refused to answer our questions re the policies and procedures here to address this type of emergency nor has management apologized for putting us through this ordeal. Nothing. They have created a cloud of doubt here. Why?
Ans: Experienced management never allows doubt and uncertainty about their employees' abilities(or their own) to grow. This approach never ends well.
G) It took me many attempts to access my relative's care charts. As POA don't I have a right to this information?
Ans : After 1 attempt with no success call MLTC. You have a right to timely access to this info.(Additionally your relative's rights have been violated - the right to be told who is providing a resident's care.) Call MLTC.
H) I don't agree with the care plan for my family but am being told I can not change it without approval from management. I understood the legislation says I decide this. No?
Ans: Correct. YOU are the ultimate decision maker. If you are being told otherwise and your wishes are not respected, call the MLTC.
I) Some of us recently took the initiative to have the City-contracted foot care nurse replaced to serve our families. There were several issues but what concerns us now is management.The residents' rights were being violated yet management remained oblivious. They claim they walk the floors daily. Maybe we should design a checklist for them?
Ans: Great idea.
J) We had a bizarre incident recently where the staff were locked out of the nurse's office on our floor one evening . The electronic lock died. What concerns us is nobody could access the office.There was no backup manual key. None. Well, not quite accurate.There was one. Kept for safekeeping in......the nurse's office! Can someone explain to whomever here that a backup key should be kept in another room? Any why did someone on another floor not have a backup?
Ans: Perhaps several measures should be adopted to prevent recurrences.
A-Store backup key in different room than subject room.
B- Make backup keys for all offices,store in lock box in building(NOT located in nurse's office).
C- No brainer: key all nurse's office locks to work with same key.Six floors will then have the same backup key.
Could have been worse.The meds room lock could have died and....
K) I discovered my family member was being over medicated. My mistake was allowing the staff to define "give as required". (Also known as PRN.) BIG mistake. Do not allow the staff to make that decision!
It will be abused.
Experience shows you have to be continually checking not only the medication but the Care Plan too. Lots of "mistakes" happen here.
Be specific and ensure your instructions are followed. Check,re check and check again. Continually.
Incidents of medication malpractice here have resulted in deaths.
Ans: Thanks for the life saving advice.
L) Where can I purchase those open back clothes I see some of the residents wearing? It would make it much easier to put on and remove clothing for my family member given their now limited limb mobility and arthritis.
Ans: Many families have used 2 companies. Silverts, and CARDA. Silverts is based in Toronto.They're internet based sales allow competitive pricing and the product seems to be pretty good. Order from their website. CARDA is a local Ottawa company.(Across from Westgate mall on Carling Ave.) They make many of their clothes in the shop, and you can have custom made clothes made. They also offer product not available at Silverts.Both offer good quality products.