Monday, June 30, 2008

New training slides

This month's free staff development powerpoint shows are now available at The topic is survey preparation.

Friday, June 27, 2008

The PHI books

Although this has been posted here before, I have had some requests to repost the links to two manuals available for free from the Paraprofessional Health Institute. They are:

Coaching Supervision

Peer Mentoring

4 Thoughts

I was in a most excellent training session with Dianne Harris earlier this week. Here are four little tidbits I picked up on:
1. Sliding scale insulin is no longer considered appropriate for the nursing home setting. I will do some research and write more about this later.
2. Nursing homes are an excellent place for BSN students to do nursing management/leadership clinicals. This is something you should consider doing, as it is a great recruiting tool for RNs.
3. When interviewing licensed nurses, be sure to ask some clinical questions to make sure that their level of competency is where you want it to be at. It is suggested that you ask these 3 questions, at a minimum: (a)What are the signs and symptoms of heart failure, (b)How would you recognize if someone was hypoglycemic, and (c)What would you do if someone was having a stroke in progress?
4. Post the list of emergency stock drugs by the phone, so the nurse doesn't take an order for a med that can't be administered right then. It will also save a nurse the time needed to retrieve the list from wherever it is usually kept, which also keeps her from looking incompetent in the doctor's eyes.

Monday, June 16, 2008

Thoughts on Nursing Home Reimbursement

There is no business case for quality in long term care. There certainly is in the hospital industry, where compliance with evidence based practice practices was shown in a Premier demonstration pilot to save 11K per CABG patient. The reason that nursing homes can't afford quality is the current reimbursement system. Under RUGs, we are financially rewarded for keeping residents sick and maintaining utilization of resources as high as possible. While this is good for the bottom line, it is no good to residents. Perhaps we could look at going back to capitation, a system in which a facility is paid X amount of dollars per month per resident, with the dollar amount being determined by the average cost of care for nursing homes in that region. While this may not be the best system for skilled residents, it is certainly feasible for residents receiving an ICF level of care. Nursing homes would then have an incentive to maintain quality standards, because poor resident outcomes would result in nursing homes having to absorb that cost (ie, there would not be additional payments for in-house acquired pressure ulcers or other preventable complications). Hospitals have a list of no-pay diagnoses, inpatient acquired complications that they are not allowed to bill for. Third party payers should demand the highest quality of care from nursing homes, just as they do from every other provider type.

Thursday, June 5, 2008

Free training slides

I am offering free powerpoint slides for staff development, available at New slides will be available by the first day of each month. Two different sets will be posted, one for CNAs and a second one for licensed nurses. This month's topics are abuse prevention and interpretation of laboratory tests. Enjoy.