Families Can Monitor the Quality of Nursing Home Care
Can I do anything to improve the care my loved one is receiving at the nursing home?
This is a common question. Today I would like to discuss what I believe is a reasonable methodology to assist families in playing a positive role in the care of their nursing home patient.
Family participating in their loved ones care is becoming more important every year. However, there is little information available to inform and educate families as to how they can successfully advocate for their loved one. The following is an introduction to Family Advocacy 101.
Inadequate Communication in the Nursing Home
One of the major impediments to good care in the nursing home is inadequate communication among health care providers (nursing assistants, nurses, physicians, and nursing home management).
The nursing staff is responsible for continually assessing patients for changes in condition and for the accuracy and completeness of charting the patients’ condition. Facility understaffing places many hurdles in the path of staff-to-staff communication.
It is not the family’s job to facilitate staff communication in the nursing home. However, a family that is knowledgeable enough to understand the weakness in the nursing home’s system of communication is able to provide a communication bridge between the patient and the nursing home staff.
The family can thus make a significant contribution to the patient’s well being by facilitating awareness and understanding of the patient’s condition.
The Nursing Home Chart
The “chart” is a collection of records, first created when the patient is admitted to the nursing home and supplemented throughout the patient’s stay.
The purpose of the chart is to enable any healthcare provider to obtain a history and current status of the patient.
Understanding the Chart
This is not as difficult as you may think. Families with the patient’s permission may examine the patient’s chart.
There are certain documents in the chart that are key to evaluating care. We’ll briefly discuss each and also how it can be utilized by the family.
Hospital Transfer Records
The patient is usually accompanied to the nursing home with Hospital Transfer Records. These are records which explain the patient’s condition upon discharge from the hospital. The records also include a list of the medications the patient is taking, and any physician orders for continued medication and care.
The Admission Record
When a patient is admitted into a nursing home an Admission Record is completed by the admitting nurse. The Hospital Transfer Records are reviewed and incorporated into the admission records for the consideration of the nursing home admitting physician.
The admitting nurse must review the hospital transfer records, examine the patient, obtain information from the patient, and educate the patient’s family regarding the patient’s needs and abilities.
The Family re: Admission Process
The family should read the patient’s Hospital Transfer Records and the Admission Records in order to make sure that they accurately reflect the patient’s condition at the time of admission to the nursing home.
Advising the nursing staff about any discrepancies or omissions will facilitate an accurate understanding of the patient. It also ensures that the staff and admitting physician will be in a better position to address all of the patient’s needs.
Treatment / Medication Administration Records
The Treatment Record documents all the treatments that the patient’s physician has ordered for the patient. There is a place on the Treatment Record for the nursing staff to document when each treatment is provided.
The Medication Administration Record documents all the medications that were ordered for the patient and there is a place for the nurses to document when each medication is administered.
The timely performance of treatments and administration of medication is important to the welfare of the patient. Failure to provide either may result in patient debility or death.
The Family: Treatments and Medication
The family should examine the treatments ordered for the patient and the medication to be administered and verify that the patient is receiving the treatments and medications as were ordered.
Pay particular attention to any new treatments and medications and tell the nursing staff and the physician if there are any changes in the patient’s condition once the new treatments and medications have been given.
A change in treatment or medication can sometimes have a negative consequence and therefore patients should be closely monitored when new therapies are implemented or new medications are administered.
Vital Signs and Weight Records
The nursing assistants commonly record the patient’s vital signs (temperature, blood pressure, pulse, and respiration) and weights. Weights are usually taken monthly unless ordered otherwise.
Any unusual readings must be retaken to allow for the possibility of error and timely reported to the patient’s physician in the event it is determined that the reading was accurate.
An elevated temperature may be a sign of infection or dehydration and must be addressed with the patient’s physician immediately.
Any unplanned weight loss must also be addressed immediately with the patient’s physician and the dietitian. In addition, a patient who has lost weight should be placed on a weekly weight plan.
It is not uncommon for recording the vitals and weights to be neglected by nursing when they are understaffed and overworked.
The Family: Vitals and Weights
Once again, the family can play an important role in assuring that the patient’s vitals and weights are regularly recorded by the staff.
By examining the vitals and weight records weekly and reporting any failures of entry to the nurse in charge and the patient’s physician, the family can help avert potential problems.
Nursing Assistant Flow Sheets
Nursing assistants provide much of the hands on care in the nursing home. They document certain elements of the care that they provide on Nursing Assistants Flow Sheets.
One of the more important aspects of their charting responsibility is to document the percentage of meals and fluids consumed by the patient.
The flow sheet forms have columns for the days of the week and cross-columns for breakfast, lunch, dinner and snacks. Each box for a particular date and meal should be filled in with the accurate meal and fluid percentages that the patient consumes.
In a busy nursing home, that lacks an adequate number of nursing assistants, it is not unusual for Flow Sheet charting to be incomplete. Unfortunately, it is also not unusual for the meals percentages documented to be fabricated, especially at times when the facility is short staffed and the percentages are recorded at a later date.
The Family: Flow Sheets
As stated before, any unplanned weight loss in an elderly patient is a serous condition and must be addressed as quickly as possible.
The family should examine the patient’s Nursing Assistant Flow Sheet weekly and report any blank boxes to the Director of Nurses.
The family should also examine the percentages of meals consumed in light of the patient’s physical condition.
For example, when a patient has unintentionally lost weight and the Nurse Assistant Flow Sheet indicates that the patient has been eating 100% of his meals, the family should be suspicious. The weight loss may be the consequence of a medical condition or may be a situation where the nursing assistants are fabricating the meal percentages that the patient has eaten.
Becoming aware of this conflict between the weight loss and the meal percentages enables the family to call this matter to the attention of the Director of Nursing and the patient’s physician.
Families place their trust in the nursing home to provide quality care. Although the nursing home staff should be an advocate for the patient, this rarely occurs because the facility is understaffed and the staff is overworked just trying to provide basic services to all the patients.
