I’ve read at various online forums tales of how CNA’s literally fill in he blanks of vital sign records- without actually getting them.

just need to vent about last night at work….another cna was to take vitals on resident on unit, she is not a regular, i am new cna and also to this ltcf. been there one week still on training.
well she was to get temp and bp..resident in hallway with me…she took temp and not bp but she wrote on vital board patients bp as 120/82…..rghghhhhh it bothered me being new i hate to start trouble but this patient cannot speak…but understands.

What if we we all did this? Blew off getting the T, P, R and B/P? What if the resident has developed high B/P and because we couldn’t be bothered to be honest, it went unchecked? What if a real temp wasn’t measured for a couple days, while the resident is coming down with a infection? What if the resident is on a new medication that has a side effect of changing their respirations, but this isn’t seen because no one took the time to count them??

This is very bad. And illegal. And unethical. And most importantly, dangerous. What’s a new CNA to do? Or an experienced CNA? You stand up and advocate for the resident. You MUST not allow this to happen, when you see it, witness it, hear about it or otherwise KNOW of it.

How do you go about advocating in situations like this?

It seems pretty simple to me. Here’s what I would do (and have done many times):
1) Tell the CNA involved that she is committing fraud and that she needs to get the VS in question, right now. While you watch.

2) Report the incident to the charge nurse immediately; explain what happened and leave your personal thoughts out of this.

3) Seek the DON and report the incident to he/she as well. In writing. ASAP…Make a copy of your report to keep for your own records. Even if the charge nurse says she will make the DON aware, go to the DON yourself. You’re covering yourself by doing so. Otherwise, it could come back to haunt you in the misconception that you were aware of the incident but didn’t report it…and so on.

DON’T BE ONE OF THOSE AIDES.
The CNA who fraudulently documents care is opening themselves up to numerous problems. They could lose their job; their certification/license; their chances to work in health care as a career will most likely be ruined for good. If actual harm came to the patient/resident because we slacked off, patients and their family can pursue legal remedy. The facility and the state body in charge of regulating CNA practice can turn the “case” over to the Attorney General and hence start the criminal justice process. You get the idea.

Trust is big in health care.
Do we really think we can trust the aide who doesn’t measure vital signs but who writes in fictional numbers?

It’s not just vital signs. When an aide fills in the blanks in this one area, I question their honesty and integrity in all areas. The box is checked for the bed bath, but did the resident really get one? There are numbers in the intake and output record, but are they truthful?

Patients trust their health care providers to be skilled and honest. Our employers, the nursing homes and hospitals and assisted living centers trust that we’re using our skills and being honest as well. Our charge nurses depend upon our skill and honesty to assist with providing timely and needed treatments and medication administration. Our co workers trust that their peers are doing the right thing for their beloved residents.

The right things mean filling in the blanks with real, honesty measured/provided numbers/care. The right thing means when something isn’t done, it’s documented as not being done. We all know there are days when we can’t get IT all done and that’s the way of this work.

Experienced aides can prioritize their work- they KNOW what care or task needs to be completed vs what can wait. New aides should feel confident to ask for direction and HELP when they need it (which might be often the first couple weeks they are on the job!)

Charge nurses should always provide guidance to help sort through these issues. When it comes to actual skills- some newer aides really have trouble measuring blood pressure. The new aide should seek the help of her mentor, or the charge nurse to really learn this skill.

Paperwork overload is no excuse!
There is WAY too much paperwork in our work. Everyone knows this. Yet, facilities don’t get paid and pass inspections if the paperwork isn’t done. In the medical chart, if it isn’t documented it wasn’t done. Sadly these are facts.

The burden of documenting has become overwhelming. The original purpose of charting was to provide a clear record of a patients’ medical condition, where members of the health care team could go to see updates and alter their interventions and treatments as needed.

The chart is rarely used for this anymore. Now, it’s a place where endless pieces of paper are stored- and kept, in the event of a lawsuit. Nurses and others document on the defensive now. This is the world many have created and our little part in it has tremendous consequences. Those vital sign numbers better correlate with the sudden medical condition discovered on the next shift. When it doesn’t, red flags are spotted and questions are asked.

Maintaining Integrity Isn’t Easy In This Work
The CNA MUST ALWAYS be honest in the care and tasks they provide. We are the front line. The first to see and know. We are extremely valuable because of our place. If we don’t feel skilled enough in providing tasks/care, we need to speak up to this and ask for help. Those of us who hear the cry for help need to be willing and able to teach. We need to recognize when a peer is having a bad time, a bad day, and offer assistance. We do this not for the aide but for the patients/residents she is assigned to.

WHY IS THIS BECOMING MORE AND MORE PREVALENT?
In the past few years I have seen an increase in aides who graduate from these small medical-skills schools who don’t have (or are not taught) the same foundations of honesty and integrity. I’m not sure honesty and integrity can be taught either…we either have these ethics or we don’t. Better screening might be one solution.

The quick turnover rates of graduating “classes” of aides amazes me- and the fact they can pass the state tests tells me they know the basics. The basics aren’t good enough anymore.

It gets lost when these fast food CNA’s get on the units and are totally overwhelmed with their assignment. They feel pressured to get everything done and this is where I often see the cheating occur. I have to wonder if these schools are not doing an adequate job teaching the students everything they really need to know. I wonder if the new aides thought the job would be much easier.

When we see cheating happen we have to speak up. Loudly at times. We might even need to make a stink once in a while. Life and death decisions are sometimes made based upon our honesty. As I said, we’re the front line. Our words have HUGE impact upon everyone’s word, all of whom are above us. If we’re not honest, then neither are they. Yet we know it, and they don’t. Remember that.

In this article, I want to present a concept that should be well understood by all CNA’s. Here, we’re going to discuss what can happen when we become overly attached to a resident, or their family and the implications this has upon the facility.

One of the better changes for some LTC facilities is consistent staffing. However, this staffing model has created some unintended consequences.

Read the rest of this entry »

In our article TIPS & TIMESAVERS FOR CNA’S, we advise new aides to keep a small notebook on their person. To write down answers to questions; to write down phone numbers and other info needed for the job.

Seasoned aides can also make use of a small notebook. They’re cheap, can be bought almost anywhere and come in so handy for CNA’s. A great resource, the little notebook.

I have one…pocket size that fits nicely in my scrub pockets. What do I do with it? A lot. When the nurse asks for VS on a resident/patient, I have paper to record the results. When a weight is needed; when a height is needed; when intake and output need to be recorded- these little pads come in real handy.

At the top of the page I write the date…day, month, year and shift I am working.

*I record the times I clock in and out- so if there is a discrepancy in my pay I can go back and check.

*I record what unit I’m working on, and the initials of the staff working with me. Even the nurses. And I note who is agency.

*I record my assignment- residents names. No need for more info; names are enough.

*Any falls or other incidents are recorded in my notebook as well…the vital stats are documented. Who. What. When. Where. Witnesses.

Some aides will go to the effort to write in certain info about their residents: BM’s, voids, showers, turning and the like.

Many aides use their assignment sheets to record all this info…and that’s fine. But I like to keep a personal record of these things. It can help you keep a clear record of your daily work and one never knows when this information can become necessary to defend one’s actions. Some aides prefer to write notes about their workday at home, away from prying eyes and nosy bosses. No matter where you do this, it’s pretty important to DO IT.

The legal environment in today’s nursing homes demand we keep clear records of the care we give. Most nursing home management can be trusted to not alter records, but not all. Aides can and have gotten into seriously hot water over issues and incidents that were not properly documented; flow sheets have been “corrected” to suit the best looking picture. Since aides are the lowest people in the chain of command, it’s way to easy to blame us for problems, issues, accidents and the like.

Who hasn’t been called at home, by the DON, demanding to know details about some incident that occurred last week? And who among us has a truly clear recollection of the events? If we had written down all the details, it would certainly help us during this call.

A little notebook can keep a lot of vital information. I wouldn’t go around telling everyone I have one though…management often doesn’t take well to such things. And we have to be extremely careful to respect HIPAA rules, but it is within our right to keep notes about our workday. I strongly advise all aides to do this.

Why it’s so important to maintain professional relationships with residents.

OLYMPIA — A 20-year-old woman has lost her nursing assistant’s license after being accused of accepting $145,000 in gifts — including jewelry, a car, a stock portfolio and a trip to Disneyland — from an elderly man before he died at an Olympia assisted-living facility in 2006.

Lila Guzman collected the gifts from Damiano Buffone from 2004 to 2006, starting when she was 18 and Buffone was a resident of Merrill Gardens on Lilly Road, according court records and a statement of administrative charges filed by the state Department of Health against Guzman this year.
[…]
According to the civil suit filed by Buffone’s daughter:

“Over a period of time from November, 2004 to May, 2006, defendant received approximately $145,000 from the decedent in the form of checks. Additionally, shares of stock managed by Merrill Lynch was transferred to the defendant.”

The suit alleges that before Buffone’s death June 6, 2006, Guzman “coerced” him into giving her stock and money while she worked at Merrill Gardens. Horn’s attorneys were able to freeze Guzman’s stock holdings, as well as at least one of her bank accounts, after Buffone’s death, the complaint states.

Now, Guzman is broke, unable to pay the money she has been ordered to give Horn as part of the judgment, Benjamin said.

“She has no money because all of her assets were frozen and taken away,” he said.

Identity theft of nursing home residents. And the CNA’s who committed these crimes.

A federal grand jury has indicted 17 people, most native Kenyans, for allegedly stealing the identities of hundreds of nursing-home residents and filing false tax returns in their names.

The conspiracy, which began in February 2005, sought more than $13.1 million in fraudulent returns from the federal government and 27 states, U.S. Attorney John Wood said Thursday at a news conference.

The defendants allegedly stole the identities of more than 300 people, most from the Kansas City area.

“Identity thieves are using more complex and sophisticated methods to commit their crimes,” Wood said.

Some involved in the conspiracy used their positions as certified nursing assistants to gather personal information, which they passed to others who prepared the returns, authorities said.

“It’s not hard to get identity information in an institutional setting,” said Assistant U.S. Attorney Curt Bohling. “They might have a chart with their name and Social Security number on it, which is all you need.”

The grand jury Wednesday returned the 18-count indictment under seal. Federal agents Thursday arrested 10 of the defendants. Officials said three others were believed to be in Kenya, and four remained fugitives in the United States.

Those charged include: Loretta Wavinya, 30; Ervin Somba, 26; Edwin Nyumu Sila, 25; Lillian Nzongi, 26; Moses Ndubai, 33; and Bernard Nyemba, 39, all of Kansas City; Vincent Niagwara Ogega, 23, of Independence; Aaron Mutavi, 28, of Overland Park; Kenneth Njagi, 31, of Lenexa; Mary Gitiha, 25, of San Francisco; Ernest Kangara, 40, of Santa Rosa, Calif.; Paul Kilungya Nyumu, 41, address unknown; and Karingithi Gotonga Kamau, whose age and address were unknown to prosecutors.

No commentary needed on this. It’s wrong. And we need to think about ways to keep SSN’s and other pertinent info out of the hands of those who might have reason to steal the name of someone else.

A reminder of some of the materials here, that can be used without charge, for CNA educational purposes or for inserivces.

Horizontal Violence

A Call For Action

Being Professional: Guide For CNA’s

CNA’s & Respect

Workplace Culture: CNA’s can make it or break it

Shift Wars

Tips & Timesavers For CNA’s

Legal Issues For CNA’s

The Nursing Process & CNA’s

Observation Skills For CNA’s

Continuing Ed For CNA’s: Just Another Inservice?

Email us for a TEXT or WORD version of these materials.

In the near future we have several more posts that will be up for grabs:

Falls: The CNA’s Role in Assessment and Prevention

Mentoring: A SKILL for CNA’s

Several months ago we wrote many posts here about the case of Mabel Taylor, the woman with Alzheimer’s Disease, who eloped from her nursing home and was found dead outside. The owner of the home, Martha F. Bell, was recently convicted of covering up the death of Mrs. Taylor. Now the nurse who was on duty that fateful night has also been convicted.

As the son of two doctors who practiced medicine from home offices and treated sick people around the clock, Allegheny County Common Pleas Judge David R. Cashman said he knows what constitutes good patient care.

“That’s not what happened here,” the judge told former nursing home supervisor Kathryn Galati yesterday before sentencing her to five years of probation for her role in a failed plan to cover up how a former resident died in 2001.

Judge Cashman also barred Ms. Galati, a registered nurse, from working in health care during that time. Ms. Galati, 61, of the North Side, in March pleaded guilty to perjury, false swearing, conspiracy and tampering with evidence.

Ms. Galati was the supervisor at the defunct Ronald Reagan Atrium I Nursing, Research and Rehabilitation Center in Robinson when resident Mabel Taylor died on Oct. 26, 2001. Mrs. Taylor, 88, who had Alzheimer’s disease, was trapped overnight in an outdoor courtyard in 40-degree weather.

Investigators accused Ms. Galati of conspiring with former Atrium administrator Martha F. Bell to deceive Mrs. Taylor’s family by directing employees to drag the victim’s body inside, wash and place her in bed and claim she’d died peacefully in her sleep.

Mrs. Taylor’s daughter, Jane Baczewski of Hopewell, testified yesterday of her horror after discovering the “elaborate scheme to conceal” the truth.

“I will live with that picture of my dear mother being dragged on that pavement for the rest of my life,” she said, her voice cracking.

Ms. Galati did not speak yesterday. Her attorney, Leslie Perlow, said she is “not the greatest communicator,” but is remorseful and knows “what she did was wrong.”

A sentence of probation seems a little insufficient to me in this case. A woman died due to the lack of good supervision this nurse failed to provide; and the actions after are just horrible. But I am not a judge or jury in this case.

Previous Posts about this case

This should raise the level of awareness of just how GrannyCams are being used with legal issues in nursing homes. The nurses and aide AND owner, in this article should be punished with the full weight of the law. It’s just strange to know they are charged based on a video…which doesn’t lie.

The Cortland County nurse has been found guilty of violating health laws and falsifying records.

Steven Nadeau worked at the Northwoods Rehabilitation and Extended Care Facility in Cortland from 2001 to 2006. He now faces up to two years in prison and a fine up to $2,000.

Nadeau was convicted of failing to provide necessary care to a 59-year-old patient in a chronic vegetative state and then falsifying documents by indicating he had provided the care.

Steven Nadeau has been found guilty of violating health laws and falsifying records while working at Northwoods Rehabilitation and Extended Care Facility.

The Attorney General’s Medicaid Fraud Control Unit used an undercover camera in the resident’s room to monitor Nadeau’s actions.

This was the first case to go to trial in New York State using video surveillance in a resident’s room as evidence. It’s led to pending prosecution of three other nurses, a certified nurse’s aide and the owner of the Northwoods facility.

So there we have it. Don’t do the care just because a camera is watching you. Do it because it’s your job. Remember: the cameras are there to bear witness to what you do…so do it good, as ordered. Be proud of the care you give and don’t be nervous because of the camera. It can also come back to prove you did everything you were supposed do.

The other day I posted about a nursing home that got sued for DOING TOO much to save a life…for not following the DNR of a resident; who ended up going to a local ER and was subjected to the usual array of life saving tools…Today we see just the opposite in this article:

Albany County has paid a $75,050 fine, levied by the federal government, after its nursing home was cited for jeopardizing the health and safety of residents last year, officials said.

The state Health Department, after an inspection late last year, notified the federal government that the Albany County Nursing Home was not in compliance with requirements for nursing homes participating in the Medicare/Medicaid programs.

Around the same time, the state placed the facility in “immediate jeopardy” status after two people died when the staff failed to resuscitate them.

Question:
What does your facility do to ensure ALL staff KNOW the DNR status of residents? Even non staff, such as agency, must know these things- what exact orders are in place, where these documents are located and facility policy and protocol for such events.

Back at the end of February Kim wrote about a nursing home that was being sued for doing everything possible to keep alive a woman who became nonresponse. The woman had a living will stating she did not want any life saving action taken upon her. Both sides claimed very different scenes and thought processes that went into what happened.

The jury found the nursing home and the doctor guilty on Friday.

WEST PALM BEACH - A Palm Beach County jury ruled a nursing home failed to honor the living will of a 92-year-old Alzheimer’s patient who didn’t want to be kept alive by artificial means.

The Friday decision marked the end of the state’s first prolongation-of-life trial. The jury found that the Joseph L. Morse Geriatric Center in West Palm Beach failed to follow the end-of-life directives of Madeline Neumann and that it should pay $150,000 in damages. The panel declined to find Morse’s former medical director, Dr. Jaimy Bensimon, negligent.

As Neumann lay dying in 1995, rescue workers arrived and began reviving her. She was rushed to a hospital, where she died six days later after various lifesaving measures.

Neumann’s granddaughter, Linda Scheible, said she wanted her grandmother’s “unnecessary suffering” to send a message to nursing homes everywhere.

Lesson: KNOW every resident’s directives. And follow them. To a T. If the T isn’t clear, call a lawyer and be prepared to get sued. No matter how the case is handled.

Seriously, all nursing homes have to have on record the advance directives of residents. The murkiness comes when a resident is really sick vs. really dying. THERE is a difference. Sometimes, when they’re very sick BUT not dying, and a dose of antibiotics will take care of them, it’s considered a medical intervention of life saving proportions. And we all know how quickly very sick turns into REALLY dying…it happens in a matter of hours and even minutes. Should nursing homes have to seek out directives for the many common scenarios we see? No matter what, it’s sad that this happened- for all parties involved. I hope it doesn’t lead to more regulation and stupidness but I suspect it will.