RECRUITMENT ACTIONS AT THE LOCAL LEVEL

RECRUITMENT ACTIONS AT THE LOCAL LEVEL Maun-Lemke L.L.C.

Staff openings are very troublesome and effect everyone along with everything. While we need home office support and assistance there are some immediate things you can do to take action at the local level. These include:

1. Make the recruitment issue everyone's concern. Tell everyone the opening count, the specifics of the openings and the team effort needed.

2. Post a fun scorecard related to the recruitment effort in the break room or by the time clock. Post success and current status of the team effort.

3. Within 7 days of hiring any new person in any area take the time to specifically interview them on how it is going. If they are enjoying their new job, get leads from them of other people they know who would be interested in working at your location.

4. Generate a list of possible rehires from the staff of people they know who have left and could be contacted about returning. These people need to have left in good standing.

5. Implement a team based celebration, reward and recognition if the recruitment effort hits a certain success level.

6. At daily rounds ask the staff who they know, if they talked to anyone and update them on the effort.

7. Include the recruitment issues as the first item on every morning meeting or stand up. Ask the managers from all areas what they have done to recruit.

8. Make new applicant processing an expedited effort and big deal for everyone. No delays when there is an applicant.

9. Put the recruitment issue with goals in the Rightness section of your 12 week plans.

10. Look at all part time positions and see if a full time job can be created. Consider 2 days on mornings and 3 days on afternoons as an example. Another example would be 2 part time jobs combined from 2 different units or areas. Consider 2 positions combined from 2 different nearby sister locations. Consider weekend only programs. Be creative and shrink the number of positions needed.

11. Always use strength based advertising. Example is a feature about one great employee and there is one position to work with that person. Don't use ads that simply list all the positions needed. This won't attract talented applicants.

12. Consider a career fair. Develop it as a team activity. Do onsite interviews at the career fair. Consider prizes for potential recruits attending.

13. Create excitement within the organization about their personal links and contacts.

14. Recognize and perhaps reward any individual who successfully recruits a new hire.

15. Expedite the interview/selection process. Eliminate delays that are not necessary.

16. Enlist the help of local schools and colleges.

17. Watch for trouble, upheaval or major change at competitors and initiate action.

18. Organize a published celebration related to your great talented staff. Let everyone know you see and recognize greatness.

19. Consider recruiting outside your area by celebrating the local attractions or uniqueness of your community. This could be weather, shopping, outdoor activities, etc. Make your place a destination location for new hires.

20. Let everyone know immediately if there are any new enhancements to pay or benefits for any positions.

21. Develop a clear understanding of the positive uniqueness of your employment versus anyone else. Make sure everyone understands those advantages. Test your folks understanding of these unique differences.

22. The time from interview to hiring decision/offer must be short. Eliminate delays.

23. Form a recruitment action team made up of talented staff. Develop a plan with goals and have them take action.

24. Set aside management time everyday to work on recruitment.

25. Have frequent positive home office communication on plans and results of the recruitment effort.

26. Make ongoing contacts with local churches.

27. Keep on top of new local businesses starting and if new jobs are coming to the area. There usually are new opportunities with new people relocating to the area.

28. Keep ongoing contact with real estate and rental organizations.

29. Work with any contract or vendor organizations on leads for your recruitment effort.

30. Post positive strength based talent seeking posters in the area.

31. Recognize talent when you are in the community and give them your business card. Say "You are the type of person I am always looking to hire. Keep us in mind"

32. Keep in constant contact with local Chamber of Commerce and Economic Development Organizations.

33. Organize a specific series of meetings with employees who meet a certain definition of "Super Talented". Interview them with their permission about their hobbies, interests, backgrounds, etc. Target your recruitment efforts to match the information from the interviews. Solicit this "Super Talented" group to help you recruit. Use them in your feature information about the organization. Use them in your advertising options focusing on strength. This also serves the purpose of keeping these folks while you go through your recruitment issues. Keep meeting with them.

34. Look for potential candidates with some previous longevity. Avoid major job hoppers.

35 Most of all after all this effort- KEEP THEM AFTER YOU HIRE THEM!!

Key Drivers of Engagement (Holleran)

1. Overall, I am satisfied with my job.*

2. I would recommend (Community) as a great place to work.*

3. I think I will be working at (Community) in three years.*

4. I believe (Community) is living up to its mission and goals.*

5. At work, my opinions count.*

6. (Community) cares for its employees.*

7. At work, I have the opportunity to do what I do best every day.*

8. I trust the leadership of (community).*

9. I feel I’m part of a team that is producing meaningful results for the organization.*

10. I feel I personally make a difference here.*

11. I often leave work feeling good about the work I did.*

12. I have friends at work.*

13. I know what is expected of me.*

14. My Supervisor offers positive recognition for a job well done.*

15. This last year, I have had opportunities at work to learn and grow.*

16. The physical safety of employees is protected.

17. Staff issues, including conflicts, are resolved fairly.

18. The workload of my team is distributed fairly.

19. I am given the necessary tools and equipment to do my job.

20. I believe our employees provide residents with the best possible care.

21. I have respect for my Supervisor.

22. I am given training on all the important parts of my job.

23. My performance review is completed and shared with me on time.

24. Communication is good at work, both on my team and with other teams.

25. I am paid a competitive wage compared to similar positions in the industry.

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Millennials Strategies & Preferences

• Value instant feedback on their performance. They do not want to wait for feedback for days, weeks, or until the yearly review, so communicate regularly. Give updates on ideas that were generated, projects that were worked on, and anything else that impacts the facility or employee. working in multicultural settings

• Instead of loyalty to a company, they have a commitment to their work, to the team they work with, and their supervisor.

• Do not like someone looking over their shoulder

• Will not waste time complaining. Will send a resume out and accept the best offer they can find at another organization.

• Prefer a “career lattice” so they can move laterally, stop and start. Their career is more fluid.

• Dislike authority and rigid work requirements.

• Like it if you encourage their creativity and initiative to find new ways to get tasks done.

• They are relationship builders. The need for strong relationships touches every aspect of their life at home, at work, and as consumers. So, assure communication models that include strategies for building "it" together.

• Appreciate a collaborative approach to such things as decision making, problem solving, and product development.

• Want the facility/organization to do well, but they also want to be a strong voice in taking the facility/organization where it needs to go.

• Rather than tell them what steps to take to solve a problem, allow them to brainstorm with you to generate ideas.

• When you need to decide on a course of action, get their feedback on which option to pursue.

• Listen to what they offer and act on their input. Be open to what they say; often their suggestions will amaze you.

• Offer variety. They are interested in equality, flexibility, and a lattice corporate structure.

• Usually not impressed with status symbols such as titles; rather, they want opportunities to learn new skills. When given the choice, they prefer flex hours to a higher salary.

• Like to try new things, so encourage them. Offer them opportunities to learn new skills, to job share, and to assist in projects.

Maun-Lemke Speaking and Consulting, LLC • 8031 West Center Rd, Suite 222 • Omaha, NE 68124 800.356.2233 • 402.391.5540 • Fax: 402.391.1025 • www.maunlemke.com

�• Want increased intellectual stimulation. If you keep them in a rut, doing the same thing day in and day out,

they'll quickly get bored.

• They expect to have the latest technology tools to do their jobs and will not tolerate poorly performing technological systems.

• They like to work in teams, so teaming and the ability to bond with others is core work ethic.

• Not fond of "bureaucratic cultures" and the "double standard" of years past. That’s why leaders should focus on creating a truly team-focused environment if you want them to stay with you.

• They want managers to do more than just manage; they need to work alongside the employees doing the daily activities.

• Like to work on assigned, meaningful teams to complete projects. For each new task or project, rotate the team leader so that everyone has the opportunity to develop his or her leadership skills.

• Allow teams to self-manage. Let them put their expertise to work and see the project through from beginning to end. The more you allow them to be a part of the team and to participate as equals, the more likely they'll be to stay at your facility.

• Be sure to build a strong facility communication process. Some leaders have attempted to create an environment of open communication, but when employees do speak their mind, nobody listens. Therefore, encourage debate and opposite opinion. Get people to open up, discuss problems, and express opinions. Then, put in the processes so the ideas and opinions they have get acted upon.

• They like to text message their friends because it offers instant communication, they expect the same communication speed from their managers. We may have to loosen rigid rules regarding use of cell phones at work, etc.

• Appreciate handwritten cards or electronic messaging with Thank You’s or recognition of a job well done.

• Have FUN at work, they want to love what they do.

• Excited by contests, incentives, and prizes.

• Put yourself in the shoes of the employee to understand their life, what they are going through, and what they need to keep “Life” and “Work” Balanced.

• Know “about” them. You do not have to be their best friend, but it shows you value them if you know something about them.

• Walk the Talk! It does not work to say this is what we are supposed to do or the way we are supposed to act if managers are not leading by example.

Is this really that much different than what employees of all ages want?

Maun-Lemke Speaking and Consulting, LLC • 8031 West Center Rd, Suite 222 • Omaha, NE 68124 800.356.2233 • 402.391.5540 • Fax: 402.391.1025 • www.maunlemke.com

Confidence Sheet

Chapter 3 - Admissions

Maun-Lemke Speaking and Consulting, LLC • 8031 W Center Rd, Ste 222 • Omaha, NE 68124800.356.2233 • 402.391-5540 • Fax: 402.391.1025 • www.maunlemke.comARMS-2.0.0 • Copyright © 2013 All Rights Reserved.

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7 Strategies for Successful Shift Interchange

Cheryl Boldt, RN, LNHA

Shift Report is the most important meeting of the day in a long term care organization. We have participated in and witnessed shift interchanges in a variety of long term care and hospital settings over the past 40 years. It has been an interesting journey in best and worst practices of communication. The best practices shared in this article are aimed at improving communication and teamwork between shifts and even departments.

The method of communication and what information is shared at shift exchange can vary extensively even within the same facility. Nurses share with nurses who may or may not share with CNAs. CNAs may or may not communicate with each other directly as the staff transitions from one shift to the next. There is usually not a well organized method of getting information to team members in other departments. The nurses as leaders need to remember they set the tone for the entire shift. Nurses need to see through the shift to get the desired results for the patients and staff. Here then, are 7 Strategies for Successful Shift Interchange.

Strategy #1. Shift Report is given in-person and includes Front Line StaffIn-person communication is the most effective and efficient and taped shift report usually meets with strong opposition from excellent communicators. Not having to face the oncoming shift in-person does have the advantage of minimizing the chances of having to deal with potential conflict or questions from oncoming staff. In-person shift report minimizes misinterpretation, allows opportunity for clarification, and promotes teamwork. Minimum required attendance at shift report is the off-going Charge Nurse or Nurses and the oncoming Charge Nurse or Nurses and oncoming CNAs.

CNAs need to know everything about the patients they care for and the dynamics of relationships with the patients and families. As Dee, a CNA with Altercare of Mentor in Mentor, Ohio so passionately stated during a shift report improvement initiative, “We are closer to the resident than anybody else. We need to know everything about a resident.” It is surprising the number of nurses who still feel there are many things a CNA does not have to be told. In fact, there is a false belief that HIPAA Rules limit what a CNA needs to know about a resident.

Strategy #2. Start on time with all required attendees presentStaff members the organization has identified as critical participants at shift report must be present and ready to go at the start of the shift in the designated meeting place. This would mean they are not punching the time clock at the shift start time or walking down the hall on the way to the shift report location. Meeting location should allow timely access to the licensed staff if there is an emergency. Nurses must know which staff is assigned for the shift.

Chapter 4 - Rightness


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Strategy #3. The team records attendance and tardiness daily at start timeThe practice of team members taking attendance and even writing names on the board of who is absent and tardy has proven to be a very effective team approach to preventing absenteeism and tardiness. Don’t forget the ever-important element of celebrating success when targeted team goals for attendance and tardiness are set and hit. We want our teams present and accounted for so the shift can get off to a great start! Peer pressure and being accountable to our team members is more effective than using only a central office monitoring process that is frequently delayed in rewarding or disciplining for attendance habits.

Strategy #4. Set an agenda and put a time limit on each agenda itemClearly establish the expectations for the content and time limit for shift report and shift interchange tasks. If we do not do this, the process can end up as varied as the preferences and communication styles of each nurse. Taped shift report started because of our inability to stay on task when in the presence of other human beings. Just think of your team as a sports team who has a limited amount of time for a game starting huddle. The clock is ticking down, the buzzer sounds, and it is time to Play Ball! Here is a sample shift report agenda:

! 7am! Start and Attendance Taken!7:00 - 7:10am! In-Person Shift Report from Off-going Nurse(s) to Oncoming Team!7:10 - 7:15am! Nurse Team Huddle with CNAs and other front line staff!7:15 - 7:30am! Oncoming and Off-going Nurses do Narcotic Count and MAR/TAR Check! ! Oncoming and Off-going CNAs do Rounds as outlined

Strategy #5. Use 7-Day Rolling Logs to drive reportThe key to keeping in person team shift report to 10 minutes or less is to assure we do not run down the entire roster. The habit of going down the roster and mentioning every patient by name and room number and then feeling the need to say just a little something about them has to go away. You know what happens… “Mabel in 101a slept, Gloria in 101b slept, Oh, and did you know her daughter-in-law went to school with my cousin Delores?”… and the report can drone on and on and on.

Shift report should cover stuff that counts. You know, the priorities that really need to be communicated. This includes the status of medical changes in patient condition as well as customer concerns or requests. The status of these issues should all be documented on your 7-Day Rolling Log. These logs can drive shift reports and keep teams on task with priority communication. This tool also helps trigger/remind the staff to document the status of each of these issues. This is also a great format to use for all team members in all departments so they can keep themselves informed throughout the day (and when they return to work after time off). It replaces the old 24-hour sheet process. Any team member can access the 7-Day Rolling Log or add an issue to it. The only rule is that the issue added must be reviewed with the Licensed Nurse so we assure a clear understanding of the issue can be communicated, followed up on, and the pocket care plan and Master Care Plan in the medical record updated by the nurse and team member if a care plan update is indicated.



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The team needs to carry information forward for a period of time that is sufficient to alert all staff to the issue or problem. The standard of practice should be to follow up for 72 hours. This means communication for 72 hours is required. As you experiment with moving information forward for 72 hours on a 24-Hour Report form, you will likely have someone say… “There must be a better way because this gets very confusing.” Thus, the evolution of the 7-Day Rolling Log easily keeps priority issues on the radar screen for 72 hours or longer if needed. There is also a format called a 72-hour rolling log you can use if you are not faced with multiple changes in condition daily.

Strategy #6. Plan for Shift OverlapThe organization determines who needs to overlap and how much time they need to overlap. It is fairly standard to have 30 minutes of shift overlap for licensed nurses to assure time for report as well as MAR/TAR checks and Narcotic Count. Off-going CNAs are customarily assigned the responsibility of covering the unit during the i.e. 10-minute verbal meeting portion of shift exchange. CNA Rounds improve quality of care and teamwork (no shift wars) if critical patient issues (fall prevention approaches) and other issues of mutual concern (things people complain about) are rounded on together and resolved together. Again, the organization determines the amount of time and how the time should be used. Shift overlap was eliminated in many facilities because the time was used poorly. Waiting at the time clock to punch out and standing at the desk complaining about the other shift was not considered a good use of this time. Organizational leaders have been very open to incurring the costs of a shift overlap again if the outcome of improved communication between shifts and departments is achieved on employee and customer surveys.

Strategy #7. Y’all Come!In many facilities, you will find Housekeepers, Laundry Staff, Dietary Staff, Restorative, Administrators, Social Workers, Activity Staff, and Directors of Nursing at various shift reports. This is a “Y’all Come!” philosophy! Why involve some of these other front line team members? Front line staff from other disciplines are valuable members of our teams. Housekeepers, for instance, know a lot of stuff! If you want to know almost anything about a patient, just ask a housekeeper! Savvy Social Workers are talking to housekeepers every day. They can tell you all about who is dissatisfied with the organization or dissatisfied with their roommate. They can help identify signs of pain and depression and tell you all about a resident’s adjustment to facility life, as well as feelings about care and services. We often fail to invite these front line staff who are a great resource into our inner circle of communication. Many of them are also excluded from participation because of our own organizational HIPAA policy. The best practice for front line staff from other departments or Department Managers is to develop a habit of routine attendance. Housekeepers on day shift may come to the early morning report and afternoon housekeepers would come to the afternoon report. Social Workers may find the afternoon report every day to work better with their schedules. The Administrator and DNS should have routine attendance worked into their schedules on all shifts over the course of the month.

ConclusionShift Interchange requires prejudicial directives, support, and monitoring. If you would like to improve teamwork and communication in your organization, take a look at this critical aspect of your operation.



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Pocket Care Plan -Template



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Pocket Care Plan -Example



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7-Day Rolling Log -Template



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“Come with Me ...” Tips on

Playing in the Health Care Sandbox


There are times in our professional careers in healthcare when flashbacks to childhood give keen insight into current situations.

I remember playing in the sandbox with my friends when I was 4-years-old. One of my playmates was “being mean to me” so I ran crying into the house to my mother. Did I mention I had begged all day long to have someone come over to play? My mother’s response was swift and firm. She told me not to tattle on my friends or speak badly of them. She reminded me of how much I had wanted them to come to my house to play. She told me to go back out there and talk with them about what had happened and to work it out. She informed me of the choices I had. I could choose to ask them all to go home and play by myself, or I could choose to go out and talk with them and keep on playing with my friends. She made it clear she would not tolerate any whining or complaining. I did not want to go back outside to confront my friends. I asked Mom once more if she would go out and tell my friends to play nice. She said, “Come with me; let’s go talk with them together.” She did not let me off the hook. Mom coached me as I told my playmates how I was feeling. I do not recall now what had happened, only that it turned out to be quite a small issue blown out of proportion. That was my first lesson in front line problem solving and learning not to escalate the truth.

This same type of passive-aggressive behavior occurs in the workplace today. Adult professionals are tattling or snitching on their co-workers and talking negatively about them behind their backs. It is difficult for many individuals to confront a co-worker respectfully and honestly regarding concerns about work performance or personality differences. Yet, it is very easy to go to the break area and tell 10 other people exactly what drives us crazy about our co-worker who is not there to defend herself/himself. It is also easy to write a note or complain to a supervisor about the person and make it the boss’s job to fix the situation. This type of behavior is below the belt. If you are a co-worker or supervisor who allows yourself to be held hostage listening to these types of complaints or negative comments about co-workers, then you are equally guilty.

The excuses offered for not talking with someone in person include not wanting to hurt someone’s feelings or make them angry. Yes, there is a risk the person may indeed feel badly when you talk with them about the issue. They may choose to get angry, not talk to you at work, talk negatively about you to others… but it is still the right thing to do.

It is important to not confront others in front of a customer or other co-workers. Please try to use “I feel” statements instead of “You always” statements to minimize defensiveness. For example: “I feel when the trash cans are not emptied from the previous shift, it gets my shift off to a bad start. Could we please talk about this and resolve it?” This addresses the issue and does not attack the person. Then take the time to listen to what the other person has to say and try to come up with a win-win agreement. In this instance it may be something like adhering to the facility policy for staff to round with each other during shift overlap to assure work is completed.

Chapter 7 - Leadership Resource Materials, Articles and “Tools”


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This approach does take courage, consideration, and yes, it may take some practice before you feel comfortable with it. You can explain to the person you feel it is better to talk with them than about them. The ball is in their court regarding how they choose to respond to your conversation. If a win-win agreement is not adhered to and the person lets you down, you need to talk with them again about it. If the situation remains unresolved, go with them to a supervisor and talk through the situation. This is better than tattling or snitching to a supervisor, talking about them behind their back, or letting the issue boil up to a bigger problem.

In many workplaces today, the Chain of Command approach is still in effect. For example, if something happens, I go to my direct supervisor who goes to their direct supervisor who may even have to go to the supervisor of another department who goes to someone else in the chain of command… and so on… and so on. This not a time efficient or effective manner in which to conduct the business of resolving concerns among co-workers. The smartest thing leaders can do is empower the front line to work out issues and solve problems themselves so they stay fixed. If leaders are given a problem they will do something well intended, but usually will not find a permanent solution. When you get those closest to the problem involved in the problem solving, the problems have a much improved chance of staying resolved. Yes, the risk of empowerment is that people may make mistakes, so you need to be ready and willing to be a coach instead of taking back total control of the situation.

The next time someone approaches you to talk about someone else… the first words out of your mouth should be, “What did she/he say when you talked with her/him about that?” You may get a deer in the headlights look and a comment about how they could “Never talk with this person” about this, or “Isn’t that Your job?” You can respond by saying, “Come with me. Let’s talk with him/her/them.” The reaction you get will be very interesting. Consistent application of the come with me approach will remind people to be very honest and does prevent escalation of some very minor or even non-existent issues.

If you are a supervisor, inform those you work with and supervise you will no longer take any more notes or conversations in any form that snitch on someone else regardless of the department. Put a sign on your door that says, “Bring them with you when you come.”

Who would have thought Mom’s lessons about playing in the sandbox would be so profound?



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Falls Walking Rounds: Team-Based

Investigation and Action Planning


The last time we all checked, there probably were still only 24 hours in a day. At work we have our 8 or 12 hour shift to git ‘er done as Larry the Cable Guy repeatedly reminds us. A resident/patient fall in a skilled nursing facility or other healthcare location causes considerable distress to the resident/patient who fell, their family, and their team of caregivers. This event also consumes a lot of time that could be spent in a much better way for everyone involved, most importantly the resident/patient.

Healthcare facilities have spent years focusing on what to do to prevent falls and minimize injury from falls that unfortunately continue to occur in our settings. We have fine-tuned the environmental, clinical, and people issues connected to fall prevention and appropriate response after a fall has occurred. Most teams are making significant progress in this area. The hurdle that remains in most organizations is the lack of an organized team approach to this problem when it does occur.

Team-based walking rounds for falls is what some teams have come to describe as proactively reactive. The information revealed sets the tone for continued proactive changes in systems for fall prevention and individualized care planning.

Who is on our Transdisciplinary Team? The resident, the family, the C.N.A., licensed nurse, therapy representative, recreation/activities, dietary, social services, restorative, maintenance, housekeeping, laundry, pastoral care, administrator, DNS, and physician. Wow, that is a very big team!

Think about the current post fall process in your organization. When a fall occurs, the front line working at the time of the fall does a good job of assessing the person for injury, notifying the family and MD; they document the post fall assessment, fill out the paperwork inclusive of the event report and dutifully place said form in the appropriate box, file folder, clipboard, or under the appropriate door. There is a chance that there was even an action taken to prevent recurrence, usually in the form of an environmental approach such as an alarm, mat at the bedside, low bed, or maybe an educational approach. We are grateful when the front line takes action in a timely fashion. The action taken will meet the requirements until the person responsible for oversight of this system gets to work the next day to assure the investigation, i-dotting, t-crossing, and care plan updates to prevent recurrence are done correctly and completely. The person charged with this responsibility may lead a weekly or daily team conference regarding the fall. This person might contact team members not present at this conference to update them on the fall, ask them how they can help, and inform them of what others are doing to prevent another fall. It is not surprising to learn that each fall takes a minimum of 2.5 hours of collective staff time to assure the correct assessment, documentation, communication, investigation, action, and follow up has occurred. The problem related to a post fall process done in this manner is that it is fragmented and frequently ineffective.

Falls Walking Rounds needs to be a daily habit. It is sufficient to have the rounds on Monday through Friday to get consistency. Each day, the team will review the fall(s) from the previous day. Friday, Saturday, and Sunday falls are reviewed on Monday. The reason this works is that, if your team routinely



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has many falls to review on a Monday, it is very time consuming. The risk prompts teams to temporarily or permanently implement a process on weekends.

All team members mentioned above attend. This large group of professionals takes the medical record, the event report, and walks to the resident/patient. Note the difference here from team members at varying times in varying locations discussing the fall with or without the chart and with or without the resident/patient in their environment. The fragmented approach makes teams feel as if they are chasing their tail.

An organized approach includes the identification of a daily time for these rounds to occur. Effective Meeting Rules apply. Establish a start time and end time. Most facilities are now averaging 15 minutes daily, but no longer than 30 minutes. There are often days where you do not have rounds because nobody fell. Teams have established a rule of 5 Minutes per Resident or maybe even 10 minutes per resident as they get started and establish a rhythm. They determine where the team will initially gather, who will bring the medical record, who takes attendance, who takes the notes, who will document in the Interdisciplinary Progress Note and update the care plan, and who is the timekeeper. Detailed planning and adherence to meeting rules results in good participation. We do not have time to waste, and team members will be more likely to not attend if the meetings are not well run. The Administrator must hold all team members accountable for showing up and taking an active role. Varying team members may otherwise not feel obligated to attend because the fall process owner is not their boss. Each team member has a role, which may overlap the roles of others and indeed the expertise of others. For instance, maintenance checks w/c and bed brake function, bed rail or bath grab bar security, call light function, and lighting. The housekeeper would look at room layout, clutter, and the condition of the floor (housekeepers know a lot about the resident/patient). The C.N.A. would review the current plan of care for compliance. The dietary representative looks at lab results and nutritional/hydration status. The nurse reviews any changes in condition and medication, inclusive of pain management and urinary status. The therapist looks at positioning, function, and devices already utilized; the social worker at behavior, depression, and socialization needs. The activities professional reviews the need for individualized meaningful life activities; the restorative staff at the success of current restorative programs. Never underestimate who will notice what on any given day.

Rarely is the resident/patient overwhelmed by the presence of this large team if you set up the scenario correctly. Explain the team’s concern about identifying the cause of the fall and doing what it can to prevent more falls; and do this in advance of entering the resident/patient’s room. HIPAA rules apply, and most teams look at this just like they do if a physician is going to see a resident in their room. If your facility’s HIPAA Policy precludes team members such as housekeepers and maintenance to have access to clinical information, change it; it is your policy.

The beauty of this process is the efficiency and effectiveness of a team-based approach to identifying causal factors, action to be taken to prevent recurrence, and establish if there is any evidence of abuse or neglect. The involvement of all disciplines results in a well-rounded knowledge of overall fall prevention approaches for individual residents.

This process can be expanded to include other events such as transfer to hospital, skin tears, bruises, burns, elopement, pressure ulcer identification, and other events which occur and demonstrate risk to resident care and safety. Other weekly meetings can be rolled into daily Walking Rounds when the process is fine-tuned.



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Documents

RECRUITMENT ACTIONS AT THE LOCAL LEVEL