Daily Skilled Nurses Notes Example: Fill & Download for Free

Let us take an Example, this is Rakbar Khan, he was 29.He was caught stealing cattle in Alwar where villagers handed him to police, unfortunately he died of health complications in custody.The Photo is when he was in Police custody after villagers handed him overThe reason behind this death is economic?Why?He has 7 children, 4 sons 3 daughtersPoints to be noted:He was married at 16 to a 15 year old.His wife gave birth to first child when she was 16.He and his wife has produced 7 kids in 13 yearsThis when he is uneducated and daily wage labor with no land or skillsAnalysisHis children and wife both are malnourished since she is giving birth from childhood continuouslyHe does not have means to feed his large family so turned to crimeThe kids will be prone to diseases due to poor health and have zero opportunity to grow and will become child laborIf they utilize any government subsidy, it will be a loss of honest tax payer since they deliberately had a large family, also government schemes don’t cover more than 2 children in most casesThese kids will have high mortality, will have child marriages, more kids and may again turn to crime and even radicalizationLarge population is not a issue to a limit when we have large number of small families not when we have large number of large familiesEven if you have 5 percent Rakbars in each village who produce kids like anything, no amount of growth can help bring true progress and development, and will lead to crime, disease and poverty.Edit -The centre, evaluating India's minority policy and Muslim community's social and economic status, said the population in Kerala rose to 3.34 crore in 2011 from 3.18 crore in 2001.Giving a break-up of the increase in population in the state during the period, the report said the Muslim population grew by 10.10 lakh, Hindu population by 3.62 lakh and Christians by 84,000.Hindus constitute 54.9 per cent of the total population in Kerala, Muslims 26.6 per cent and Christians 18.4 per centKerala Muslims economically better and literate, population growth rate higher: ReportEdit 2 - This is the reaction of a MP when Assam government recently decided to make Assam government job eligibility as only two children to encourage family planningBadruddin Ajmal,All India United Democratic Front chief on Assam govt's decision that people with more than 2 children wouldn't be eligible for govt jobs:Islam doesn't believe in the concept of having only 2 children. No one can stop the people who're bound to come to this world. pic.twitter.com/CdkwqIZUt0— ANI (@ANI) October 27, 2019Edit 3 - People have commented that education will help in better family planning.A Malayali nurse who worked at AIIMS in Delhi breathed her last on Christmas Day after a prolonged battle with breast cancer. 43-year-old Sapna Tracy, who had been working at the pulmonary ward at AIIMS for the last 19 years, was diagnosed with third stage breast cancer in 2015 – but Sapna and her family chose to delay the treatment that could have saved her life.The reason: Sapna was pregnant for the eighth time when she was diagnosed, and as a pro-life nurse from a catholic family, she decided to keep the foetus, putting her life at risk, instead of opting for an abortion.Death of Catholic mother of 8 who delayed cancer treatment, and the abortion debateHer Religious zeal trumped her education

I rushed into a patient’s room and asked my preceptee (who was in his final shifts of his 12-week preceptorship) “you didn’t give that Lovenox yet, did you?” He raised his hand up from her abdomen, empty syringe in hand, and proudly announced that he just administered it. This was in the morning, within an hour of getting report on our 6 patients, and we were under pressure to hurry and give meds to this particular patient so she could go to surgery. ….Yep. Surgery.Needless to say, I had to report the med error to my facility, the surgical team, and the patient. The surgery had to be postponed for another day. It came along with all the shame and guilt you can imagine.There is a 6th Right: Right Reason. Every med must be considered for appropriateness by the nurse. Just because it was ordered by a physician, approved and provided by pharmacy, and scans in without flagging any warnings from our EMR systems, our critical thinking while serving as the last line in the med admin process VERY often catches near-mistakes. It is exceptionally rare (if ever) that a nurse makes it through a shift without challenging legitimately the appropriateness of one or more meds on the list of dozens of meds they are assigned and expected to administer. There are many potential weak spots leading to this. For example, the ordering physicians to think ahead and discontinue inappropriate meds for the patients’ upcoming treatments. Sometimes this is just due to having multiple physicians on the case, and the left hand doesn’t know what the right hand is doing. In this case, for example, the attending physician ordered the standard Lovenox daily for DVT prevention, but the surgical team scheduled the patient for surgery, the patient was scheduled for surgery but pharmacy doesn’t check for such things and the EMR system is also not associated with this detail, so there it is: the lovenox is Ordered, Approved, Provided, and on the Scheduled Med list on EMR. Some other examples of such disjointedness that is 99.9% only caught by the astute nurses’ critical thinking skills (using the 6th Right): meds that will be dialyzed out, PO meds for newly NPO patients, standardly ordered meds despite symptoms making those meds contraindicated (i.e. stool softeners for a patient with diarrhea), and let’s not forget that sometimes we are trying to provide patients with the meds they would have taken at home but they were unable to provide accurate info to begin with so they end up being given our best guess at what is the intended med and dose of their fill-in-the-blank med.Another common reason is that in healthcare, the only constant is change. A real pet-peeve of mine on Cerner and/or paper charting specifically is not being flagged that an order has changed. For example, I see on the EMR my patient is scheduled to get antibiotic A in a few minutes. I obtain the med, which is dispensed to me. I scan it and administer it, only to catch later that just prior to admin of antibiotic A, a physician ordered that A should be discontinued and antibiotic B should be given instead. The time lag before pharmacy reviewed it and Cerner and paper charting are infamously incapable of effectively alerting us to this new order in real time. Another thing about Cerner and paper orders are that these formats make orders VERY easy to miss. After my current job, I will not work for another facility with either of these unsafe systems. A “med error” I got written up for was that I missed an order to give a Gatorade to an NPO patient an hour before her surgery (now I’ve learned that this surgeon carb loads PO prior to his surgeries). I didn’t see the Gatorade order because it was visually lost to me in the several dozen same-font, cluttered and disorganized listing of orders, not to mention it contradicts the surgeon’s NPO order AND wasn’t looking for such an order because it was so unusual. That was the first Gatorade order I’d ever had in my nearly 14 years of nursing. So, now I’m bitter about the write-up, grossly frustrated and disappointed in the ordering system, and highly anxious about the huge potential for more serious mistakes (and anxiety and other negative feelings makes a human even more prone to making a mistake). It is, indeed, maddening.Punitive work cultures, communication issues between humans, and information system failures to alert the nurse of real-time results can also lead to med errors. I reported myself mid-shift when I realized I missed a normal-valued lab result that I had no idea was even drawn (thinking from the prior nurses’ report that it was a lab not due until near the end of my shift). I should have responded to this lab result with a very sight adjustment in a drip. I informed the patient, the physician, my charge nurse, and my facility via an incident report of the self-caught error. I’m confident had I not caught it myself that no one else would have, either, and according to my colleagues “should have just kept my mouth shut about it.” Ethically, I felt obligated to hold myself accountable, but I got written up for this med error. This further increases my anxiety about the potential for making errors and my resentment at having to work with an info system that has much to be desired in the prevention of med errors. We are asked, and indeed expected, to write incident reports on all deviations from the norm of care so the system can identify patterns they might be able to prevent in the future, but with a punitive culture (and having so much documentation required already that we are lucky to be able to clock out “on time”) …it’s just unrealistic to think all errors and near-misses are even documented.Being late with a med is a med error. This is very common, though, for any number of reasons. During med pass, patients will need help to the bathroom, food/drink needs, calls for unscheduled meds they need urgently, family members and patients have questions to be answered, the meds you are supposed to give are not prepared yet or simply can’t be located, unusual vital signs and lab results need to be called to the doctor, and the list goes on and on…. And there you are, nearly every shift something will be given late to someone. Bam! …Med error.An easy “trap” to try your darnedest to avoid is drawing up the correct dose a partial med (pill that must be split with a device, partial IV med vial…) while also administering a multitude of other meds AND while being almost constantly interrupted. Good luck with never making an error with odd doses in the midst of the turbulence of med passes on a busy hospital floor. Keep in mind, too that we are performing all this multitasking and critical thinking in a noisy, socially exposed environment, listen out for safety concerns, and have to pleasantly smile while adhering to every policy in all we do.The last example I’d like to mention is common: the nurse takes all the steps to set up the primary and secondary lines to administer an IV med as a secondary, but the clamp is closed. Of note, I can’t think of a nurse that hasn’t experienced this med error at some point.Not one physician, pharmacist, EMR system designer, or nurse wants to have any part of a med error. In fact, the extreme anxiety of the potential to make errors and the shame and guilt when errors are made contribute greatly to the woes of our professional community. I don’t see true resolution to widespread, common med errors until and unless we create and implement systems/technologies which allow crystal clear communication between all professional disciplines involved in actual real-time.In order to survive with your sanity intact, learn from the mistakes of others, be as proactive as possible about reviewing orders over, and over, and over again, learn about your physicians’ particularities, ask tons of questions of the more seasoned nurses around you, learn about coping skills such as mindfulness to be able to face the fact that there will be times you will unintentionally make mistakes, form the best habits possible to minimize your risks of making mistakes (watch that your IV med is actually dripping so you know that clamp is open), and listen to your patients! They will help you more than any EMR or electronic ordering system with checking the 6 Rights. If they are questioning the reason for a med, then you should pay special attention to questioning it, too.

Are you afraid that your hospital stay won’t be covered by your Medicare plan? Medicare covers hospital care under Part A.Medicare Part A includes hospital care, care received in a skilled nursing facility, hospice care, and limited home health services. Note that there are limits on what Medicare covers for these services.Basic care included under an inpatient hospital stay are a semi-private room, meals, general nursing, drugs administered in the hospital, and other services and hospital supplies.Understanding Medicare Part AMedicare Part A covers inpatient care. You will probably be automatically enrolled in Part A whenever you turn 65. If you are not already enrolled in Part B and need to enroll manually, you can do so during your initial enrollment period, which is a six-month window that begins three months before you turn 65.Part A deductibleThe Part A deductible is the amount you’ll have to pay before Medicare starts covering your hospital bills.The Part A deductible for 2021 is $1,484, and applies to each benefit period rather than calendar year. A benefit period in Part A begins the day you’re admitted to the hospital and ends when you haven’t received any inpatient for 60 days in a row.Part A CoinsurancePart A coinsurance is the percentage of your hospital costs that you are responsible for. A Medigap plan can help cover these costs.If you are admitted to the hospital, you will pay the following coinsurances (or percentages of services) in addition to your deductible:Days 1 – 60: $0Days 61 – 90: $371 per dayDays 91 – lifetime reserve days: $742 per day until you have used up your 60 lifetime reserve days (you get 60 lifetime reserve days over the course of your life)Beyond lifetime reserve days: all costsThe same coverage and costs apply to a mental health hospital, but you will have to pay an additional 20 percent for Medicare-approved services and treatments.After a benefit period has ended, your benefits will start over. If you are readmitted to the hospital after going more than 60 days without receiving inpatient care, you will have to pay your deductible again, but you will also not owe any coinsurance for the first 60 days.Part A skilled nursing facilityIf you are admitted to a skilled nursing facility, the daily coinsurance rates are:Days 1 – 20: $0Days 21 – 100: $185.50 per dayDays 101 and beyond: all costsAll coinsurance rates for skilled nursing facilities are subject to benefit periods.What’s not covered?Medicare doesn’t cover everything, so you may have to pay out of pocket for certain services. Even if Medicare covers the costs of a service or piece of equipment, you will most likely still have to pay your copayment, coinsurance, and the Part A deductible, which is $1,484 in 2021.Some examples of services that Part A does not cover are:A private room (unless medically necessary)Private-duty nursingPersonal care items, like razors or slipper socksExtra charges, like a telephone or TV in your roomNon-donated bloodMeals delivered to your home24-hour-a-day care at homeHomemaker servicesPersonal careCustodial (long-term) careTalk to your doctor to find out specifics about what Medicare won’t cover.Important terms to noteLifetime reserve day- A patient gets only 60 of these over their lifetime. These are any day over 90 days in the hospital, and hold a higher coinsurance rate.Benefit period- A benefit period in Part A begins on the first day you’re admitted to the hospital and ends after you’ve spent 60 days in a row out of the hospital.Source: medicareworld.com