High temperatures

This past week I came across a situation that happened several months ago, in which a resident was running a high fever 102.6 he was left alone in his apartment and was not checked on all night. He experienced a fall, laid on the floor and was not found until the next morning several hours later. The caregiver who took the resident's temperature failed to intervene by not calling the facility nurse to report the high temperature, by not assisting the resident to get his Tylenol and by not checking on the resident to see that the temperature was reduced.
Orientation and training of facility policies and appropriate protocol for staff are so critical. Had the caregiver received the orientation and training that is required the outcome for this resident may have been prevented.
Also the facility managerial staff failed to do an investigation of the fall. If the investigation had been completed it would have come to light that this employee was lacking completion of the orientation.
The investigation should have included the who, what, when where, and why of the fall, the actions of the caregiver, and an evaluation of the training of the caregiver. Development of appropriate strategies to prevent the situation from happening again was also indicated.

Thursday Thirteen Edition #6 Suggested steps for an investigation by staff in an Assisted Living Center

13 steps suggested for an Investigation for food borne illness

1. Select a number of residents from the total number of residents who became ill; review their records for documentation of when the symptoms started and when they stopped.
2. Determine the time frame to be investigated.
3. Examine the dishwasher. Is the dishwasher cycle reaching 165 degrees for hot water temperature dishwasher? Is the dishwasher chemical dispensing system dispensing adequate amounts of chemical sanitizer to register adequately on the test strips? Check the dishwasher logs for the time frame being investigated.
4. Are the dishes clean after being processed through the dishwasher?
5. Is the dishwasher operating as it should according to the manufacturer’s directions? If staff are having to manually turn on and off the water to the dishwasher something is not operating correctly.
6. Examine the hand wash sink and the supplies staff use to wash their hands. Is the sink functioning properly? Is there adequate soap and paper towels?
7. Observe the food preparation process used by the cook. Is the cook following safe food rules? Changes gloves between different tasks? Was left over hot food cooled with in the parameters of safe food handling?
8. Are staff properly washing their hands the required length of time and using correct technique? Changing gloves when appropriate?
9. Review the meal menus, the actual food that was served to residents during the time frame being investigated. Was the food obtained from an acceptable food vendor?
10. Review food temperature logs for the dates and food that was served to residents during the time being investigated. Was the food cooked to the correct temperature? Check the thermometer being used; that it is functioning according to manufacturer’s specifications.
11. Review staff schedules for staff that worked and were in contact with the residents or the residents’ food in the sample of residents. Were any of the staff sick and if so what were their symptoms? If staff called in sick what were their symptoms and when did they start?
12. Review the facility’s policies for infection control. Did staff follow the policy? Does the policy/procedure need to be updated?
13. Analysis your collected data and determine follow up action based on the data.

Thursday Thirteen Edition #5

Thirteen suggestions to investigating falls or incidents involving residents
1. Ask the resident involved what happened - write down verbatim what they say.
2. Inquire if anyone in the area witnessed the incident or heard anything. Write down who you talked to and what was said with the date and time.
3. Survey the environment where the incident happened.
4. Make a list of possible contributing factors, such as time of day, lighting, temperature, activity prior to incident etc.
5. Review resident's diagnoses and allergies.
6. Review resident's medications. Are there any new medications causing interactions? side effects?
7. Interview family members. They could know a piece of the puzzle and not realize it.
8. Interview the person that completed the report.
9. What was the mental/emotional status of the resident? Were they upset prior to the incident, are they experiencing confusion?
10. Was the resident doing something out of the ordinary? If so why?
11. Evaluate the data. Can you answer WHO, WHAT, WHERE, WHEN, WHY.
12. Was the incident caused by lack of knowledge or skill of the caregiver?
13. Develop preventative strategies based on the evaluation and data of the investigation.
This is just a starting point of suggestions. Doing an in depth investigation requires time and experience.

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