Training the Staff
As new nursing staff members begin to work, I will often introduce myself to them and explain that certain patients would need pain medication prior to therapy. One nurse I spoke with told me he had assessed pain on several people and they did not want to have anything for pain. The brief conversation went something like this.
"Can we get these people medicated prior to therapy?" I asked, showing him a list of patients.
"I already assessed pain on some of these people and they did not want anything for pain," the nurse replied.
"Did you get the patients up out of bed to assess their pain?"
"No, why would I do that?"
It is easy for patients to say they are not in pain when they are not moving and snugly in bed with the blankets tightly wrapped around them in an 80-degree room. The moment a therapist comes in and assists/instructs the patient with bed mobility or LE exercises is when the pain will begin. To be fair, most veteran nurses will accommodate their schedule of "passing pills" to ensure therapy patients are properly medicated, because they know orthopedic patients will require something to decrease their pain level during therapy.
It is the new nurses we end up having to educate the most. Hopefully they have been through a good orientation and realize that therapy is the most important aspect of a SNF, so therapists always come first when a request is made. (I am joking, people). However, since therapy makes the facility money through reimbursement of our skilled services, our requests for pain medication should not be curtailed or delayed because it could cost the facility in lost revenue.
Other aspects of training nursing staff include ensuring patients have footwear available (socks, shoes, non-skid socks etc.), cups at their sink, towels, briefs and wipes (if appropriate), as well as enough blankets. Often I am delayed in my schedule and skilled treatment of patients because I end up walking to the other end of the facility to the laundry room looking for clothes and socks for the patient. All of this is non-billable time for patient care and if I do this with three patients, the time adds up -- especially if the laundry room is locked and I have to look for someone to unlock the door.
Fifteen minutes times three equals 45 minutes in lost patient care time that could be used as a treatment of another person to reach a higher RUG category, which will equal more revenue for the facility. A domino effect can easily take place, but as therapists we can stop it before it begins by educating the nursing staff about what we want and especially why we need it. And if the bottom line is involved, everyone understands the color green.