Weekly RN Report to Management

Senior Housing Management

Weekly RN/DWS Report to Management

SOP# N152 Revision 3

Effective Date: 11-16-07

Prepared by: DCH Approved by: CAM

FACILITY NAME: WEEK ENDING DATE:

(RN Wellness Coordinators, Complete this page weekly and forward to and

Resident Transfer Section

Residents movement; (circle resident travel pathway with number order) Emergency Room (E), Hospital (H), Skilled Nursing Facility (SNF), Nursing home (NH), Returned to your Facility (C), Death (D)

Circle all that are true for each resident; exampl; (Resident to ER (circle E-1st), admitted to hospital (circle H-2nd) then to Skilled facility (circle SNF-3rd,) Returned to your facility (circle C-4th)

Apt # Name Location Reason Expected return date

E H SNF NH C D
E H SNF NH C D
E H SNF NH C D
E H SNF NH C D
E H SNF NH C D

Falls Summary Section

(Record only those falls that require emergency transport for MD assessment)

Falls total/week
/ Fall injury type; Head trauma, Hip fx., skin tears, arm injury.
1)
2)______
3)______
4)______
5)______ / Plan to address fall for each resident listed (example; PT for strengthening)
List any special events to address as preventive measures
1)_ Plan:
2)_Plan______
3)_Plan______
4)_Plan______
5)_Plan______

Community Name: Report for Month of ____, 2007

RN’s include this page with the last report for the current month

MAR Management

Alternate Measures Flow sheets in use for PRN medications:

Number of Meds DC’D for non-use in 60 days: ______

Pain management section

Residents using Narcotics for pain control:

Complex Pain management; (example; more than 14 PRN pain meds used in a month, or 3 or more pain meds in use)

Apt # Name Type of Pain management challenge

Wound Care Section

Report only skin condition events as repeat skin breakdown occurrences over the last 3 months

Apt # Name Type of condition Home Health Involved

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