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 DE 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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