| As resident acuity levels increase, assisted living | | | | When it comes to medication management, a host |
| providers must keep close tabs on the services they | | | | of clinical issues center around administration errors, |
| provide to steer clear of litigious situations. Assisted | | | | delegation and training, medication review (especially |
| living isn't what it used to be-and that's not a bad | | | | psychotropic medication), and a resident's right to |
| thing-but it does mean that providers must be more | | | | refuse medication. Community policies should be clear |
| diligent about how they deliver their scope of | | | | on medication management and the resident's right |
| services. Residents' rising acuity levels, including | | | | to refuse. A physician's order for every medication |
| increases in their co-morbidities, chronic diseases, and | | | | should be readily available and include all the required |
| behavioral challenges, have caused the once | | | | information regarding dosing and administration. |
| universally accepted social model of residential care to | | | | Medication administration training should be thorough |
| evolve into a model that must provide higher levels | | | | and in accordance with the state's regulatory |
| of specialized clinical care. | | | | guidelines. |
| With this evolution comes an increased responsibility | | | | Providers also should consider random |
| on the part of assisted living providers to meet the | | | | community-level audits of medication administration |
| medical and clinical needs of their residents. However, | | | | records. This will help expose medication |
| it also exposes them to more legal risk if they are | | | | documentation shortcomings, such as medication |
| not strategic and detail-oriented about the services | | | | documentation errors or omissions and inaccurate or |
| they provide and how they provide those services | | | | inappropriate documentation of medication |
| to residents. | | | | administration holds or refusals. |
| Assisted living communities, of course, are regulated | | | | Nurses in Charge With more and more nurses being |
| in every state. But whatever the regulations require, | | | | hired into assisted living companies as managers, |
| it's clear that when armed with strategies to combat | | | | clinicians, and supervisors, another emerging care |
| negative resident outcomes associated with common | | | | issue is nurse delegation. These issues usually center |
| adverse clinical events, assisted living providers can | | | | around medication administration, but can also impact |
| take proactive, rather than a reactive, approaches to | | | | resident care where a particular treatment is |
| resident care-and this will help them minimize litigious | | | | delegated. Nurse delegation is generally a creature of |
| situations. In that vein, there are two clinical issues | | | | state statute and regulation, but key to its successful |
| assisted living communities must pay close attention | | | | implementation are an understanding by both the |
| to in particular-fall prevention and medication | | | | nurse and the delegated caregiver of what the |
| management. | | | | delegated task is, an appropriate level of supervision |
| Double-Duty Documentation Whoever said, "nothing | | | | and monitoring, and documentation of the delegated |
| is certain but death and taxes," didn't get it quite | | | | task. |
| right. The quote should be, "nothing is certain but | | | | Again, thorough and detailed documentation is critical |
| death, taxes, and the fact the residents will fall." | | | | to not only providing appropriate care, it also is |
| It is of course important to develop a system for | | | | important as it pertains to regulatory and legal issues. |
| preventing resident falls, but when it comes to | | | | And here the old nurse's adage rings true and that is, |
| staying out of litigious situations, it is equally as | | | | "if it's not documented, it's not done." Detailed |
| important to thoroughly document detailed | | | | documentation preserves the record, serves as a |
| assessments about why the resident fell or has fallen | | | | communication tool, and can insulate against |
| multiple times. Is the resident falling on the way to | | | | regulatory and civil legal liability. |
| the bathroom during the night shift? Is the resident | | | | In the current model of assisted living, identifying key |
| falling routinely at sunset? Is the resident falling near | | | | clinical issues affecting residents and taking proactive |
| the kitchen in the afternoons? Does the resident | | | | approaches to those issues not only enhances the |
| appear to be over-medicated? This kind of analysis | | | | quality of care and quality of life for residents, it |
| not only helps hone appropriate resident-focused | | | | gives providers the ability to better meet the needs |
| care, it also serves as verification that the assisted | | | | of those residents while reducing their potential |
| living community took the appropriate steps to care | | | | regulatory and civil liability. |
| for the resident and remedy any risky situations. | | | | |