In our facility, we wanted to restart the Restorative Nursing Program to keep our patients at their highest practical level, to be proactive with declines and to capture appropriate resources being provided to patients. Due to high turnover on the nursing team, as well as nursing leadership, it became a challenge to keep the program alive at our facility. With a new Director of Nurses hired, it created an opportunity for us to cultivate a partnership with the nursing team and revamp the program to the benefit of our residents.
We identified the following problem areas:
- The therapy department did not have a specific system to identify appropriate residents to refer to this program.
- The RNP was not properly trained in how to carry out the program.
- The therapists were uneducated on how to create recommendations for clinically appropriate patients to the nursing team.
- There was a lack of communication between nursing and therapy about who was on the program and who might need a referral.
We then implemented several solutions:
- Identify significant changes in function through reports in PCC and review weekly.
- Meet with the MDS Coordinator weekly to determine referrals through MDS reports.
- Meet with facility staff weekly to discuss any changes, including declines or improvements.
- Implement therapy discipline-specific quarterly screens and ROM screens.
- Train each patient we refer to this program through one-on-one restorative training and additional trainings throughout the year.
- Train therapy team in how to appropriately screen patients and make referrals to the Restorative Nursing Program.
- Create a culture of therapy, Functional Maintenance Program, Restorative Nursing Program or activities, involving all patients at our facility in at least one of these programs.
- Get behind the program and drive the bus, not allowing others to get complacent and quickly fixing issues that arise. Instill confidence in those who provide the program and those who refer to it.
Outcomes
Once our facility put systems in place to identify appropriate patients to refer to this program, we added two full-time restorative aides to provide restorative nursing six days per week. Since then, our residents have increased socialization through this program and have experienced shorter length of stays on therapy services. Due to continual staff education, nursing is more aware of how therapy can help. When there is a decline or an improvement, the therapy department receives more timely notifications.
Additionally, we have an increased Medicaid rate due to the facility being able to capture the additional resources being provided to the patients through the robust utilization of this program. This has allowed the facility to pay for the additional full-time restorative nurse aides and helped shift burden off the primary caregivers (certified nurse aides).
By Stephany Kozeny M.A. CCC/SLP and Mandi Kelly LVN RAC, Wellington Rehabilitation and Healthcare, Temple, TX