[CampbellSoupCan]

My agency gets many referrals for SNV to provide wound care to stasis ulcers, from doctor's office. This doctor's nurse also works for our Home Health agency. So a bunch of our business comes from this nurse's referrals. I admit the pt, call this doctors office to verify orders with this nurse, and here is what I am told" oh that wound will never heal, because of the pt's poor circulation, but here is the wound care bla bla bla." I schedule them for wound care, and discharge them in about 15 visits( as I have been told to do). Any more than 15 visits, and the company loses $$$.-My point is, I don't think we should take patient's that we know have a poor chance of healing and waste M'Cares money. Am I wrong to be upset about this ?

[caliotter3]

Although you may be justified in feeling the way that you do, it is the responsibility of your agency's business or general manager and Director of Clinical Services to set the guidelines for what type of business they will accept. There may be a professional difference of opinion as to the appropriateness of this care, so I would not be hasty in reporting your misgivings. They may not be operating out of established guidelines. You might want to talk to these people about this and see what they have to say about it.

[yayanurse]

Take away that the nurse also works in a doctor's office....if the patient is still eligible for the services then I do not see a problem. It's a small world in the medical community and nurses frequently work for more than one employer. It's good that the doctor thinks highly of the care that your agency provides that you get repeat business.

[DutchgirlRN]

Originally Posted by CampbellSoupCan

I admit the pt, call this doctors office to verify orders with this nurse, and here is what I am told" oh that wound will never heal, because of the pt's poor circulation, but here is the wound care bla bla bla."

Does this agency have a CWCN Certified Wound Care Nurse? Is the statement that the wound will never heal coming from the nurse and not the doctor? If a doctor orders wound care and it's within Medicare's guidelines then there's not a problem. We have seen patients with stasis ulcers, determined they will not heal with wound care and have referred the patients to a surgeon who was able to close the wound.

Sometimes you have to go around the corner to get next door.

[Homie]

Most stasis ulcers heal, and re-open eventually...nature of problem. How quickly either the healing or recurrence happens varies with each patient and what they are going thru on many levels. I firmly believe that sometimes patients benefit from a change of view...and find that most ideas on wound care changes are accepted in good spirit (most times...not all times!!) Sometimes the patient has a change in status making it difficult to travel for care, and needing HH due to a Homebound status occurence.

I like DutchgirlRN's comment about having to go around the corner to get next door!! Well said...

I like anyone who is willing to ask for someone's thought as to "why" a thing is occuring the way it is...before they pull the trigger!!