[illinoislpn]

I work for a home health agency, we do mostly medicare patients.
The RNs are supposed to do Start of Care Assessments, Recertification assessments, Transfer and Discharge assessments.
The OASIS forms that need to be filled out ask the discipline of the person filling out the form. It lists specifically, RN, PT, OT, SLP/ST.
It does not have LPN listed. I have been "asked" to do these assessments, and "Just give it to the RN, she will put it in the computer". Some of the forms require the signature and title of theperson filling out the form. I was told "Go ahead, do the assessment and sign the form, the RN will countersign, our LPN in Anytown does."
The LPN in Anytown is also entering them in the computer, but there again, before you can put in the assessment, it asks the discipline of the person entering the info, LPN has to check that discipline is RN, even though LPN is entering info.
My question is...What are the legal ramifications if I fill out a form that CLEARLY states RN, PT, OT, SLP/SP are the discipline doing the assessment? Wouldn't I be representing myself as a RN? Or am being too anal ?

[NRSKarenRN]

Originally Posted by illinoislpn

Can LPNs LEGALLY do recerts ,transfers, and discharges using OASIS?.

NO if Medicare/Medicaid patients

Standard: Initial Assessment Visit

The regulation for the initial assessment visit set forth at proposed § 484.55(b) (now § 484.55(a) in accordance with the reorganization scheme discussed above) required that a registered nurse perform an initial assessment visit based on physician’s orders to determine the immediate care and support needs of the patient either within 48 hours of referral, within 48 hours after patient’s return home, or within 48 hours of the physician-ordered start of care date. We proposed that when rehabilitation therapy services are the only services ordered by the physician, the initial assessment would be made by the appropriate rehabilitation skilled professional....

...We do not believe the comprehensive assessment can be completed by the licensed practical nurse in accordance with the COPs. The introductory text to § 484.55 requires that the comprehensive assessment meet the needs of the patient and include information on the patient’s progress toward clinical outcomes. Thus, completing the comprehensive assessment involves an evaluation of the patient. In the current conditions of participation, patient evaluation is included in the duties of the registered nurse at § 484.30(a) and therapy services at § 484.32, but is not included in the duties of the licensed practical nurse at § 484.30(b). In response to comments, we have revised § 484.55(b)(2) to require that the registered nurse complete the comprehensive assessment.

...
Section 484.55(d) addresses the update of the comprehensive assessment. In this standard, we proposed to require that the comprehensive assessment must include information on the patient’s progress toward clinical outcomes, and be updated and revised (1) as frequently as the patient requires but no less frequently than every 62 days from the start of care date, (2) when the patient’s plan of care is revised for physician review, (3) within 48 hours of the patient’s return home from the hospital, and (4) when the patient is discharged. The comprehensive assessment updates must include the appropriate OASIS items as indicated on the data set...http://www.cms.hhs.gov/OASIS/Downloads/collection.pdf

Bottom line, am I being asked to do something illegal? Would my license be at risk?

YES as practicing outside scope of practice in Illinois, especially IF these are Medicare/Medicaid patients.

Section 1300.APPENDIX C Minimal Skills List for Licensed Practical Nurses

The minimal skills for licensed practical nurses taking remedial education in accordance with Sections 1300.35 and 1300.41 are as follows:

a) Nursing Care Plan
Participate in the collection of data with the registered nurse to assist in developing a nursing care plan.
http://www.ilga.gov/commission/jcar/...0ZZ9996cR.html

Not in place of the RN.

Medicare fraud phone line: HHS fraud watchdog line at 1-800-HHS-TIPS

Feel free to give a copy to your boss, if new to homecare they may not be aware of the regs.

[sharona97]

Maybe explain to them the form needs to be changed, it's your signature and license. I would feel the same way. It will probably come back to bite you , but if a change for the positive is made, you've done a great service to your workplace. IMHO.

[illinoislpn]

You were right, it did come back and bite me, I got "suspended" today, because I have a 50lb weight restriction, Funny thing is,...they knew that when they hired me 3 months ago, (I will probably receive the axe on Monday.) My weight restriction was never a problem UNTIL I refused to fill out the OASIS assessments.
That's okay, I really don't want to work for someone who would do that anyway.

[DutchgirlRN]

A reputable HH agency would never ask you to fill out an Oasis. Glad you got out of that situation. There are reputable HH agencies out there who play by the rules. Best of Luck to you.

[illinoislpn]

They are aware of the regs, they just choose to interpret them differently. They say I can do any thing OASIS wise as long as the RN countersigns it. That's not the way I read it.
SO, NOW I was "suspended" because I have a 50 lb weight restriction.
I fully expect to be terminated Monday.
My employment physical says I can't do heavy lifting. Funny, this was not an issue until I refused to do OASIS assessments.
According to the LPN job description it says I must be able to lift up to
25 lbs, so my weight restriction should not be an issue.

[TazziRN]

Hire an attorney and cite labor laws as well as your state's Nurse Practice Act.

[illinoislpn]

I received a call today (Sunday!!!) asking me to please be in the office at 10am Monday morning for a meeting with the DON, Operations manager, and the home office HR person....I know they are going to try to give me the axe, even though I have emails where I informed the operations manager and RN over our office 4 times. Wish me luck....

[TazziRN]

Print out what Nurse Karen wrote and take it with you.

[caliotter3]

We can only assume that illinoislpn got the axe since she hasn't updated us. Just what happens when an employee tries to do the right thing or correct an infraction.