[canoehead]

Ahhhh, remember that the Duoderm and dressing change will not be PAID FOR by insurance without an MD order. I think it's a financial issue rather than a practice one.

[aimeee]

Ah, but hospice is paid per diem so dressing supplies are just paid out of the per diem. And you get paid the same whether you visit every day or only once a week.

[Larry in Florida]

Originally Posted by aimeee

Ah, but hospice is paid per diem so dressing supplies are just paid out of the per diem. And you get paid the same whether you visit every day or only once a week.

Lord do have mercy, Its about the patient and critical thinking. 2-4 years of education, no telling the years of experience and ya have to think about an order BEFORE APPLYING SOME DUODERM! Are we becoming lemurs ? why be a nurse for God's sake! Of all the posts I've read this one gets my goat. Whats next get an order to take bp's. Common sense where have you gone ?

[NRSKarenRN]

ANYTHING involving "assessment" and subsequent "treatment" outside the hospital setting in homecare and hospice requires a physician's order due to regulatory requirements.

Prudent hospice organizations have developed standing plan of treatment orders that include care for stage 1-2 pressure ulcers, common meds for symptom + pain mgmt orders.

Homecare plan of treament orders even need to include language such as "Assessment of body systems" for nursing and "eval and treat" for therapy other wise viewed as non compliant with Medicare/Medicaid conditions of participation.

For patients under homecare/office, doctor/NP sees patient at home or office andgives prescription to patient/family to get filled, Homecare/Hospice staff have to contact practitioner for verbal/written order to be signed as considered "deviation from plan of care signed by doctor at start of care". No wonder doctors are swamped with paperwork.

[aimeee]

Originally Posted by NRSKarenRN

ANYTHING involving "assessment" and subsequent "treatment" outside the hospital setting in homecare and hospice requires a physician's order due to regulatory requirements.

Prudent hospice organizations have developed standing plan of treatment orders that include care for stage 1-2 pressure ulcers, common meds for symptom + pain mgmt orders.

Homecare plan of treament orders even need to include language such as "Assessment of body systems" for nursing and "eval and treat" for therapy other wise viewed as non compliant with Medicare/Medicaid conditions of participation.

For patients under homecare/office, doctor/NP sees patient at home or office andgives prescription to patient/family to get filled, Homecare/Hospice staff have to contact practitioner for verbal/written order to be signed as considered "deviation from plan of care signed by doctor at start of care". No wonder doctors are swamped with paperwork.

Too True!!!!

[a21chdchic]

Everyone is right, do need the order. Just do what needs to be done, then get the order. A good med. director will back you up, as long as you can give a good rationale to back you up.

Ana

[chris_at_lucas_RN]

Originally Posted by rnkalee

I saw a home patient yesterday who had a new pressure sore on her little toe. She requested Duoderm and I had some in my car so I cut some small ovals, applied one to her toe, and left the remainder for her to use. I charted a progress note on it. My D.O.N. said that I should have gotten a physician order before applying the Duoderm. She said I was practicing medicine without a license. Is that true?? I come from an neurosurgical ICU background and could use supplies such as Duoderm as I saw fit so this was news to me.

Thanks for the help!
Karen

It could actually depend on the policy and procedure of your hospice.

I am used to ordering DME and taking care of business without an order, so long as it does not involve medication or invasion of the body proper.

The hospice where I am now, you have to get an order for all DME, and you actually have to have an order for pulse oximetry!!

[earle58]

Originally Posted by emmycRN

The duoderm could not have hurt the pt and should not require a doctors order.

i have seen duoderms left in place too long, where it has necrotized the wound;
stage 2 turned to stage 3/4.

leslie