Calling family for TX!!!

Just to clarify, does management want you to call all the families of all your patients, or just the family that complained? How time consuming!

In the ER I worked in, the nurses had a sheet where they would circle all the charges on, then I'd enter them into the computer. I think on the floors it was similiar, the nurses would tell the secretaries what charges to enter each day. So it was all done by the nurses, but it really didn't have anything to do with the families like you're mentioning.

Well unless the patient consents its a HIPPA violation to discuss care with the family. Last I knew people in ASL's still generally run their own affairs and as such are the only ones you need to talk to unless they request their family's be consulted.

RJ

What happens if you just don't call? Are they going to fire you over it?

That is completely insane!!!!!!!

HIPAA, aside.

And if the family refuses, are we to let the patient develop life threatening complications...and let them die, because of the cost?

In the last LTC I worked whenever any kind of dressing supplies were needed, such as Duoderm or sterile 4X4's they were ordered from our facility pharmacy and came in a box that had a prescription label on it clearly identifying that those dressing materials belong to that particular patient. We had some families who did not use the facility pharmacy and wanted another pharmacy called to provide the supplies (Reason: cost). We also had families that wanted to be notified when treatment supplies were being ordered because of the charges appearing on their monthly bills from the pharmacy. Some families tracked those charges carefully and got on the administration if they felt the nurses were ordering too often. Some families are very savvy about charges for medical supplies. If there is something they wouldn't approve we just had to call the doctor back and get the treatment orders changed to the satisfaction of both the doctor and the family. There are many medical supplies that are not paid by Medicaid and Medicare that have to be paid by the patient (or the patient's family). Don't know if you're aware, but a box of Duoderm is VERY, VERY expensive and the family probably had a fit when they saw the charges for it. I had to get a box of Duoderm for a stasis ulcer on my leg and the cost was over $100. A problem we had to be careful of was nurses helping themselves to the treatment supplies of one patient and using them on other patients. Our facility had very few supplies in stock. I think this was done as a cost-cutting and cost-containment measure. It is perfectly acceptable for nurses in LT care to get involved in this issue of cost of supplies and discussing it with patients. It's part of a nurses role in addressing a patient's financial concerns and acting as an advocate. Most nurses have been trained within acute hospitals and because of the size of these organizations very seldom have to deal with the financial end of things. However, it is more common in nursing homes for it's charge nurses to need to be aware of a patient's financial situation.

One of our assigned projects when I was in my senior year of my BSN program was to go "shopping" at a medical supplier and get prices on a list of medical supplies our instructor had given us. It was an eye-opening experience. It is not typical for nurses to see the costs of the supplies they use. However, in LTC we are dealing with a smallar employer on one hand and the long term patient and their family on the other. It is a unique relationship.

Very interesting.

I wasn't aware of that.

In Illinois the State regs state that a family member/POA/Guardian must be notified of any changes. A treatment order would be a change. Are you sure that they did not mean notification of change in condition. I would refer families to the billing department about prices and if there is a cheaper tx that would not compromise pt care I would ask the MD for a change. Is you facility all private pay?

Just a few points...
1. My corporation came up with list of all the charges it might be possible for one to incur as a patient. It is at least 5 pages of small print. They told the admissions coordinator she had to review it with ALL admits even if Medicare,Medicaid,or Managed Care. Absurd! They are not paying for these things so why tell them?
2. I believe the CMS guidelines required family/HCP notification of any pressure area.
3. Duoderm on a closed area???? Not the treatment of choice. We've had really good results with Xenaderm....stage 2's especially. And it's reimbursed by both Medicare and Medicaid.

Now I work in a Large nursing home and we are required to call the POA for all change in orders and discuss the change of plans. If they dont want the treatment prescribed then we have no choice but to call the doctor back and have the order canceled. The majority of the time it is no problem with new orders as long as the family understands the reasoning behind it. Now having said all that garbage, if the patient is the POA discussing it with him/her should be sufficiant. Beyond that is a HIPPA violation.