Home Care Treatment Sheets

graysonret · Jun 17, 2004

These days, with all the malpractice suits, and lawyers looking for any slip to pocket a few million, agencies are trying to cover all the possible loopholes they can...even if it sounds ridiculous. I know, I get all sorts of weird things too. How about "Identify the patient each shift" on a home health case? :) It's sad but seems to be necessary. I've argued points several times, but the agencies's legal departments think otherwise. I just shake my head. Nursing used to be patient oriented. Nowadays, unfortunately, it's cover myself first, patient second.

nightingale, RN · Jun 17, 2004

Dixie:

I wonder if you might get more responses in our Home Health Forum here at AllNurses. I can move this thread over there if you like (or have another Moderator do it). Just let me know.

Dixiedi · Jun 17, 2004

Move it along please! That's the link I thought I hit when I started the thread, just dindt pay attention I guess!

nightingale, RN · Jun 17, 2004

I have moved it to the Home Health Forum. I anticipate you will get more "like minds" on this Forum.

renerian, BSN, RN · Jun 21, 2004

Anything I do gets recorded.

renerian

Dixiedi · Jun 21, 2004

Anything I do gets recorded.
renerian

On the treatment sheets? Don't you think that should only include actual Tx and not HHA chores? Yes, we do have to record that they are done but shouldn't it be on a separate sheet?

Dixiedi · Jun 21, 2004

These days, with all the malpractice suits, and lawyers looking for any slip to pocket a few million, agencies are trying to cover all the possible loopholes they can...even if it sounds ridiculous. I know, I get all sorts of weird things too. How about "Identify the patient each shift" on a home health case? :) It's sad but seems to be necessary. I've argued points several times, but the agencies's legal departments think otherwise. I just shake my head. Nursing used to be patient oriented. Nowadays, unfortunately, it's cover myself first, patient second.

This home has 4 special needs kids. two with trachs, 1 on vent another bipap. Both of the others and the 1 on the vent have TF. The 4th, on bipap gets st cath twice each shift, she's also the one who didn't get supper until 2200 because she is up in W/C and out to the family room with the family (spina bifida) and is on pureed diet. My first night there I thought she had eaten with the family! The Tx sheet entry that the nurse is to get her something from the kitchen, run it through the food proccessor was mixed in a mess of entries for taking the trash out, taking VS Q2H. Things that are either polilcy or just ordinary tasks and I missed it! Penmanship is a major issue too.

Then there's the everyday care, bathing, trach care, etc... you get the picture. There's so much going on in this home that it really is needed to document eveerything they do or at the very least you risk the family loosing some of their nursing hours. Besides the 4 special needs kids this foster home also averages 6 other kids at any given time. Wonderful people.

My point is not that I don't think it should be documented but that there is no reason to document it more than once.

If a TF (say keto diet (recipe included) to run via kangaroo over 10 hours vol 1000cc is on the Tx sheet and you initial that when you hang it, chart gastric content, condition of g-tube or buton, etc before starting then at least Q2H chart tolerance to that TF why would you also include an enry on the tx sheet that is...

Check tolerance to TF Q2H? You have charted it in the narrative, why initial the Tx sheet?

Same with the VS, it's on the check sheet as well as in the narrative and the primary also wants you to initial it on the tx sheet?

Double and triple charting doesn't make sense. To me, it would look like you are trying to document more than is actually being done.

My suggestion would be a Tx sheet/s, Rx sheet/s, Maintainance sheet/s, Equipment sheet/s. Then there's the nursing notes page 1 and 2 (check sheet and narrative), staffing roster which is essentially time sheets, Docs orders, hospital/dr visit sheet/s, etc etc etc.

Too many homes the deviders are not even properly used becasue some nurses just think it's easier to just chart at the end of hte shift (something I hate to see any nurse do as a matter of habit) and flip from1 pg to the next until they run out of sheets just initially every line that the previous nurse initialed for that time period.

I've seen tubing changes get missed with this habit casue the nurse the day before didn't do it (wasn't due that day).

It all just seems way to sloppy to me.

renerian, BSN, RN · Jun 23, 2004

I guess as long as the information is neat,legible and recorded I don't mind where it is for small things. I have recorded many a meal cooked for home health clients, trash, animals you name it.

renerian

Dixiedi · Jun 23, 2004

I guess as long as the information is neat,legible and recorded I don't mind where it is for small things. I have recorded many a meal cooked for home health clients, trash, animals you name it.
renerian

Neat and orderly is my issue I think. The list just goes on and on about household duties, horrible penmanship and in no particular order, then without warning there's a Tx that is vital to getting through the shift and it's missed because you can't tell one from the next and can't reak 1/2 of them.

renerian, BSN, RN · Jun 23, 2004

Yes neatness is imperative.

renerian

kids · Jun 24, 2004

I was just wondering if anyone else has nursing staff who insist on putting such things as the below list on the patient treatment sheet. I believe they should not be there. Only nursing treatments should be there. These tx sheets are so long it's easy to miss an actual tx!
empty the waste can QS
VS Q2H (this is our agency standard)
Laundry QS
Assess tolerance to TF (wouldn't that be included in actually running the TF and not be a separate entry?)
Lising individually every piece of equipment in the home (this is also listed on the equipment sheet--- I'm talking about an QS initial on the Tx sheet! as if it were a tx for things like... hospital bed, side rails, kangaroo pump, IV pole, W/C, just everything)
I did an oncall shift in this home and one of the girls didn't get any supper until almost 10PM! (Long story, but is directly related to all the junk on the Tx sheet.)
Oh well, just wondering what other nurses are running into on Tx sheets.

As I recall you are doing Peds private duty.

In my experience (in peds private duty) with 3 different companies I have never seen it any other way.

If any task is care planned there has to be documentation that it was or was not done. Putting it on a record to be initialed provides a quick visual can drasticlly reduce the amount of narrative that has to be done. The only 2 choices is the med or tx sheet. Part of the reason it was done this way (at my jobs) was because the parents also "worked" off of the sheets also.

If Q2 hour VS is the office standard putting it on the tx sheet seems redundant (every one knows, right?) the fact the VS appear on the flow sheet documents they are being done. And I agree, assessing TF tolerence should be with the TF. (BTW, Q2 hr VS seems really excessive on a healthy chronicly ill child, we did them Q shift with SpO2 Q4 unless ill/change in condition.)

The lousy handwriting and seemingly random order of stuff is something should be addressed by the primary nurse on the case or the clinical coordinator.

It can can be completely solved by typing (or creating in Excell) master sheets for each patient that are photo copied each month (and update by hand) and the master updated by the clinical coordinator every 60 days when the careplan is reviewed and the 485 done.

(At my last job, I created an Excell template that was very user friendly, I was able to convert 2 cases med/tx sheets per day from hand written to computer generate masters. It took only a couple of minutes to go in and update it every 60 days. My boss got me write a "users guide" and burn it along with the template to disk under the pretext of showing it to my counterpart at the sister office. In reality she took it to Corporate in GA, claimed it as her own work and ended up getting an award for my work. Everyone who actually worked with her knew she was only marginally computer literate.)