How specific on 485?

[bloomicy]

Our agency is working with a QI consultant who is totally gung-ho on the 485 POC, and is having us put down every single intervention we do for a pt -- to the point where "assess lung sounds qv", "assess GU and GI status qv", "assess pain level... qv", "notify MD for HR >100 or 36 or

you get the idea. Basically, our 485s are now 4-7 pages with every possible goal and intervention for a pt. It's getting SO out of hand, and the nurses are going crazy!!!!!! We've got the disciplines and frequencies... but what else NEEDS to go in there? Do you have all the basic interventions in there at all, do you put them elsewhere, or does your agency just leave that stuff off?

How specific (or nonspecific) are your 485s? For a pt with >1 diagnosis, for example (like most HH pts are!), what do you put for #21 (Orders for Disciplines and Treatments)?

Thanks in advance!

[HCSllc]

Yikes. I'm a consultant, too and I would lose all my clients if I asked them to write 7 page care plans. The problem with care plans that are too lengthy and too specific is that important stuff gets buried. Furthermore, think of an entire episode. If your visits are weekly you have eight visits max between comprehensive assessments. You are not that good. Sorry. Determine what you want for the patient and how it will be accomplished.

I had an article published in Homecare Outcomes this week about writing care plans if you have access to that publication.

Be real careful what you write because if you don't perform all those myriad orders you haven't followed the plan of care which became MD orders when he or she signed the 485.

j