worried about documentation

[shefrn1]

I just got offered per diem for Bayada......I'm keeping my hospital job to to make sure I like home care before I go full time...the hiring manager thought that was a great idea

I think the part i'm most nervous about is the documentation...I don't know why....I think i'm just used to doing the same cardiac procedure documentation for 15 years

Everything is electronic and I'm not worried about that...i'm good with technology

Any tips and pointers on documentation....they are starting me on just revisits at first and then work my way to SOC (thanks to you guys I know what that means )

[Isabelle49]

It's great that you will be doing electronic documentation. Most programs cue you on areas that must be addressed. If there is something you need to address that wasn't covered, you can usually do this in a narrative section. With your experience you will do well, since assessment and evaluation are most important in home health and I'm sure you've had a lot of that in the cardiac arena.

ETA: make it easy on yourself by prepping before visits so you will know what the patient's diagnoses and medications are. It's also a good idea to check for any narrative notes that may have been posted in the record. When I see patients for a revisit for the first time, I do a review of the electronic chart and usually make a cheat sheet that I can quickly refer to just before I go into the home. This really helps. You'll be surprised what you will remember when you go back for subsequent visits.