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NRSKarenRN, BSN, RN Moderator 118,778 Views

Joined Oct 10, '00 - from 'RN Spirit from Philly Burb'. NRSKarenRN is a PI Compliance Specialist, prior Central Intake Mgr Home Care Agency. She has '35+' year(s) of experience and specializes in 'Home Care, VentsTelemetry, Home infusion'. Posts: 27,326 (22% Liked) Likes: 13,413

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  • Jan 18

    Found at Medscape Medical News
    Ken Terry
    January 06, 2017


    Use of Secure Text Messaging for Patient Care Orders Is Not Acceptable


    Joint Commission Reinstates Ban on Order Texting


    Citing patient safety and workflow issues, the Joint Commission last month restored its ban on the texting of orders in hospitals after consulting with the Centers for Medicare & Medicaid Services (CMS).

    In the December issue of its Perspectives newsletter, the Joint Commission, which accredits hospitals and other healthcare organizations, said that computerized physician order entry (CPOE) should be the preferred method for submitting orders, "as it allows providers to directly enter orders into the electronic health record (EHR). CPOE helps ensure accuracy and allows the provider to view and respond to clinical decision support (CDS) recommendations and alerts."
    If CPOE isn't available to the practitioner at the time of the order, a verbal order is acceptable, the Joint Commission said. Verbal orders should be infrequent and not used for the convenience of the practitioner, the body noted.
    According to the Joint Commission, the impact of secure text orders on patient safety remains unclear, for the following reasons:

    • Placing the burden of entering orders from texts on nurses may increase the burden on them and adversely affect their ability to provide care.
    • Transmission of a texted order, unlike a verbal order, does not allow for real-time clarification and confirmation of the order.
    • If a CDS recommendation or alert is triggered during the order entry process, the nurse would have to contact the ordering practitioner for additional information, which could result in a delay in treatment....
    See JCAHO pdf Clarification: Use of Secure Text Messaging

  • Jan 16

    Most ECF = Extended Care Facility receive that patient with a decubitus ulcer already developed or identified from inpatient stay at a hospital.

    Case #1: Family member had cardiac arrest post anaphylatic reaction to IV Vancomycin, spent 6weeks intubated in ICU went into rapid A fib anytime turned or BP plumeted. Had redness R buttocks pinpoint opening when finally stabalized sent to telemetry. Upon getting to SNF, wound had opened to stage 3; rehospitaled another facility, now stage 4 with severe protein calorie malnutrition. Discharged to Home care where we used wound vac and decub closed after 6 months including 2 further short hospitalizations.

    Case#2: Healthy father with dementia had 2 episodes diarrhea 1 week apart: sudden onset high temp, confusion, inability walk shows up in ER with Stage 2 gluteal fold decub as unable to properly clean backside. Healed with home care intervention. Stage 2 reoccured as health deteriorated, on Hospice as only wanted to sit, unable to ambulate.

  • Jan 15

    Found at Medscape Medical News
    Ken Terry
    January 06, 2017


    Use of Secure Text Messaging for Patient Care Orders Is Not Acceptable


    Joint Commission Reinstates Ban on Order Texting


    Citing patient safety and workflow issues, the Joint Commission last month restored its ban on the texting of orders in hospitals after consulting with the Centers for Medicare & Medicaid Services (CMS).

    In the December issue of its Perspectives newsletter, the Joint Commission, which accredits hospitals and other healthcare organizations, said that computerized physician order entry (CPOE) should be the preferred method for submitting orders, "as it allows providers to directly enter orders into the electronic health record (EHR). CPOE helps ensure accuracy and allows the provider to view and respond to clinical decision support (CDS) recommendations and alerts."
    If CPOE isn't available to the practitioner at the time of the order, a verbal order is acceptable, the Joint Commission said. Verbal orders should be infrequent and not used for the convenience of the practitioner, the body noted.
    According to the Joint Commission, the impact of secure text orders on patient safety remains unclear, for the following reasons:

    • Placing the burden of entering orders from texts on nurses may increase the burden on them and adversely affect their ability to provide care.
    • Transmission of a texted order, unlike a verbal order, does not allow for real-time clarification and confirmation of the order.
    • If a CDS recommendation or alert is triggered during the order entry process, the nurse would have to contact the ordering practitioner for additional information, which could result in a delay in treatment....
    See JCAHO pdf Clarification: Use of Secure Text Messaging

  • Jan 15

    Most ECF = Extended Care Facility receive that patient with a decubitus ulcer already developed or identified from inpatient stay at a hospital.

    Case #1: Family member had cardiac arrest post anaphylatic reaction to IV Vancomycin, spent 6weeks intubated in ICU went into rapid A fib anytime turned or BP plumeted. Had redness R buttocks pinpoint opening when finally stabalized sent to telemetry. Upon getting to SNF, wound had opened to stage 3; rehospitaled another facility, now stage 4 with severe protein calorie malnutrition. Discharged to Home care where we used wound vac and decub closed after 6 months including 2 further short hospitalizations.

    Case#2: Healthy father with dementia had 2 episodes diarrhea 1 week apart: sudden onset high temp, confusion, inability walk shows up in ER with Stage 2 gluteal fold decub as unable to properly clean backside. Healed with home care intervention. Stage 2 reoccured as health deteriorated, on Hospice as only wanted to sit, unable to ambulate.

  • Jan 14

    Quote from Ptrcthllh
    If anyone know what the online service that are used by insurance companies and facilities to give guidelines base on age, service, and co- mobidities could you post it . I want to increase my knowledge in this area of nursing.
    Interqual criteria or Miliman criteria are the two programs used in Case Management/UR.

  • Jan 13

    This is a frequently asked question at allnurses with YES the overwhelming reply in our numerous threads...
    I've had a Malpractice policy for 40 years, just like I have auto drivers insurance...never needed to use it.



    Should I Carry Malpractice (Liability) Insurance?

    One healthcare risk manager's view of individual nursing malpractice insurance

    MALPRACTICE INSURANCE: FAQS

    Pros and cons of nursing insurance


  • Jan 13

    Once you have been disciplined by BON for working with lapsed license requirements in this case mandatory Continuing Education requirements, it is there permanently.

  • Jan 13

    This is a frequently asked question at allnurses with YES the overwhelming reply in our numerous threads...
    I've had a Malpractice policy for 40 years, just like I have auto drivers insurance...never needed to use it.



    Should I Carry Malpractice (Liability) Insurance?

    One healthcare risk manager's view of individual nursing malpractice insurance

    MALPRACTICE INSURANCE: FAQS

    Pros and cons of nursing insurance


  • Jan 12

    This is a frequently asked question at allnurses with YES the overwhelming reply in our numerous threads...
    I've had a Malpractice policy for 40 years, just like I have auto drivers insurance...never needed to use it.



    Should I Carry Malpractice (Liability) Insurance?

    One healthcare risk manager's view of individual nursing malpractice insurance

    MALPRACTICE INSURANCE: FAQS

    Pros and cons of nursing insurance


  • Jan 12

    This is a frequently asked question at allnurses with YES the overwhelming reply in our numerous threads...
    I've had a Malpractice policy for 40 years, just like I have auto drivers insurance...never needed to use it.



    Should I Carry Malpractice (Liability) Insurance?

    One healthcare risk manager's view of individual nursing malpractice insurance

    MALPRACTICE INSURANCE: FAQS

    Pros and cons of nursing insurance


  • Jan 12

    I am one of the QA nurses staff love to hate. Under Medicare payment is based on FUNCTIONAL deficits listed on the OASIS which needs to match the 485 plan of care. Incontinence IS a functional deficit, can lead to falls and should be listed on every client. I add functional deficit answers to about 90% charts i review.

    I highly suggest you attend an OASIS training workshop or at least check out OASIS Answers website for CMS Q+A sections to understand CMS guidance on answering questions. In speaking with my manager, since I attended a Blueprint for OASIS Accuracy workshop, my clients functional scores have improved as reflected at discharge along with agency's functional scores above state average as reported on CMS website.

  • Jan 12

    Once you have been disciplined by BON for working with lapsed license requirements in this case mandatory Continuing Education requirements, it is there permanently.

  • Jan 12

    This is a frequently asked question at allnurses with YES the overwhelming reply in our numerous threads...
    I've had a Malpractice policy for 40 years, just like I have auto drivers insurance...never needed to use it.



    Should I Carry Malpractice (Liability) Insurance?

    One healthcare risk manager's view of individual nursing malpractice insurance

    MALPRACTICE INSURANCE: FAQS

    Pros and cons of nursing insurance


  • Jan 12

    I am one of the QA nurses staff love to hate. Under Medicare payment is based on FUNCTIONAL deficits listed on the OASIS which needs to match the 485 plan of care. Incontinence IS a functional deficit, can lead to falls and should be listed on every client. I add functional deficit answers to about 90% charts i review.

    I highly suggest you attend an OASIS training workshop or at least check out OASIS Answers website for CMS Q+A sections to understand CMS guidance on answering questions. In speaking with my manager, since I attended a Blueprint for OASIS Accuracy workshop, my clients functional scores have improved as reflected at discharge along with agency's functional scores above state average as reported on CMS website.

  • Jan 12

    Once you have been disciplined by BON for working with lapsed license requirements in this case mandatory Continuing Education requirements, it is there permanently.


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