We have a separate hospice team, but for on call purposes it is all together. They have talked about hospice taking their own on call if they continue to grow...but that would mean both sides would take call more often - every 3 weeks or so (just the weekends) rather than every 6-7 like it is currently. Our weekends are busier too if there is alot going on with hospice patients - 40-50 patients now.
I thought that the reason to go electronic approval was to cut down on paper like you are doing...not sure why we are still printing it all out for charts except for what they said about surveyors...so who knows! Hope you are having a good weekend

We have been doing the electronic approval for 1 year or so, started that shortly after switching to the laptops. We talked with our state department of health auditor prior to doing so and she said that as an auditor she likes it better when agencies are paperless, she can just sit at a computer and look at what she needs. We haven't had our state survey yet since switching so I guess we will have to see how that goes when the time comes. We still print 485 and orders to be sent to physician for signature but everything else is paperless. We do have a hospice also, currently only about 25 active patients, the hospice is brand new to us so still working out the kinks and learning as we go...if there is a hospice call after normal hours I will usually go myself. We have 2 nurses that each work part time and are "hospice nurses" if they are available they will go out after hours to see their patients. I don't like to ask the home health nurses to go out to pronounce the hospice patients. Calls from hospice patients seem to run in spurts..for a while we were getting alot of them already actively dying so there were quite a few calls to be handled, lately everyone seems to be stable so not so many calls.

It's funny how each agency has their own way of doing things, huh? For us, whoever is primary call takes the calls and makes the visits from 430p-8a. I don't mind it too much...since it's only about once every 6-7 weekends I get my fri/sat on call nights. Our FT on call night RN is WONDERFUL...she rarely every calls the backup..she sees pretty much all the patients herself. DO you guys have hospice too? Alot of our calls are hospice patients..and especially pronouncements at night...I would say out of every 10 calls I get that 8 are hospice ones.
We just switched to electronic approval at work 2 weeks ago and are still ironing out the kinks. They are still printing out all of the approved notes, orders, OASIS, 485, etc but we don't have to physically sign them...just electronically. I think will cut down on the nurses' workload, but the office staff still have alot of the same tasks with the paperwork. Makes it easier to track I guess. Allegheny has been pretty good with finding "lost " things and working with us and answering questions. So totally paperless? I would think that it makes it tough for surveyors and the like maybe? How's that working?

I am on call mon-fri 4pm-8am, 24hrs on sat/sun. Poor me......lol. I actually rarely have to go out to do a visit. I field all the calls(some nights several/some nights none at all). I will try to talk the patient/family thru the problem over the phone if I can. If a visit can't wait until the next day and needs to be done I will call the nurse that lives closest to the patient. They are very good about going out when asked. They understand that on the rare occassion I call they are expected to go, that is the trade-off for them never having to carry the pager and be on-call. We schedule 2 RN to work every weekend. They cover all planned admissions and visits plus anything extra that comes in from 8am-4pm. They don't always have a full weekend of work, sometimes there is alot and sometimes they will only have a visit or two. They get time off during the next week. For planned evening visits like a pm insulin teaching or IV antibiotic that is bid we ask for volunteers first, and keep a list of who is volunteering, if supervisor sees that anyone is not taking their share of evening visits she will nudge them into volunteering by pointing out that it is kept tract of and volunteering means they never have to be on call and thus responsible for all evening visits that might come in during their turn to be the one attached to the pager.
Do you print out all of your OASIS and visit notes? Allegheny seemed to think we were crazy when we said we wanted to be paper-less. We are still debating weather it is a good idea or not because we have noticed some glitches with the software and clinical notes have been lost.

Hello, We also use allegheny software, we have used it on the office side for many years, went to the laptops for clinical documentation a little over 1 year ago. I don't to many visits anymore but the ones I do are much quicker charting with the computer. I think part of being efficient with the computer is just to learn the steps. I notice that "newer" nurses that were hired after we switched to computer don't seem to have a problem because that is the only way they know. The nurses that have been doing home health for many years don't like the change and don't seem to want to learn to be proficient...excellent clinical nurese, couldn't ask for better patient care so I hate to see them feeling overwhelmed by documentation. Has your agency ever tried designating anyone as Admission nures...we are toying with the idea of have one or two nurses do all admissions. They would not do any case management so that would eleviate all that responsibility, once the patient was admitted they would be given to someone else to manage. We are thinking this may give them a chance to be more proficient and be able to stay on task with getting the admission documentation done timely and also take all that work away from the other nurese allowing them to do more visits in a day and stay up to date with that documentation. Question, do you have a set requirement for when your notes, OASIS are expected to be completed?

Hi, we also do case management, with clinical supervisor to take referrals, handle insurances, the admitting nurse takes part in deciding what dx will be primary but someone else does the actual coding, I am in the office currently and part of my job is to manage schedules, each primary nurse manages their patients, gives me a list of visits to be done for the next day and I shuffle them around, add in admissions, delegate some visits to LPNs on staff to try and make everyones schedule as even as possible. Are you using laptops/point of care software. My nurses have complained it takes much longer to do oasis paperwork on the computer since we switched. I will generally try to keep them at 1 admission visit & 3 regular re-visits and they seem to feel this is overwhelming yet the business office is wanting more visits done in a day. Do you feel you guys manage the work load with 5-6 visits a day and the amount of travel you do?

Hello, I just read a reply you posted regarding average pay, mileage, etc. I was wondering if you would be interested in discussing it further. I am also in PA, moderately rural area. Would like to have someone to compare things with, see how our work load compares to others. Hope to hear from you soon, feel free to email me directly, cynda66@comcast.net