Stop times for IV piggybacks now required on MAR?(by Medicare) - page 2

We just got a memo that we are now required to both sign that we gave an IV antibiotic piggyback, and then put a stop time, otherwise Medicare won't pay. Another government mandated inconvenience, if... Read More

  1. by   wayunderpaid
    Quote from caroladybelle
    This will be a BIG problem on hemo/onco floors.

    Most of my patients have triple lumen centrals. Not including TPN/Lipids, or PCAs, I still may be giving 5 or more IV meds per hour on many of them....and I often have 2-4 acute pancytopenic patients at a time, not including other less critical patients
    Agree with you 100%. With 4-5 day heme/onc patients on day shift receiving blood products, antibiotics, chemotherapy, rescue agents, and electrolyte repletion, this extra burdensome requirements for nurses only takes away from the quality care we can provide. This requirement has not bee implemented at the hospital where I work. Was clinical nursing involved in this decision, or some bureaucrat who knows nothing about patient care? (or nursing management not in clinical practice)
    This is a bad idea!
  2. by   canoehead
    If I hang a med it likely went in unless I document a complication and not that it was stopped.

    Likewise, when I chart that I put someone on a bedpan it follows that eventually I took them off.

    I ambulate a patient....but then they end up back in bed. Simple concept.
  3. by   FireStarterRN
    The rationale we were give was purely because of billing a medicare requirements. We were not told anything of patient safety issues, only that we were losing money.
  4. by   USIJurgy
    We have the same problem...and even another one.
    Whenever we have a pt go to the floor because theyre admitted, we have to chart, "Pt to floor with NS continuing to infuse." Or else we don't get to charge for it at all.
    It is ridiculous on our ICU admits when we have to chart, "Pt to floor with NTG, Propofol, and Levaquin continuing to infuse."
    Ugh. Charges.
  5. by   RNgonewild
    why don't they just cut our heads off? as in "running around like a chicken with it's head cut off?"
  6. by   FireStarterRN
    Quote from RNgonewild
    why don't they just cut our heads off? as in "running around like a chicken with it's head cut off?"
    Now there's a good idea! Maybe put that in the 'Bright Ideas' box!!!
  7. by   withasmilelpn
    Who comes up with these requirements? We just started doing a similar thing with our nebulizers, documenting that 1. We gave it.
    and 2. How long it was administered for!
    So everybody writes 10 minutes. Just one more box to fill out... I think if you signed for it it is self evident.
    And unless the state is actually in at the time, I'll be damned if I write that patient x got up mid treatment and went to the bathroom, then finished it 20 minutes later!
    If they are billing for our time in regards to IVs, I want my cut,- just like an MD! I think the goverment is counting on nurses screwing this up so they don't have to pay. If the goverment is truly concerned with eliminating fraud and ensuring patients recieve all their services, they would stop burying us alive in paperwork and let us get back to the bedside.:trout:
  8. by   wayunderpaid
    Quote from withasmilelpn
    Who comes up with these requirements? We just started doing a similar thing with our nebulizers, documenting that 1. We gave it.
    and 2. How long it was administered for!
    So everybody writes 10 minutes. Just one more box to fill out... I think if you signed for it it is self evident.
    And unless the state is actually in at the time, I'll be damned if I write that patient x got up mid treatment and went to the bathroom, then finished it 20 minutes later!
    If they are billing for our time in regards to IVs, I want my cut,- just like an MD! I think the goverment is counting on nurses screwing this up so they don't have to pay. If the goverment is truly concerned with eliminating fraud and ensuring patients recieve all their services, they would stop burying us alive in paperwork and let us get back to the bedside.:trout:
    Next documentation requirements for billing purposes will be:
    Protonix, 40 mg. PO, given at 8:02:15, in mouth at 8:02:21, swallowed at 8:02:27
    Heparin 5000 units, midline, btwn umbilicus and first pubic hairs, cleaned with alcohol at 8:05:30, let dry 30 sec. per policy, pinched skin at 8:06:03, SQ injection between 8:06:15, 8:06:25. Kept syringe in for 30 per policy (sec.25-55), withdrew syringe (55), activated safety device (56), sharps (59), get the heck out of there (8:07:00)
    I wouldn't be surprised if this start/stop iv med requirement is coming down from nursing ( our own colleagues) in government. People who sit in desks doing QA, (get this title for a nurse in my hospital: "utilization review", give me a break!, anything to avoid patient contact!), iow, people who have not touched patients in a while.
    This is a true story. JCHACO recently cited at hosp. because a transcriptionist a.k.a. unit secretary transcribed an order without a leading zero (.4 instead of 0.4), and the RN carelessly signed the order in the MAR.
    I understand the rationale behind using leading zeros always. But mistakes are much more prone to happen when nurses are overworked, understaffed and are given a difficult or dangerous assignment, etc, rather than a leading zero!
    I wish that someone with some sense would seep up through the ranks and sit up at a board/decision making meeting and say: Are you kidding me?? You are joking, right?? This policy will not, and cannot be implemented! Whoever has the guts to do that deserves to be president!

    wayunderpaid

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