Monthly RN visits.... never the same one...

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    ok, i just have to vent! have been with current pt for 6months. we all know that unless you are an rn in pdn a rn has to come do the monthly supervisors/post hospitalization visits. now i do not have a problem with this, what i do have a problem is having a new nurse at each visit! 7months and 6 different nurses!

    it gets so old to have to answer everything from day one to present day. my pt is only 7.5 months old and when they come for the visit, the typical reply" i never seen baby xyz, so please start from the beggining" drives me insane! i give them a complete report and they say this wasn't changed on the 485, etc, etc, etc, not my problem. talk to the docs or case manager.

    i send in copies of all rx's hospital discharge summaries, all doc visits ( get the office to make me a copy before we leave) so there is a record, cause i keep a copy in the clinical notebook that has a big stamp on it that says faxed along with date and time! i have even corrected the 485 and sent it in. no luck!!!

    so why doesn't the 485 get changed? even mom gets so tired of this.

    ok , i "m through now. but i needed to get this out of my system, cause it just makes me nuts!

    any advice or suggestions on how to handle this?:wink2:
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  3. 4 Comments so far...

  4. 0
    It is embarrassing when the family is aware that the agency is not handling the paperwork appropriately. They usually can converse quite competently about the process and do not appreciate that they are not getting proper paperwork help to assist them with the requirements of their programs.
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    It sounds as though who ever filled out the Oasis, did not check with the old 485 to see what was going on. Also, sounds as though they have not been doing any type of summary, which would include the history of the patient. But most of all, they could have easily pulled the medical records and gained insight on the patient's history and status. Some agencies can not keep a RN Supervisor because of all of the paperwork involved, however, this is no excuse in the 485's not being correct. Sorry to hear about your frustration.
  6. 2
    Quote from nurse hobbit
    ....have a problem is having a new nurse at each visit! 7months and 6 different nurses!

    it gets so old to have to answer everything from day one to present day. my pt is only 7.5 months old and when they come for the visit, the typical reply" i never seen baby xyz, so please start from the beggining" drives me insane! i give them a complete report and they say this wasn't changed on the 485, etc, etc, etc, not my problem. talk to the docs or case manager.


    any advice or suggestions on how to handle this?:wink2:
    if patient is less than 21, oasis is not required.

    however, frequency of rn supervisor visits is determined by
    a. agency policy,
    b. insurance contract regulations.

    who is the case manager? our 2 nursing supervisors @ each branch are considered the "case manager" with 500 + new admits/month at each branch. it is nearly impossible to keep all the details together. they've mostly been with the agency over 5 yrs on average. having a 6 different rn do home supervision visits indicative not well run program ---sounds like they are sending just "anybody" to get paperwork done rather than organized programs---rapid staff turnover is a red flag in this area.

    suggestion:
    1. when you fax order in do you send to a specific person or just to dedicated fax # assigned to case?
    when faxing orders in, address to specific office staffer responsible and call to confirm fax received, note on your chart copy who confirmed receipt.
    yes there is a fax and sock gremlin who love to munch away on crucial material.
    2. update your 485 with current order and attach faxed form to back.
    3. call week before scheduled visit to medical records to confirm all your orders in permanent chart just not stuck in inbox on case managers desk.
    4. ask mgmt if you can be assigned 2 supervising rn's due to above issues. i found that when you partnered up staff on cases, much easier as both staff know patient so orders a breeze

    thanks for being the patient advocate and being concerned about providing high quality patient care.
    GeriatrxRN and Lorie P. like this.
  7. 0
    Quote from nrskarenrn
    if patient is less than 21, oasis is not required.

    however, frequency of rn supervisor visits is determined by
    a. agency policy,
    b. insurance contract regulations.

    who is the case manager? our 2 nursing supervisors @ each branch are considered the "case manager" with 500 + new admits/month at each branch. it is nearly impossible to keep all the details together. they've mostly been with the agency over 5 yrs on average. having a 6 different rn do home supervision visits indicative not well run program ---sounds like they are sending just "anybody" to get paperwork done rather than organized programs---rapid staff turnover is a red flag in this area. this a a brand new office that just opened last july, still working out the bugs.

    suggestion:
    1. when you fax order in do you send to a specific person or just to dedicated fax # assigned to case? i always address it to the docs on a cover sheet! former militay habit called cya!:d
    faxing orders in address to specific office staff responsible and call to confirm fax received, note on
    your chart copy who confirmed receipt.have done that too and i always chart who came for the visit and how long they stayed!
    yes there is a fax and sock gremlin who love to munch away on crucial material.
    2. update your 485 with current order and attach faxed form to back.
    thanks will do that!
    3. call week before scheduled visit to medical records to confirm all your orders in permanent chart just not stuck in inbox on case managers desk.
    will try that too!
    4. ask mgmt if you can be assigned 2 supervising rn's due to above issues. i found that when you partnered up staff on cases, much easier as both staff new patient so orders a breeze

    thanks for being the patient advocate and being concerned about providing high quality patient care.
    thanks so much for all the great advice! since it is a new office, they have had to make major changes in who was the docs verses case manager. i hope it is better soon. other than that, no other c/o.
    have agreat week!


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