Certification of Terminal Illness Physician narrative

[holistic1028]

I know this may sound crazy but the hospice agency I work with now has a MD director that expects for his narratives to be written by the nurse and he signs! The nurse DON that was doing it for him no longer works there and now I am the only hospice RN left but its like he has the same expectations. He is not a BRAND NEW hospice doctor so Im sure he knows certifications require a brief physician narrative. I am a nice person and help out as much as I can but I am NOT taking on that responsibility of doing someone elses job! And that just sounds fraudulent to me in someway. I have to write my own nurse narrative and I do a pretty darn good job with detailed information of why patient meets criteria. I have worked at other hospice agencies before and most review the nurse narrative and composed their own from that (since they dont have to see pt F2F).

I have never had this problem before and it is kinda uncomfortable for me to address it! None of my recent admissions have physician narratives attached! I mentioned it to admin and she suggested I should just copy and paste my nurse narrative to the physician narrative and he signs them in IDT meeting!! I told her that would not work and would be suspect because both narratives are apart of the certification.

After our last meeting, I mentioned that they needed to be done and he kinda acted like he didnt know what I was talking about so I showed him... he then made a copy of a form he uses at another hospice agency he works for and gave me this "guide" of how another nurse broke down pt's information with spaces in between each.. ie terminal dx, co-morbids, functional limitation, weight loss, PPS FAST scores etc. (I do this in my nurse narrative anyway! just not in bullet form like he the one he showed me) then at the bottom it says "Based on the information and examination the patient meets the criteria for Hospice with prognosis likely less than 6 months" then there is space for him to sign under it..

Now I know legally a physician can delegate dictation but that is as he is speaking it right?! Also I am not a secretary and have time for that regardless, I have my own work to do and I dont think its fair to expect me to do physician narratives as well as nurse narrative!

Has anyone else heard of or had this problem before? Can you please SHARE how this is done with your agency? When or how does your physician certify terminal illness?

[softrbreeze]

We write all the pertinent points down on a separate piece of paper: PPS score, any recent falls, infections, weight loss, etc. The MD just jots down what she wants to on the cert/recert and signs. I don't find this problematic- the MD is basing his/her signature on what we tell them anyway. Making it easier for them also makes it easier for us. I can't even begin to tell you how many times I've sent a Rx to the MD's office only to have it returned unsigned.

[holistic1028]

I do that..is what I'm saying..ALL of that is in my narrative on why they meet criteria ..SEE what your saying is how its supposed to be..this doctor actually wants someone else to write his brief narrative ..all he wants to do is sign ...

[toomuchbaloney]

Unfortunately, you are going to have to babysit the physicians narrative because that is the arrangement that has been created and maintained by this agency.

I would have a problem with filling out his paperwork for him. I would not have a problem with handing him the packet of information which would be the basis for his medical decision, I would have a problem taking my time to create the list of medical points, that should be a portion of his medical expertise and judgement.

But yeah, your agency made this bed for the MD now you have to make it on a regular basis.