Computer Charting and Medicare guidelines in HH.

[kitkat1063]

I have searched this site for a similar topic with no luck, so if it is here somewhere I apologize for the duplicate question. I am fairly new to HH and have a few questions regarding computer charting and medicare guidelines. I have asked my co-workers and supervisors and receive conflicting answers (which is a frustration in itself) so I am asking you guys and gals! We use AllScripts (if anyone has heard of it). A few questions I have are:

1) When we do our assessments there are check off boxes for pt ed such as prevention of skin breakdown, deep breathing and coughing, diet and medication compliance and so on. Some of my fellow nurses say that is enough patient teaching and others state that you must type in patient teaching to the comment section of each body system in order to be compliant with Medicare-which is true. I do add more details to many assessments, but more often or not I found myself to be repeating patient ed within the same chart, which increases charting time. Other nurses from different agencies state that they just have check offs similar to ours and have had no issues with medicare compliance.

2) Does medicare have any restrictions on how many patients a HH nurse can see daily? One of our nurses sees 4-6 insulin dependent diabetics twice a day, therefore she can see 8-12 daily. I have a few nurses from different agencies say that is not supported by Medicare, others say there are no regulation on the number of patients a nurse can see in a day.

3) If I am seeing a patient three days a week related to increased SOB or dizziness or even wound care is it necessary to do a full assessment every visit or what AllScripts has is an OnCall assessment that is more focused on the problem at hand. I guess for this issue I am just wondering if we are creating more work for ourselves by doing full assessments every visit during the week.I feel that if I am seeing a patient routinely for CHF, HTN, chronic pain, etc etc it is more beneficial to the patient and caregivers to focus one assessment to one diagnosis to get the most out of the patient teaching, than on the next visits do a follow up with compliance and effectiveness of patient ed and move on tho another diagnosis, but I still need to be in compliance with my 485 and Medicare. Soo if I see a patient several times during the week wound it be in compliance to do the first visit as a full assessment and the others be more specific to a certain diagnosis or problem at hand? I hope this makes sense when reading it.

4) For nurses out there that have computer charting for home health, which system do you use and how much time at home are you having to spend charting?

I truly understand the importance of proper charting and patient education and hope this all makes enough sense to those reading and hopefully answering. I spend all day seeing patients and then when I get home it seems as though the charting never ends due to what seems like double and triple charting. Any info would be much appreciated. Thanks for reading and hopefully answering!

[paddler]

I worked for a HH agency who also used Allscripts. This was after working elsewhere in HH who has Roadnotes. RoadNotes was horrible. CareFacts is also beyond horrible. Allscripts was awesome. For the most part I just used the check-boxes you describe. Any teaching and out of the ordinary comments I would include summarized nicely in a Clinical Summary. It's very difficult for people following you to look up specific issues or concerns if you do not keep it in one place, such as the Clinical Summary. This also eliminates the need for double and triple charting which I refuse to do. I would almost always finish my charting in the home during the visit and due to the handy check-boxes it would take less than 10-15 minutes per patient. For a SOC I could very efficiently assess, teach and chart a SOC including the OASIS in 60-75 minutes, while doing about 90% of the SOC charting in the home. That's why Allscripts was great. Very easy flow and efficient data entry and careplan building.

Quick answer, but I hope it helps.

[merlee]

We had some wonderful booklets for teaching, and I would say I taught chapters 1&2 from CHF booklet, pt and fam state good understanding. Asked them to read 3&4 for next visit. And so on. Most of the booklets had about 7-8 chapters. Sometimes we only got thru one chapter.

One full assessment /week, the rest were focused on whatever the need was.

Your agency should have written guidelines.

Best wishes!!

[AnnemRN]

I have used Allscripts in HH in the recent past. Each regularly scheduled visit required a full assessment. The oncall visit was only used for unscheduled urgent visits. My understanding is Medicare does not limit the number of SNV's. It is unusual to see a patient twice daily though, there must not be a willing, available caregiver to perform the care needed and the patient must not be able to do it either.

In your summary only add what wasn't covered by the check charting.

[emilysmom,RN]

I was always told we can only see pts once a day. I would love to have computers.

I have searched this site for a similar topic with no luck, so if it is here somewhere I apologize for the duplicate question. I am fairly new to HH and have a few questions regarding computer charting and medicare guidelines. I have asked my co-workers and supervisors and receive conflicting answers (which is a frustration in itself) so I am asking you guys and gals! We use AllScripts (if anyone has heard of it). A few questions I have are:

1) When we do our assessments there are check off boxes for pt ed such as prevention of skin breakdown, deep breathing and coughing, diet and medication compliance and so on. Some of my fellow nurses say that is enough patient teaching and others state that you must type in patient teaching to the comment section of each body system in order to be compliant with Medicare-which is true. I do add more details to many assessments, but more often or not I found myself to be repeating patient ed within the same chart, which increases charting time. Other nurses from different agencies state that they just have check offs similar to ours and have had no issues with medicare compliance.

2) Does medicare have any restrictions on how many patients a HH nurse can see daily? One of our nurses sees 4-6 insulin dependent diabetics twice a day, therefore she can see 8-12 daily. I have a few nurses from different agencies say that is not supported by Medicare, others say there are no regulation on the number of patients a nurse can see in a day.

3) If I am seeing a patient three days a week related to increased SOB or dizziness or even wound care is it necessary to do a full assessment every visit or what AllScripts has is an OnCall assessment that is more focused on the problem at hand. I guess for this issue I am just wondering if we are creating more work for ourselves by doing full assessments every visit during the week.I feel that if I am seeing a patient routinely for CHF, HTN, chronic pain, etc etc it is more beneficial to the patient and caregivers to focus one assessment to one diagnosis to get the most out of the patient teaching, than on the next visits do a follow up with compliance and effectiveness of patient ed and move on tho another diagnosis, but I still need to be in compliance with my 485 and Medicare. Soo if I see a patient several times during the week wound it be in compliance to do the first visit as a full assessment and the others be more specific to a certain diagnosis or problem at hand? I hope this makes sense when reading it.

4) For nurses out there that have computer charting for home health, which system do you use and how much time at home are you having to spend charting?

I truly understand the importance of proper charting and patient education and hope this all makes enough sense to those reading and hopefully answering. I spend all day seeing patients and then when I get home it seems as though the charting never ends due to what seems like double and triple charting. Any info would be much appreciated. Thanks for reading and hopefully answering!

[blackjack0807]

My company has done the diabetics twice a day. These are patients who are unable to self administer due to a variety of reasons, most commonly dementia. It is covered by medicare, however the reimbursement is less than the actual cost. Same for IV's 2-3 times a day. We try to teach, but if they aren't teachable still have to give them the medicine.

We use MAT charting.