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Continuous Care

Hospice   (5,458 Views 15 Comments)
by jennifer_gail jennifer_gail (Member) Member

jennifer_gail has 3 years experience and specializes in Home Health, Hospice, LTC.

2,442 Profile Views; 21 Posts

Hi all! Starting a new position Monday as a continuous care nurse. I am a new grad (July 14) and have worked LTC the last 5 months, but is there any words of advice anyone could give me? I'm excited, but also a little nervous. TIA!

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ktwlpn is a LPN, RN and specializes in Med Surg, Homecare, Hospice.

3,844 Posts; 30,860 Profile Views

Good luck

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3 Followers; 36,940 Posts; 98,027 Profile Views

Another good luck here. Didn't they give you any orientation? If not, you need to do as much research as you can about expectations. Take your cues from the nursing notes left by the other continuous care nurses so you are in the right ball park. Chart at least every two hours, or however a frequency you are told. One of my agencies changed the two hour frequency to every hour. When mindfully observing a person that is always asleep, especially at night, that can be a chore.

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QEOLAdvocate has 7 years experience and specializes in Adult Gerontology Primary Care, Palliative.

96 Posts; 3,224 Profile Views

Continuous care typically involves round the clock or near round the clock administration of medications for symptom management, such as pain, agitation, shortness of breath, and you are there to be at the bedside, monitoring the patient, getting new orders from the physician (if current medications/interventions) are not providing relief of symptoms, and providing care. It can be draining, typically the shift is 8 hours, but of course, your agency/facility should be training you in regards to what to expect, and what is the agency's protocol and policies. A word of advice from the case manager's point of view: doing hour by hour charting is really really helpful for the case manager to be able to understand what is going on, what is helping, and what isn't helping. Good luck!

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7 Posts; 1,160 Profile Views

Thank you all for this post. As a recent Grad, I too was considering the continuous care route. My Mom passed away in 2007 from pancreatic cancer. Her hospice nurse was the greatest. Very compassionate and professional, yet real enough to tell me that if I didnt get myself into nursing school she'd kick my but all over town! LOL I should have listened to her then. But here I am 7 years later almost 8 years later as a new Nurse. I think I know where my calling lies.

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Remember to chart minimum hourly. Focus on symptoms and if relieved, make sure you chart that they are relieved by your interventions. The biggest thing is your charting needs to justify you being in there. Focus on teaching as well in charting. "Non-verbal pain recognition taught to wife (PCG). Wife states 'I am exhausted'. Wife unable to learn at this point. Will attempt to teach further when she is more alert." Otherwise as previously stated, your focus is on symptom control and anticipating what symptoms may be coming and work with the MD to stay on top of it. Good luck. It is a great position.

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jennifer_gail has 3 years experience and specializes in Home Health, Hospice, LTC.

21 Posts; 2,442 Profile Views

Thank you all for your replies. I had my first case today, a patient that was put on hospice this morning. I arrived at 1300 and at15:50 he had passed. I feel like I made a difference to him and his family and helped him to pass peacefully. I did not get any orientation, but I figured it out and charted hourly until TOD.

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149 Posts; 6,421 Profile Views

Chart every 2 hrs? My goodness, my employer has been mandating we chart every 15 minutes while doing continuous care! LOL So glad I don't do CC often!

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The best advice I can give is to ask the family to clarify the goals of care. You might not want to just walk in and say "what are your goals of care?" but you can get cues from the family. Remember that you are in their home and they have probably been taking care of the patient for months or years on their own, and they know him best, not you. If they want to turn him every 4 hours rather than every 2, that is probably ok. If he is at EOL, it isn't going to matter. You are there to educate, but I think some continuous care nurses do not realize they are there to learn as well.

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Continuous care is billed and reimbursed in 15 minute increments which is one reason many hospice's require every 15 minutes charting. Charting must be sufficient enough to support meeting the continuous care guidelines set by CMC. A patient who is actively dying does not meet the criteria for continuous care unless there are intensive symptom management issues at hand. Similar to GIP it is essential that all documentation reflect the level of care requested and delivered. There are times our hospice does "continuous care" and can only bill for routine because it is the right thing to do but they do not meet the stiff criteria. In my rural community there is no inpatient hospice to fall back on so we have to do what is best for the patient and family regardless of cost or reimbursement. As an executive director it can be a real challenge but we sleep well at night. :yes:

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lifelearningrn has 4 years experience as a RN and specializes in School Nursing.

2,284 Posts; 24,761 Profile Views

There are times our hospice does "continuous care" and can only bill for routine because it is the right thing to do but they do not meet the stiff criteria. In my rural community there is no inpatient hospice to fall back on so we have to do what is best for the patient and family regardless of cost or reimbursement. As an executive director it can be a real challenge but we sleep well at night. :yes:

I thought that it was illegal to misrepresent level of care when billing medicare? I could be wrong, but I was under the impression that companies that provide CC at EOL even when symptoms were under control was considered incitement and a big no-no.

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206 Posts; 5,364 Profile Views

I thought that it was illegal to misrepresent level of care when billing medicare? I could be wrong, but I was under the impression that companies that provide CC at EOL even when symptoms were under control was considered incitement and a big no-no.

Perhaps what is meant is that the hospice sent staff to help stay with the family/patient because it was needed continuously to help the

them cope - the LOC may have remained the same, and the hospice organization may have borne the cost and not bill Medicare for actual continuos care.

This also comes up when a person is too young to be on Medicare but needs to be GIP or CC. The insurance companies don't reimburse us but we know that it is still our mission to be there.

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