Discharge/recert

[RN416]

Hey everyone. I'm new at home health (less than 6 months) and I'm struggling with discharges and recerts, specifically how to make the decision whether to discharge or recert when the patient's certification period ends. Obviously if the patient has a wound or pleurx or something you would recert. But for the patients we just see for teaching and monitoring, such as CHF, COPD, etc., I have trouble making a decision when it comes to end of cert. Do you guys have any tips for someone new at this and trying to figure it out? Thanks!

[Beeda]

The first visit I make I am already planning for discharge. Your care plans are there to help. As you reach a goad...med teaching, instructing s/s of disease, when to call the doctor, etc, end those care plans. When they are ended, you are done. For example: new diabetic teaching. Goal: indep with FSBS, knowledgeable of oral hypoglycemic/insulin (major effects, side effects, how/when to take), diabetic foot care, s/s to report to md, management of sick days, s/s hypo/hyperglycemia, nutritional education, meal planning, carb balancing and how to read packaging... you are looking for basic proficiency and 2 weeks stability (stable blood sugars and no significant med changes).

for other chronic diseases like CHF/COPD you are looking that they understand disease process, meds, and s/ to report or when to go to the doctor. Again also look for 2 weeks stability which means stable VS, no major med changes, stable activity tolerance. If they are not capable of understanding or learning after 2 weeks or you are not making any progress with instruction, identify who is the caregiver you will teach. Don't forget, Medicare does not cover chronic management of most homebound patients (exceptions of foleys, etc). When the patient is no longer truly home bound, they must also be discharged and referred for further management (md, heart care clinics, pulmonologist, cardiac rehab). I tell my patients from the beginning that my care is a short term, intermittent bridge between hospital or rehab and their return to (relative) health.

Please also remember to discuss your care plans/ patients with your supervisor who can help you when deciding to keep or discharge. Sometimes I will just ask myself if there is anything I am adding to the equation, is there something I am missing, or if they are just ready to graduate. It is very rare that I will keep someone with a chronic disease on service for more than one cert period

good luck

[RN416]

Thank you so much, this is very helpful!

[berube]

We are TOLD, that unless they are no longer homeboud we MUST recert, no longer can we use our clincal judgement, very sad