Does your agency accept patients with orders like this?

powernurse · Jan 10, 2007

Maybe it is because there are only two of us and we are overworked and getting farther and farther behind as it is, but when we got a cheery phone call today with a patient referral for PICC line antibiotics every 8 hrs. (vancomycin and cephapine) for 3 weeks we both sat down and literally cried...we had just been celebrating that we only had three days left on a very difficult patient we had been sharing (who lives an hour away from both of us) who had been getting daily Levaquin IV for two weeks. Then this nightmare came over the wire.
Do all home health agencies grab at anything they can get with greedy hands? Or do some HH agencies actually consider their employees?

My first question would be ... is the patient or family teachable? If so TEACH, TEACH, TEACH.....

and no, not every agency is soooo greedy that they will jeopardize their license or their nurses licenses for more $$$$......

the agency i work for now would but when i worked in connecticut, we would close to admissions if we were short on nurses.... at least until we examined the pt population we had and d/c'd those who were ready, etc... my guess though is that in the real world most places are like who we are stuck with right now....

Ugghhh! :madface:

Cattitude · Jan 10, 2007

maybe it is because there are only two of us and we are overworked and getting farther and farther behind as it is, but when we got a cheery phone call today with a patient referral for picc line antibiotics every 8 hrs. (vancomycin and cephapine) for 3 weeks we both sat down and literally cried...we had just been celebrating that we only had three days left on a very difficult patient we had been sharing (who lives an hour away from both of us) who had been getting daily levaquin iv for two weeks. then this nightmare came over the wire.
do all home health agencies grab at anything they can get with greedy hands? or do some hh agencies actually consider their employees?

:eek: what are they thinking? i've read your other posts in the past and my goodness, you guys have it rough. i think that you and your coworker need to have a serious sit down discussion with your higher ups. do you think they would listen?

seriously , your health is at stake. i believe we need to be happy and somewhat content so we can help our patients and not driving around like a maniac to do abx t.i.d. that is just lunacy. :banghead:

i realize that i am lucky as i work for a long term agency, we don't do any iv abx at all. we do have a short term branch with an iv team but they are a separate facility.

my bossess are pretty considerate most of the time and i appreciate that , especially after some of the stuff i read here.

hey, you could move to ny and come work with us?

hang in there and do something good for yourself!

beez

CapeCodMermaid, RN · Jan 10, 2007

First of all, I am a nurse but NOT a home health nurse..although I hope to get that job tomorrow.

I had to have IV antibiotics every 8 hours for 4 days at the hospital. My doc wanted me to stay for another 7 to continue the every 8 hour schedule. NO thank you, I said. My friend can come run the IV for me at home....much to my surprise, there is a system for delivering IV antibiotics through a PICC line every 8 hours that only requires a visit from a nurse every other day. You wear a fanny pack which contains a cassette filled with the antibiotic. It runs via a pump at a KVO rate until the abx is delivered. It saved me from having to stay at the hospital, it saved the agency from having to come to my house every 8 hours and I was even able to go to work.

Check out the options before you say no to it.

Jo Dirt · Jan 10, 2007

I didn't have the otion of saying no. They grab anything they can get. And this patient doesn't have a caregiver to do it.

It gets bad when you start to resent these patients when your job is to take care of them. But home health shouldn't be a 24 hr. same as hospital service.

We're ready to quit.

nurseangel47 · Jan 10, 2007

Sorry to hear they're burying you alive with caseloads! Sounds like an agency I once worked for. Lasted about 8 months until the daily minimum visits was enforced after a huge corporate buyout of the company.

As usual, the bottom line reighned.

On the other hand, at a privately owned agency, the owner is a Christian, not to indicate that I believe you have to be a Christian in order to be nice, though...and she and her staff who take referrals are always mindful of whether or not they have available staffing for a request BEFORE they accept it as a company policy. Which is really better all around for everyone concerned. Nice people=nice place to work!

Noryn · Jan 11, 2007

I briefly worked home health and had a lot of respect for my manager as she seemed really knowledgeable. She had always told me that Medicare no longer paid for nurses to do things like this or wound care on a regular basis, rather it paid to teach caregivers how to do this. If someone did have an order for an IV q 8 hours, for the first day or so we did go out and do this while teaching a family member how to do it as well. If they didnt have a caregiver, we were unable to take the patient. Private insurance along with medicaid was similar.

Sometimes we would speak with the doctor to see if there were alternatives, in this case, perhaps bid instead of q 8 hours.

Home Health Columnist / Guide · Jan 11, 2007

there is a system for delivering iv antibiotics through a picc line every 8 hours that only requires a visit from a nurse every other day. you wear a fanny pack which contains a cassette filled with the antibiotic. it runs via a pump at a kvo rate until the abx is delivered. it saved me from having to stay at the hospital, it saved the agency from having to come to my house every 8 hours and i was even able to go to work.
check out the options before you say no to it.

cadd® ambulatory infusion pumps

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and elastometric pumps:

medscape article (free registration): disposable infusion pumps

have been around for over 10 years and revilized homecare infusion.....biggest issues is cost of devise. many insurance companies refuse to pay for these iv devices. medicare does not cover the cost of most iv medications except for intractable pain mgmt. they will pay for cost of " nursing visits" . therefore agency makes $ by sending nurses every 8-12 hours to administer drug.

working for homecare agency's with inhouse pharmacies, more likely to see these products being used for all patients as can see more patients in a day. sometimes i saw 8-10 established pts in 8 hours: only in home 10-15 minutes for chemo hookup/disconect or dressing change and set vs, flush line and out the door to next client with drive time 30-45 min between cases.