Doing follow up visits with no clear orders?

Libby1987 · Apr 2, 2017

Your question reflects either a lack of minimal orientation, or a lack of minimal absorption. I don't think you have enough of a basis to be on your own and should still be with a preceptor, or at minimum have very close access to one.

Needing an online forum for such basic information is not a safe position for you.

LadyT618, MSN, APRN, NP · Apr 3, 2017

How long is new to home health? Is this your first home health agency? Is it a small agency or large agency? How important is education within your agency?

I can tell you that the initial referral is insufficient for follow-up visits. It is a federal condition of participation (COP) to inform the physician of your assessment and to coordinate care with him/her regarding plan of care and to obtain approval for said plan of care. Without that approval, NO ONE should be visiting the patient! Should your agency decide to just simply send off the Plan of care (485) and wait to see if they get a signed copy in return, you must wait on signed copy to return before seeing patient. It's as simple as that. I get the feeling that you knew that but perhaps are working within an agency that does not adhere to this COP. The questions you have asked are leading me to that conclusion, but I may be wrong :) The fact that you can recognize AND identify AND are concerned that you are being sent to see patients for follow up visits without any follow up orders sounds like you're throwing a flag in a football game....calling FOUL!! :)

peaceriver · Apr 3, 2017

Thanks Im new to home health. My first month. It's my first agency. It is a small one. I only got 1 and a half days of orientation. I have asked the Don for proof of orders and she said for follow ups (teaching cases) I make it up as I go along but i dont feel comfortable. My intuition says something i s wrong

LadyT618, MSN, APRN, NP · Apr 3, 2017

OMG!!!!!!! "I make it up as I go along"????? Your BS radar is right on point. If at all possible, please shop around for a new employer. This sounds extremely scary. Are you a new nurse or just new to home health? Your intuition is right on the money! Please please PROTECT YOUR LICENSE!!! Just like Smoker the Bear would tell us only we can prevent forest fires, I think he would say only YOU can protect your license :)

peaceriver · Apr 8, 2017

Ive been a nurse for about 8 years. Have 9 months of hospital experience back in 09. Worked as a health writer/educator at a company for 6 years then worked at a clinic as a community nurse last year.

LadyT618, MSN, APRN, NP · Apr 8, 2017

So your BS radar needle should be pointing toward "get out while you still can!!" :) You know what's going on. Either stand your ground and they'll have to take it and adhere to the rules or if they refuse then you can keep on truckin' on to the next home health organization. Home Health is a most WONDERFUL area of healthcare. Your talents should NOT be wasted on those who are trying to get over.

LPN2018, CNA · Apr 8, 2017

This happens more frequently than anyone would think. Sometimes a Care Plan is in progress, yet the PCA or Aide is not left with any directives. At best, either the office gives verbally or family is present and explains what the nurse or case manager is including in care plans. Never does a caregiver go in without first getting report.

LadyT618, MSN, APRN, NP · Apr 9, 2017

That too is ridiculous! Coordination of Care is supposed to involve EVERYONE, no matter their rank! It's a federal regulation. Instructions need to be clear and complete. Pester the powers that be if things aren't clear.

G224

(Rev.)

Â§484.36©(1) - Written patient care instructions for the home health aide must be

prepared by the registered nurse or other appropriate professional who is

responsible for the supervision of the home health aide under paragraph (d) of this

section.

The expected outcome for this high-priority standard is that the home health aide

receives written instructions for patient care that are clear and complete and address

patients' current needs .

The aide assignments must consider the skills of the aide, the amount and kind of

supervision needed, specific nursing or therapy needs of the patient, and the capabilities

of the patient's family.

Â§484.14(g), look for documentation by the aide in the clinical records that describes

significant information or changes in his or her patients' conditions and to whom he or

she reported the information. Notes should be dated and signed by the aide.

Isabelle49 · Apr 13, 2017

Agree you should find another company to work for. You NEVER make it up as you go along. You teach according to what has been set by the Plan of Care or 485.