Giving report on admit, recert, roc

HealthyNurse · Sep 9, 2011

Many agencies have requirements for "care conferences" or something similar after OASIS timepoints. I think that it can be very helpful to clinicians in ensuring that the patient receives all necessary services and for troubleshooting any patient concerns before they become major issues. It doesn't seem all that unreasonable what your office is asking, although they don't give you much time to do it in. Also, it seems like they expect you to be in the office to give report (?). Can you ask if it can be done over the phone? I see most agencies doing these type of conferences by phone, for the most part, unless it is a brand new process, in which case the first couple conferences may need to be in-person, or unless there is a need to meet with other disciplines. Is there a specific reason why they have told you that the report can't be taken before 1pm?

If you are able to call in the report, could you call in-between patients? What about calling after you pick-up the child from school? It may seem inconvenient, but I think most of us have been there- making phone calls, charting, etc., during our time "off". I wouldn't be so quick to brush off your agency's expectations regarding this because the conferences do serve a purpose. Try to talk to your manager about the process they have set-up and help them to see how it will impact your time that could be spent delivering patient care.

paddler · Sep 9, 2011

I agree, who has the time? We're supposed to call the doc, and family and the office and the scheduler and the way I see it is everything I am telling them IS IN THE CHART. THis is why I document. Please don't make me make 5 phone calls for each freaking patient I see when everything you need to know you can look up yourself!

HealthyNurse · Sep 9, 2011

I agree, who has the time? We're supposed to call the doc, and family and the office and the scheduler and the way I see it is everything I am telling them IS IN THE CHART. THis is why I document. Please don't make me make 5 phone calls for each freaking patient I see when everything you need to know you can look up yourself!

Sorry, but having worked on the other side in quality assurance and management, I respectfully disagree. There is a purpose for care conferences when done appropriately. Unfortunately, the reason why there is a need is because the majority of clinicians don't understand documentation regulations and the information ISN'T in the chart. Many clinicians also have a difficult time coordinating the care of patients and ensuring that the patient is receiving all needed services, appropriate treatments, etc. Not because they are poor clinicians, but because they are so busy that it's easy for things to be missed. When done correctly, care conferences can help to make sure the patient receives appropriate and coordinated care and experiences good outcomes by avoiding rehospitalizations.

paddler · Sep 10, 2011

I'm not talking about Case Conference, I am talking about giving report about the things the OP mentioned which are documented in the same place in each patient's chart for each admission and are not difficult to find.

Case conference, I agree is useful and necessary but is not what is discussed from an admission report.

HealthyNurse · Sep 10, 2011

Okay, I see what you are saying now. I misunderstood...I thought the OP was referring to more of an admission case conference and not just a typical report. Do the office personnel do anything with the information? Do they make suggestions about care and services needed or do they just accept the report? If it's just a report, then it doesn't make a lot of sense, unless the report is going directly to the person who will be case managing.

KateRN1 · Sep 10, 2011

In every office that I've worked in, that report from the field nurse is used for staffing the case, developing the calendar, identifying current and future needs, and for anticipation of any issues. I can't tell you how many times I've been on call, the field nurse hasn't called in report, and the patient calls me to ask a question. It happens every single time I'm on call. There's always one person who doesn't understand what report is for.

Ask for a copy of the report form so that you have a better idea of what information the clinical manager needs from you and then make sure that you complete those items first, save the rest if you have to, but you should really have a good idea of the ADL and TUG scores if you are doing a thorough assessment. If the patient needs therapy, the TUG score and ADL scores are what we use to develop an initial idea of what the HHRG score is going to look like and how much therapy the patient will need.

If you don't understand what the clinical manager uses the report for, ask to sit with him/her for a day so you can see what goes on, what happens to that information, and what goes on in your office that they have to limit report to that time during the day.

Believe me, there's a reason. We don't come up with this stuff just to aggravate people or try to make life difficult.

Isabelle49 · Sep 10, 2011

Okay, I see what you are saying now. I misunderstood...I thought the OP was referring to more of an admission case conference and not just a typical report. Do the office personnel do anything with the information? Do they make suggestions about care and services needed or do they just accept the report? If it's just a report, then it doesn't make a lot of sense, unless the report is going directly to the person who will be case managing.

This is not a 'case conference'. We have a case conference meeting every Wednesday and it consists of yes or no answers as to whether or not a patient is going to be reverted or if PT/OT or ST will continue to see the patient and that is it, nothing else.

The report given on Admit, Recert, ROC primarily is to make sure the first 6 diagnosis are case mix and that there are no diagnoses at the bottom of the list that would not gain points for the HHRG, also, we are required to give the scores to the Oasis questions that add to the HHRG score, and nursing frequency. This report is strictly for financial purposes - the case manager will calculate the amount the agency will make and can then determine what percentage will be spent on patient care (I know, I have done the job for the company). If the percentage of cost is greater than 32%, then the diagnoses and/or answers to HHRG generating Oasis questions are manipulated so that the percentage is not more than 32%.

BTW, our case managers can change our scoring on the OASIS without our permission. This is done, processed and about 2 weeks later the clinician receives a form to sign indicating which answers need to be changed on paper. The form also says that the case manager has discussed the changes with the clinician who assessed the patient, although this never happens.

Again, these reports and Case Conference are strictly for budgetary purposes. This is what bugs me. Plus, since I am a prn nurse, I get thrown all of the 'bones' no one else wants. I have a standing wound care at 1230 every Mon, Wed and Fri. I make that my first case that day and work my way back home, cause if I didn't, I'd have to hang out on the street waiting to see patients. Now, tell me, how am I to be in the office after 1pm every Mon, Wed and Fri to give report - those are the days paperwork must be turned in. I think I might try to get a job as a phlebotomist!

HealthyNurse · Sep 10, 2011

Unfortunately, in the current practice environment, the financial aspect of home health care has to be a concern for everyone in order to stay open and continue to deliver services. It is unfortunate that the conferences are being used only for that purpose though. I usually see them being used for both- financial and quality of care concerns. What doesn't make sense is why they are requiring you to come into the office to give the report. This could easily be done over the phone, if you have already turned the paperwork into the office. Why don't you ask your manager about it? If they are only concerned about the financial aspect, they are losing money by taking you out of the field and paying mileage to the office.

Isabelle49 · Sep 11, 2011

Received an email with next week's schedule telling RN's that report should be called from the patient's driveway. How many of you field RN's are so fast and efficient that you can you can do your assessment, review all meds, take history, do teaching, wound care etc, complete your Oasis, Braden before you leave the patient's driveway? Please tell me I'm not crazy. The new manager who sent this email out NEVER turned paperwork in on time.

KateRN1 · Sep 11, 2011

I've always called report either from the patient's home or on my way to the next visit. The paperwork doesn't have to be completed to generate an OASIS report. Although I'm in management now, when I do field visits, I still call report immediately afterwards and do have that information for the report. I'm not sure what the problem is. In that list of things, I hope you've done them all (with the exception of completing the OASIS) before you leave the patient's home. You can't do an assessment, review meds, take history, and perform wound care after you leave.

mommy1975 · Oct 28, 2011

It' so interesting to me to be able to read this thread. We have struggled for so long with field staff not calling in report. My DON doesn't force the issue, so for MONTHS, I have had to read clinical summaries to even find out the recommended frequency because I can't get report any other way. There is a TON of missed information in the referral that the field staff isn't getting-missed meds, no attention paid to immunizations, incorrect hospitalization dates, etc, etc.

I think most of the problem is that they are FFS and feel too rushed to do things correctly/thoroughly. I actually had a field RN write in her clniical note last week that there was no PMH in the referral, but there was 15 pages of it!! When we get a referral with precious little information, I immediately fax the doc for an H&P and med list, hoping to get it back before my field RN goes out, so she can do a more thorough job. . . . .

So, what ends up happening is we return the files to them for correction, which I know aggravates them, too, because they never had enough training at the outset. This is a really tough job to learn, moreso than most nurses working in a hospital understand. I know I didn't have any idea it was this hard before I started.

The field RN HAS to call report to up to 5 people because he/she directly saw the patient. The Case Manager can't give report to OT or PT on a patient they've never seen. Field staff should be properly reimbursed for their time. I look forward to opportunities to make these changes!