Home health charting in home

[Barbie A Doll]

I don't really know where to ask this question. Maybe you can help me.

As a clinician in Home Health, I have been able to chart in my home via

computer for years. There has been some discussion in our agency to

not allow charting in a clinicians home. I know that Home Health

agencies for years have encouraged charting in Patients and/or

clinicians home to increase productivity (not going to office or going

to office as little as possible). Is there a position paper or

somewhere I can go to get info on this practice (charting in other

places besides office) that is standard and excepted practice

throughout the industry? I would really appreciate your help.

Dana

[caliotter3]

When the new emphasis on HIPAA came about a few years ago, at our inservices about HIPAA, the instructors discussed that charting at Burger King was going to have to stop. They were joking, but I have charted at a restaurant before, and I never saw anyone trying to look at what I was doing. I see nothing wrong with charting in your home, if you want to. Charting in the client home is a given. That, or the car, are the preferred places. I never go to the office unless absolutely necessary and would resent being told that I had to, unless of course, they are going to pay one to sit in the office. I doubt that there are position papers on this subject.

[annaedRN, RN]

I love HH...part of that is the flexibility in being able to plan your day in a way that suits you...starting from home, seeing all your pts in a row and charting later, charting as you go, planning personal appts and working around them, etc. If HIPAA is not being violated - should it matter? I think not. As far as I know, there is no COP stating you cannot chart in your own home. I imagine your agency is wanting to make it a policy for some reason (unbeknownst to you ..) I can say that if my agency instilled that policy, I would have to seriously consider if I would stay on. Find out the reason and go from there! Hope it works out for you!!

[caliotter3]

I think they want to supervise the nurses in the office and they want to claim there is better compliance with HIPAA by limiting the places where the chart/note/documentation sees the light of day. Perhaps this agency does not place a copy of nurse daily notes in the field chart to prevent the family from having access. By keeping the note in the office, the company has almost total control over the contents of the note and where, who has the note. The family can't copy the documentation if the documentation is not kept in the home.

[KateRN1]

I always chart in the pt's home or the office and let me tell you why. If I do a string of regular visits and then save the documentation for when I get home, I run the risk of forgetting an important aspect of the visit and show a shorter visit length than is actually done, because the documentation should be part of the visit. If nurse A is doing 30 minute visits and charting when she gets to her own home, and Nurse B is doing 1 hr visits because she's charting in the pt's home, it looks like Nurse A has better productivity and time management than Nurse B. In fact, they are spending roughly the same amount of time per pt, just the venue for the documentation is different. Plus, I find that spending that little bit of extra time with the pt and family goes a long way to ease the idea of "drive-by nursing visits." Pts feel that I spend a lot of time with them and really listen to their needs, rather than rushing through the visit so I can get home to do the charting. It helps to decrease the after-hour phone calls for silly things, IMHO.

Now SOCs and ROCs I nearly always complete in the office. I did one of each yesterday, plus a regular visit and a nursing meeting, and didn't get home until after 6 pm. Then I have dinner, bathtime, and bedtime for the kiddos and no chance to work on work because I have to get some sleep myself. I was at the office at 0730 this morning and it took me until 1230 to finish all the paperwork, orders, calling docs, and faxing that go along with a SOC and a ROC. By doing it in the office, they see how long it really takes to complete these things and I don't hear crap about why I can't see a full day's worth of patients today.

There has always been the unspoken idea that HH nurses are expected to complete a lot of their work in their own homes, but I just can't manage that. I have a life and a family that needs care, too. I won't sacrifice my family for my job, I already put in 9-10 hour days. Of course, it is a HIPAA violation if your family members are reading through your documentation, but there are better reasons to do the documentation in the pt's homes--don't shortchange yourself.