Frequency/POC help--Please!

[RNRutRO]

when we admit a patient, it is up to us to come up with the frequency for the cert period. some patients are easy, bid insulin, or daily wound care. but for your adverage general post op knee replacement, or chf patient, what do you put? how do you come up with your frequency? please help! what is too many, and what is not enough?

also, any 485 poc ideas/goals would be appreciated.

thanks for your help!

[paradiseboundRN]

The first week after the SOC is usually the most critical and the most likely that will go back to the hospital. So, I usually start with twice a week (Mon-Thurs, or Tues-Fri) unless I see something in the assessment that would warrent more often. For example, new edema, new uncontrolled pain, sudden uncontrolled BS, etc. would make me put 3x/week for the first week at least. Any new symptom is a concern. In the beginning of a cert, I try to see the patient every 3 days (2x week) at least and give them instructions to call if new symptoms start. Unless it's a daily, I can't see a reason to see a patient more than 3x week. The nurse need to teach the patient how to care for themself and then give them a chance to use the teaching. For example, for CHF, you teach them to weigh themselves and report a weight gain to you. If you go there everyday, you can't see whether they're are learning anything. The longer you are in home care the easier this get. I hope I've helped!

[RNRutRO]

yes you've helpped! i've been doing this over a year, and it is the area i stress over the most. i think "am i seeing this person too much? too little" but, your frequency sounds about like mine. we have to do a frequency for the whole cert period, and i usually "front-load" the visits. mostly twice a week, and then decrease to once a week for the last four weeks.

what stumps me most, is on recerts. say you have a patient that is on o2, and your last visit, you go see the patient, and guess what? the nc is in, but the concentrator is turned off. or she continues to have some de-sats every other visit or so. so, i feel like their goals are not met, but then what. keep them on once a week?

[paradiseboundRN]

I agree. Choosing whether to recert is a tough thing. I usually do not recert patients unless they are having new problems. My reasoning is this: Is the patient going to make any more progress with learning how to care for themselves if I recert? Will my visits make a difference in the outcome? Usually not. In the case of the O2, she is going to de-sat whether you come 1x per week or not. If she is really not getting enough oxygen, then you can call to get the O2 increased. Then, it would be appropriate to recert with pulse ox checks 2x week for 1 and then 1x1 and then d/c. This is how I would handle it. I know some agencies want the nurses to recert everyone. They are thinking about the $$$$$. But I won't recert unless it's justified.

[RNRutRO]

this is what i was taught on rct's, does the pt have any new meds? has the patient been in the er, or hospitalized this past cert period? has the patient not met their goals? any new dx? rct if so.

when we recert pt's it's always for the 60 days. unless they no longer are homebound, or they request discharge. we do not usually ever discharge early.

thanks for your thoughts.....