Trend for PT doing RN role?

Specialties Home Health

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I've recently started a new role as an Acute Care CM at a hospital. Part of my job is to arrange Home Health care for Ortho patients, usually post op joints. Now we are being told not to order SN (skilled nurse) for these patients as PT can fill that role: monitor incision, remove staples, draw labs (PT/INR). I have some concerns with this and wonder if this is normal across the country? Thank you in advance.

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Specializes in Hospice.

As far as I know, medicare requires an RN case manager for home health. If no skilled nursing need is identified, PT/OT/SLT can carry the case. Assessing incision/wounds, blood draws, etc are skilled nursing. Regardless of what is put on the referral, a skilled nurse will go in first for the start of care and if there are skilled nursing requirements, that is what the plan of care will reflect.

All home health care plans are subject to physician orders. The doc will sign off (rarely not) the RN case manager plan of care.

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We have this practice in Northern California, with our healthy joint replacements.

Lab draws and fingersticks are not skilled and the anticoagulation clinics manage the warfarin. So many patients self monitor, it's really akin to saying an RN is required for glucose management. Wound clinics are often staffed with physical therapists for wound therapy, staple removal is pretty basic. PTs have at least a BS with most now masters or doctorate prepared with heavier science backgrounds than nursing, they're capable of performing an INR/reporting the results, changing a giant bandaid and pulling staples. RNs are needed for disease management and more complex procedures. I haven't seen an issue with it other than hearing the PTs say they, if given a choice, would rather not have to bother with it, otherwise no complaints.

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Thank you for your comments

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Thank you Kaisu, That is what I thought. I have concerns about setting up home health without SN, just PT. I think pt will be at risk if they develop post op complication, such as infection. But this is what they want us to do. I was just wondering how prevalent this was.

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We teach patients and caregivers to recognize symptoms of infection, why do you think a PT wouldn't recognize an abnormal or symptom of infection and call the MD? Or get a nursing order if patient needs something outside of their scope?

Maybe it's because you haven't worked with home health PTs, but we're all used to being the eyes and ears when we're out seeing a patient. A nurse may not see the patient for another 3 days, they aren't going to walk in minutes after the therapy like an inpatient facility. Our PTs are super sharp and I haven't come across one who wouldn't know to respond appropriately to an infected incision, in fact I've see a lot of great catches and sometimes I've seen them be more observant.

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Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.
I've recently started a new role as an Acute Care CM at a hospital.

OP: Libby1987 has it right. Patients are taught to perform some of their own basic needs prior to discharge. Also, PTs are trained to perform some very basic nursing skills to include wound management (staple removal, wound care) as well as they can take a BP and recognize a poor one and a good one.

As a former Staff RN by the bedside in acute care, I can safely state I had no idea what PTs could and could not do based upon my bedside work experience because in acute care, PTs did not seem to do anything nursing related (some I knew barely wanted to do their own jobs)! It was not until I started to write referrals as an inpatient CM and ED CM that I learned more. Thus, in order for you to be more comfortable with their role, you should talk to the PTs in your current place of work. I think you will be surprised by their responses.

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Our PTs don't do labs, but yes PT's can be case managers, you do not have to have an RN case manager. We have several PT only patients which means they get no nursing at all. If an acute issue comes about that requires a skill of a nurse, then we have to call and get an order from the MD and do a RN add on. It is very common for PTs to do wound care in hospital settings, so monitoring a surgical incision and removing a bandage really isn't unheard of. Our PTs also call the MD and report with any issues.

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Specializes in RN, Staff Developer, ADON.
On 7/4/2018 at 10:47 AM, Kaisu said:

As far as I know, medicare requires an RN case manager for home health.

I am a case manager in home health. I can assure you that it is NOT a requirement. We have several patients who are PT only.

BUT, PT's do not perform staple removal, draw labs, etc. They can monitor the incision, but if they have questions, we nurses get the call. Haha. (I am in Northwest Florida)

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Specializes in Hospice.
Quote

We have several patients who are PT only.

I guess I wasn't clear. We have many PT only patients too. An RN Case manager MUST do the initial start of care. If no skilled nursing need is identified, then the case is managed entirely by PT.

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Specializes in RN, Staff Developer, ADON.
On 3/16/2019 at 11:52 AM, Kaisu said:
On 3/16/2019 at 11:52 AM, Kaisu said:

An RN Case manager MUST do the initial start of care.

Nope.... if physician only orders PT, they are the ones who do the OASIS. PT and ST can be considered stand alone disciplines and can do their own OASIS. OT can not.

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Specializes in Hospice.

Must be just my agency policy then. Or perhaps a state specific thing?

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