Home health scope of practice for RN's state of Texas

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I am trying to get clarification on a particular MD order I am seeing in the home care setting. I have been referred to someone at the state board but have received no return phone call. Please comment on what physicians orders for "Eval and Treat" means to any of you out there. I frequently see this order. Different nurses interpret this differently. In my mind it ultimately it ends up being a scope of practice question. Any views you have would be helpful or referral to where I can get answers to my questions. Thank-you!!:)

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To me it means patient needs eval and treatment by different disciplinary. A doctor cannot evaluate patient for dysphagia so he writes an order for a speech therapist to evaluate for dysphagia and treat if neccesarry. A doctor cannot evaluate patient's mobilty so he wants physical therapist to evaluate and treat the patients.

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The appropriate discipline - - i.e., PT, or Wound Care - - evaluates the situation, makes recommendations, usually calls or faxes the MD who then usually approves the recommendations and orders them.

And if the recommendations are fairly ordinary, then they are put into practice.

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I am trying to get clarification on a particular MD order I am seeing in the home care setting. I have been referred to someone at the state board but have received no return phone call. Please comment on what physicians orders for "Eval and Treat" means to any of you out there. I frequently see this order. Different nurses interpret this differently. In my mind it ultimately it ends up being a scope of practice question. Any views you have would be helpful or referral to where I can get answers to my questions. Thank-you!!:)

Can you narrow down your concern, or give an example? :)

If it's not the nurse who is evaluating and treating (which it would NOT be), why are the nurses wondering? If the person that is the one doing the evaluating and treating is understanding it, what is the issue?

Seriously- I'm interested :)

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Specializes in Thoracic Cardiovasc ICU Med-Surg.

LOL. I did home health for six years and I have seen this order a lot. To me, it means the doc is saying the patient clearly needs a home health nurse, but he's letting you decide if the patient needs PT OT HHA MSW. If I found any wounds, I would use my judgement as to what kind of treatment--Aquacel Ag for draining wounds that could be infected. Or tegaderm prn skin tear.

There are places on the oasis that you can write those in and they become part of the 485.

Myabe it just means the patient needs help, and if the doc wrote out everything he really wanted you to do (assess and instruct regarding meds, cardiopulm status, diabetes, activity, diet and lifestyle changes) it would take forever.

I naturally called the MD office after the SOC and gave them a quick update on what I found.

(NO food in fridge, insulin in freezer, roaches everywhere, garbage to the ceiling etc)

I loved home health but hospital nursing is in some ways so. much. easier emotionally.

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lol. i did home health for six years and i have seen this order a lot. to me, it means the doc is saying the patient clearly needs a home health nurse, but he's letting you decide if the patient needs pt ot hha msw. if i found any wounds, i would use my judgement as to what kind of treatment--aquacel ag for draining wounds that could be infected. or tegaderm prn skin tear.

there are places on the oasis that you can write those in and they become part of the 485.

myabe it just means the patient needs help, and if the doc wrote out everything he really wanted you to do (assess and instruct regarding meds, cardiopulm status, diabetes, activity, diet and lifestyle changes) it would take forever.

i naturally called the md office after the soc and gave them a quick update on what i found.

(no food in fridge, insulin in freezer, roaches everywhere, garbage to the ceiling etc)

i loved home health but hospital nursing is in some ways so. much. easier emotionally.

in what way? :)

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Specializes in Thoracic Cardiovasc ICU Med-Surg.

Well, I work surgery. We fix there hearts, valves, aneurysm, remove the lung cancer. They get better. They go home.

Home health...you see the truth of how people live. How they survive with no support and almost nothing. I had a lady who had macular degeneration back in Fl, she had no air conditioning and there was about twelve inches of dust on everything. Her life stopped when she lost her vision.

I had another patient who had a incomplete spinal cord injury at 19. I saw him three times a week for bowel program, but I also did his wound vac dressing, changed his supra pubic cath, flushed his port, administered his IV. I was the person he told that sometimes he thought about taking a whole bottle of Valium.

Another lady lived alone and could manage everything except eating and taking her meds. Her house was spotless, but she forgot that she hadn't eaten in two days. Or then she'd taker her morning pills a few times because she couldn't tell what day it was. And according to Medicare there was no skilled service because she was unteachable.

Oh yes. Hospital nursing is easier. At the end of the day, your day is over. The home health nurse still has to schedule appointments for the following day, finish the days clinical notes, document any phone calls to the MD and make sure there are orders for all the patients on service.

I love it, I learned a TON, but I don't think I will EVER go back.

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