Is this practicing without a license?? - page 2

I saw a home patient yesterday who had a new pressure sore on her little toe. She requested Duoderm and I had some in my car so I cut some small ovals, applied one to her toe, and left the remainder... Read More

  1. by   NRSKarenRN
    ANYTHING involving "assessment" and subsequent "treatment" outside the hospital setting in homecare and hospice requires a physician's order due to regulatory requirements.

    Prudent hospice organizations have developed standing plan of treatment orders that include care for stage 1-2 pressure ulcers, common meds for symptom + pain mgmt orders.

    Homecare plan of treament orders even need to include language such as "Assessment of body systems" for nursing and "eval and treat" for therapy other wise viewed as non compliant with Medicare/Medicaid conditions of participation.

    For patients under homecare/office, doctor/NP sees patient at home or office andgives prescription to patient/family to get filled, Homecare/Hospice staff have to contact practitioner for verbal/written order to be signed as considered "deviation from plan of care signed by doctor at start of care". No wonder doctors are swamped with paperwork.
  2. by   aimeee
    Quote from NRSKarenRN
    ANYTHING involving "assessment" and subsequent "treatment" outside the hospital setting in homecare and hospice requires a physician's order due to regulatory requirements.

    Prudent hospice organizations have developed standing plan of treatment orders that include care for stage 1-2 pressure ulcers, common meds for symptom + pain mgmt orders.

    Homecare plan of treament orders even need to include language such as "Assessment of body systems" for nursing and "eval and treat" for therapy other wise viewed as non compliant with Medicare/Medicaid conditions of participation.

    For patients under homecare/office, doctor/NP sees patient at home or office andgives prescription to patient/family to get filled, Homecare/Hospice staff have to contact practitioner for verbal/written order to be signed as considered "deviation from plan of care signed by doctor at start of care". No wonder doctors are swamped with paperwork.
    Too True!!!!
  3. by   a21chdchic
    Everyone is right, do need the order. Just do what needs to be done, then get the order. A good med. director will back you up, as long as you can give a good rationale to back you up.

    Ana
  4. by   chris_at_lucas_RN
    Quote from rnkalee
    I saw a home patient yesterday who had a new pressure sore on her little toe. She requested Duoderm and I had some in my car so I cut some small ovals, applied one to her toe, and left the remainder for her to use. I charted a progress note on it. My D.O.N. said that I should have gotten a physician order before applying the Duoderm. She said I was practicing medicine without a license. Is that true?? I come from an neurosurgical ICU background and could use supplies such as Duoderm as I saw fit so this was news to me.

    Thanks for the help!
    Karen
    It could actually depend on the policy and procedure of your hospice.

    I am used to ordering DME and taking care of business without an order, so long as it does not involve medication or invasion of the body proper.

    The hospice where I am now, you have to get an order for all DME, and you actually have to have an order for pulse oximetry!!
  5. by   leslie :-D
    Quote from emmycRN
    The duoderm could not have hurt the pt and should not require a doctors order.
    i have seen duoderms left in place too long, where it has necrotized the wound;
    stage 2 turned to stage 3/4.

    leslie

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