How does your agency set frequencies?

[DutchgirlRN, ASN, RN]

We had a mandatory staff meeting on Friday. Our DON found 16 out of 20 charts when she was doing the billing on which we lost money, not alittle, but alot. i.e. reimbursement $2700, cost $5,000+. The company (9 branches) as a whole is doing great. This won't effect us at present but if it continues obviously it will. We talked about HERG (?) scores and appropriate SN frequencies.

When I started working there I was told to load the visits to the front of the cert period, esp with CHF and COPD pt's, who are at high risk for rehospitalization. Everyone put all new admits at 3 week 3. That's what I did and no one ever said a single word. In fact, sometimes I'd discuss the frequencies with the case manager suggesting that 2 x a week would be appropriate and was told no lets go with 3 x week.

We talked about how if PT is in 3 x a week that nursing probably would be appropriate with 2 x week. The thought is that PT's take the VS. When I was seeing patients alot of times I would think "what am I doing here time after time, nothing new, hard to find anything to teach on, this is ridiculous". We don't have regular patients. Once admitted I might see them only 1 or 2 more times during the cert period. I don't agree with that and I keep hearing that is going to change but between people calling in sick all the time and family emergencies it never seems possible.

The majority of the loss has been in SN frequencies and in wound care supplies. With supplies I pleaded innocent. I always write them down and I always take a small of a supply as possible. Usually just a week at a time. I've seen others go out with hands full of dermagran or hydrofera blue packets. The patients wound care changes, the stuff is in the home, we're out the money. From now on we have to have the case manager go with us to get our supplies from the closet. They apoligized like crazy for that new rule but that I do understand, although I'm not guilty.

So, I've rambled on...how does your agency teach you to set frequencies?

[Cattitude]

so, i've rambled on...how does your agency teach you to set frequencies?

well, even though i primarily do long term care, at times when our pt's come out of the hospital we do bill to medicare. so when that happens we change our frquencies to a range. 1-3 xwkx 9wks. that way we're covered for whatever the pt. needs.

[color=#483d8b]

[color=#483d8b]now having said that, my agency is pushing us to make 25 visits a week. they'd love us to make more but the 25 is what they consider optimal.

[color=#483d8b]

[color=#483d8b]as far as supplies, they also want us to be thrifty and make sure the pt's have their own ordered.

[color=#483d8b]

[color=#483d8b]

[color=#483d8b]

[CapeCodMermaid, RN]

I'm still really new to HH nursing but have already heard the dont waste money lecture at every orientation class. Some things seem obvious...a daily dressing means a daily visit. Some ortho postops only need to be seen once a week for microcoag and staple removal...a new diabetic would need more visits for teaching. And, we order patient specific supplies. No joke, our supplier will send 4 packets of skin prep if we don't want a whole box. I'll be interested to see how they determine frequency of visit for the not so obvious diagnoses.