Impossible medicare regs!

[dsgrandmarn]

We have been told that, starting in April, we are going to have to chart every patient contact we have during the shift. All we have are a few computers on wheels and some stationary ones, None of these are very friendly and it can take 2-3 minutes to log on. My facility is an inpatient hospice unit and most of the time we are so busy giving pain meds that we often can't chart until the shift is over. None of us has any idea how we are going to be able to do this without better technology. Anybody already doing this? With what sort of technology? Thanks for any ideas.

[lamazeteacher]

Well, until you have time to sit at the computer, you could do it the old fashioned way. List your patients' room #s, lengthwise on a piece of paper or card, then the hours of your shift go on top, so your contacts can be checked QH. If they want more than hatch marks, like detailed reasons for the contacts, one word should suffice.......:

4P 5P 6P 7P 8P 9P 10P 11P

221A // / eat'g // /med // /// / slp'g

221B

222A

222B

223A

223B

Then when you chart, put more detail in, to indicate the reason for the contact, if it's necessary. Actually, charting should reflect all contacts - that's nothing new. Why is it that Medicare patients need this documentation, and not others?

[MisMatch, LPN]

We started this March 1st - Q shift charting on all medicare pts. Technology - surely you jest! We still do narrative notes on paper. At least I work nights, so notes tend to be short, ie: slept all night, no c/o pain or discomfort. Yes, I'm usually charting these after shift - next we'll be hearing grief about the overtime from the DON.

[Straydandelion]

Excuse the side track:

I am now very curious not doing UR anymore, however doesn't medicare still pay per diagnoses/drg? If so, how would this help in the billing?

[morte, LPN, LVN]

i would e interested in seeing the new regs

[diane227, LPN, RN]

Here's the way I look at stuff like this, I don't even pay attention to it. You can't chart on every patient, you won't have time. If it is something significant, I would probably chart it. Minor stuff, no

[mama_d, BSN, RN]

Wow. Not sure that I have any suggestions that would really help you out.

What about getting something like a stenographer's notebook (do they even make those anymore?) and using one page per patient and just charting a quick note for each time you have patient contact? Like "2200 pot/med" for toileted and meds given, then you could expand on that when you do your actual charting.

Sounds like you're going to have a very close relationship with your computers...I don't envy you at all.

[dsgrandmarn]

Thanks for everybody's input. I appreciate your ideas and sympathy. I don't have the answers to the more detailed questions about Medicare, not my forte at all. Keep the ideas coming. I'll probably be sharing them at work at some point.

[HouTx, BSN, MSN, EdD]

YIKES - pretty soon, we'll all just have to wear head-mounted web cams and use speech recognition software while we take care of patients.

Srsly, automated systems may make this change more difficult. Those 'beasts' automatically record times as you enter information - so goodbye block charting. You can't go back and enter a full shift's worth of info at one time - without a huge amount of overriding the system.. which you probably won't have authority to do.

Just about the only way to manage frequent charting with an online system is to have a terminal in each patient room. Then we get complaints from patients & families .. "the nurse was just playing around with the computer all the time instead of taking care of Mom/Dad"..