LTC physician visit

[Roni Davis, LPN]

Hello, first time LTC nurse here! Does anyone have any tips for physician weekly visits ? I typically need to do a walkthrough with him and each patient and review orders/ medications.

[Davey Do]

It sounds like you have a handle on the necessary, Roni.

Prioritize resident's areas of concern and oil wheels that are actually squeaking would be encouraged.

In my experience, just about every geriatric patient or resident can come up with some new complaint when a prescribing caregiver is available. The geriatric population has med lists "as long as your arm" because they will be prescribed a med for any and all ills whether pathologically founded or not.

An individual who is not a complainer will sometimes be put on a back burner and forgotten.

I doff my hat to you, Roni, for reaching out to improve the care for those you serve.

[NRSKarenRN, BSN, RN]

Center for Medicare has specific regulations regarding physician visits

§483.30(c) Frequency of physician visits.

Quote

The resident must be seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter.

A physician visit is considered timely if it occurs not later than 10 days after the date the visit was required.

This F Tag Help article re F712 Physician Visits.  Keeping a calendar or log of patient admit/readmit / visit dates will help you to know 30 day intervals.  One SNF I worked perdiem kept  tickler individual list in front of each chart which you could list doc issues to address,  med reorders needed, patient issues/request.  Night shift was responsible for listing med reorders needed and pulling lists for weekly physician rounds ( I pulled at 4AM). It was not kept as part of permanent chart.    In the good old days  (30yrs ago) of paper charts, orders needing co-signature were folded so corner stuck out side of chart as easy flag; when my Dad was in dementia ALF unit recently, they did same thing.

If you are on computer system, check with pharmacy if you can run list of expiring orders.

ASK the doctor what they would like to make most use of visit. You will soon get a routine down.   ?

 

[Golden_RN, MSN]

At one SNF I worked at, we kept a log of very minor pt issues that any nurse could add to (things too minor to page a Dr for).  Things like minor questions from a pt or family member, forms that need to be signed, weight changes etc.  Rounds w/ the MD is a great time to address any of those types of issues.  Also make sure the recapped orders are signed by the physician and anything from the pharmacy drug regimen review is addressed.

[JerDJ, BSN]

Years ago when I worked in SNF, whenever I did rounds with the physicians I made sure that I had the charts ready, any issues/concers, labs reviewed to show or discuss with physicians. It's very easy to forget what you would want to discuss with the physician so it would be best to write down things before he or she comes in. And then make sure you are familiar with the patients as they do like to ask questions.