Medicare's ridiculous requirements or is this my company?

[I<3H2O, BSN, RN]

I work for a large corporation and they are forever changing what is "required" in our documentation. When I started several years ago, orders were written kind of vague such as wound care: "cleanse with saline, cover and wrap". Now it has to be written, "skilled nurse to perform wound care to left calf using clean technique by removing old dressing, cleanse wound with wound cleanser, pat dry using gauze, apply medihoney 2mm thick, cover with non adherent dressing covered with abd pad and secure with tape."

We can no longer write "may accept orders from consulting providers" now we have to write may accept orders from Dr. Larry Smith, Dr. Michael Gray, and Dr. Susan English.

We have to write out a lengthy description of how the patient is homebound: limited range of motion of left knee, pain 7/10 with ambulation, risk of infection due to surgical wound, is only able to ambulate 10 feet and then must rest for 3-5 minutes due to SHOB before ambulating any more.

Diabetic foot checks must be documented on every single visit. Blood sugars must be documented on every single visit or we must document every single visit that the doctor has advised the patient that they do not need to check their FSBS.

Every intervention must have a goal date.

Cannot check a pulse ox without an order to do so.

Cannot write an aide care plan that has ANYTHING PRN because the aide is not skilled enough to decide. Cannot write that the patient may have a shower or a tub bath b/c the aide is not skilled enough to decide. (hello, can the PATIENT not decide?)

Do this and more in less time, less time, less time and don't you dare forget anything.

[caliotter3]

Those orders sound like the orders written by one of my previous agencies, and akin to the care plans at another agency that went on and on for seven or eight pages, how to change a diaper, how to wash your hands, ad infinitum. And you should have seen the ___awful preprinted MARs they came up with. I always thought the (insert appropriate salty adjective and noun) were the bad nightmares of someone who obtained one degree too many.

[Libby1987]

We've been doing all of this things like that for years. Not 100% positive if all is required to that degree but we do excellent in our surveys and audits.

[Haddoa]

Our wound care orders have to be written like that. Doctors have to be specified. But we only check bs at each visit if it is ordered. If it is which is rare as we see then 1-2 times a week. Then we do it takes 15 seconds. We have to specify tub or shower can't pick both but our very competent bath aide deals with any changes or what the pt needs so I can't say that has been a problem for me personally. Oh and when I write my orders and goals I alway put in prn O2 sat for increase sob or change to lung sounds, easy and always covered!

medicare always looks for reasons to not pay. That is why everything must be so specific! Annoying at times but I am so used to it now it's second nature.