Missed alot during orientation, help please!

steelcityrn, RN · Feb 1, 2006

Well....lets see where to start...order first comes from either the case mng at the hospital or skilled unit or a dr's office. Intake person at the hh agency takes all info required and checks insurance to be sure its exceptable. Nurse then gets the form. The intake person writes the initial order for homecare.Nurse then takes a admit packet and any skill check list if you have them for the dx. Depending on how much info you are required to fill out on the oasis varies. Our QI person goes over all paperwork with a fine tooth comb but prefers certain areas such as codes and plan of tx to be filled in by her. She is very picky, but I take pride in all my work so have no problem with her like the others. Once all papers are signed and assessment is completed on the patient then any new orders for meds ect may be done. If you obtain a new order for say lasix 40mg po qd and say hosptial bed, app overlay these can be added to the oasis so no order needs written. Now on the second visit and so on, you will need to write a order for it and the top copy is then sent to the dr for his signature for the chart. Recert are done q60 days but can be done few days within that date. Nurse must do admit the day of physical tx if therapy is only ordered. Post hospital must be done within 24 hours post discharge. If the person was only a 23 our hold, no post hospital is done. Discharge packet can be done by the last group in ( rn or pt/ot) That one I like cause you will find that usually the rn may get only 3 or 4 visits then you write a order to place skilled nursing on hold continue with pt to follow pot. There are soooo many things I could go on forever! Just keep up with your work daily, I find that those who let everything sit until the next morning are always having a bad day!

DutchgirlRN, ASN, RN · Feb 1, 2006

SteelCityNurse,

THANK YOU ! THANK YOU ! THANK YOU ! So far I've been finishing up all of the paperwork as soon as I get home. One time only I let it slide until the next morning and learned first-hand what a mistake that was. Thanks for all your help! Dutchie

renerian, BSN, RN · Feb 1, 2006

Comment on coding for you. If your company is having you look up codes in the ICD 9 manual be careful. That is a financial piece and putting wrong codes on is not a good thing/someone who knows coding needs to do that.

I hope they are paying you for making an orientation manual.

renerian

steelcityrn, RN · Feb 2, 2006

Your very welcome:) If you ever have any questions just ask anytime!

jnette, ASN, EMT-I · Feb 2, 2006

I orientated 3 days for HH. Orientation consisted of riding with 3 different nurses. It's a small company, fairly new with no orientation manual. I am working on a orientation manual while I am educating myself on HH. None of the nuses I rode with showed me any paperwork other than the NN, Resump, Recert and Admission. Now I'm being asked to write all sorts of orders, transfer to hospital, resume HH. No one told me to do recerts every 60 days just told me that I would be told when they are due...not! I don't mind correcting all these issues and the DON does understand the problem. Therefore is very excited about me producing an orientation manual. I've been through the HH thread and cannot find any info on paperwork such as what I missed. Can anyone help? The majority of our patients are private and do not require Oasis. Is the paperwork the same for both other than not using Oasis codes? Each recerts in 60 days? Both need orders for written for going in the hosp? Coming home? Is an order written for admission or for discharge or is just the admit & discharge paperwork enough? Any info would be most valuable to me. I love the job, the patients, and don't mind the papework, I just need to understand what's expected. I can't seem to get the same answer from anyone at the office.

Your HHA sounds very similar to mine............ermm.. well, the one I will soon be part of, that is !

Ours too, is relatively new, and I don't think there is much concrete orientation other than going out with other nurses for a week or two. They do have policy and procedure manuals available to read, etc., but I'm not sure about an orientation manual per se. Will have to look into that. Heh.

Good questions, Dutchgirl, keep 'em coming. I know I will have a mountain of questions myself when I start. And since all these HHA do things so differenty, it can be quite confusing, eh? :chuckle

DutchgirlRN, ASN, RN · Feb 3, 2006

Good questions, Dutchgirl, keep 'em coming. I know I will have a mountain of questions myself when I start. And since all these HHA do things so differenty, it can be quite confusing, eh? :chuckle

We can compare notes and help each other out! I do not do any of the coding, Thank God! That is left us to those with the knowledge and experience. We have had several orientation sessions to understand how Oasis works so that we fill out the admissions,recerts and re-admits correctly. The first two flew over my head so fast all I heard was MOO this and MOO that. This last one was excellent and I actually understood it. I think the difference was in the presenter. Anyway, we have 95% private insurance patients which we don't do Oasis on and only 5% Medicare. We have 80-100 patients at the present time and are working on getting more Medicare patients. Lets keep in touch. Cheers!

CardioTrans, BSN, RN · Feb 3, 2006

A good website for you is http://www.cms.gov

Click on providers, then home health. There are tons of oasis questions and answers for your "learning enjoyment". There is also a home health provider manual that list the rules and regs. Also, there is a list serve that you can join where different home health providers send emails that have a variety of information regarding changes in home health.

I must say 3 days of orientation is not good. It takes months and months to learn the rules. Even though you have a majority of private insurance patients, you are still a Medicare provider, so you still have to follow the Medicare rules to an extent. Most insurance companies require a comprehensive assessment on admission. We have what is called a "non-oasis comp assessment" that we do for private pts. Its basically the oasis without the moo questions. We still do recerts every 60 days, or depending on the number of visits allowed by the insurance company.

I wish you luck!

Jonesy · Feb 3, 2006

I am new to HH as well it is a totally new field of nursing for me. I have such a hard time as well with all the oasis info and admission info Recerts ect... I am making so many mistakes and I am asked constantly to correct them it can be very confusing at times! I stay at work just to make sure I get that PAPERWORK in. I also feel bad because one of our agency traveling nurses is not going to be working with us anymore d/t making to many mistakes:uhoh21: and that makes me nervous!! Well, input would be good. I feel like you during the orientation process.

DutchgirlRN, ASN, RN · Feb 4, 2006

A good website for you is www.cms.gov I wish you luck!

THANK YOU! Great info. We just went to non-oasis admission forms for private pay a couple of weeks ago and use the same form for their recerts and re-admits as well. It really is unfair not to fully equip a new nurse with all the info. Finding out the one's orienting me didn't have all the info themselves and those that did, didn't think to share it is a bit discouraging.

Almost every day I get a call, Who did you see on this date, at this time? Also did you fill out a admit or NN on this one, an order for PT/INR on that one? Drives me crazy.

I do believe that this particular agency is very disorganized. The admission packs were always missing 1/2 the necessary paperwork. I complained so long and so loud that finally they are complete. It took several phone calls to straigten this out.The DON is the intake nurse and wears all the hats including doing all the Oasis and took all the call until just a week ago.

I'm putting together an orientation manual as I go along and learn. Simply as a means to educate myself and be able to do my job correctly. Kind of sad when you think about it.

In their defense I have to say they have been very kind and considerate to me. I have deteriorating corneas, as many of you know, and they have gone out of their way to accomodate me. My Mom had a heart cath yesterday and they have gone out of their way to get my patients covered without a single complaint or sigh, only concern for me and my Mom's condition. I got a kick out of the DON. She called me yesterday to see how Mom is doing and she told me that several of my patients refused to let the other nurse visit them. They prefer to wait for me on Monday. I take the good with the bad and hopefullly by educating myself the bad will only improve!

jnette, ASN, EMT-I · Feb 4, 2006

We can compare notes and help each other out! I do not do any of the coding, Thank God! That is left us to those with the knowledge and experience. We have had several orientation sessions to understand how Oasis works so that we fill out the admissions,recerts and re-admits correctly. The first two flew over my head so fast all I heard was MOO this and MOO that. This last one was excellent and I actually understood it. I think the difference was in the presenter. Anyway, we have 95% private insurance patients which we don't do Oasis on and only 5% Medicare. We have 80-100 patients at the present time and are working on getting more Medicare patients. Lets keep in touch. Cheers!

Sounds like a plan to me ! I'm excited to start, yet dreading what they DON'T teach me at the same time. I like to do things RIGHT. I'm hoping they will teach me well and efficiently, but after all I'm reading here, not really holding my breath, either. WAH !

When you get your orientation packet done, I might want you to share it with me............??? Of course we may do things differently, but surely there will be SOME good info in there I can use!

I'm calling them Monday to let them know yay or nay after giving them time to deliberate on my offer of pay/visit. I'm thinking they'll accept. If so, I'm going up there on Tues. after work to sign on the dotted line.

We have 198 patients and growing. But I don't know the ratio of private vs. medicare .............. yet. I do know we are Medicare certified.. and that evidently that makes our paperwork a lot less than other agencies' for some reason.. anyone have any ideas on this?

OK, so yes, we'll certainly keep in touch... so much to learn !!! :uhoh3:

Cardio trans... thank you for all your input here to us newbies in this field.

I'm sure we'll be back for more !

And Nrskaren's stickies and links are invaluable as well. Thank you! Thank you ! :bow:

CardioTrans, BSN, RN · Feb 6, 2006

I think that I have a blank weekly schedule that I put all my patients that I case managed, their recert dates, phone numbers and the days that I saw them. I filled it out each week and turned a copy in to the office. That way they knew who I was planning to see. Of course it never matched what they had, because they would always try to spread me out, and I had a system of being in a certain area on a certain day and seeing all the pts in that area....barring any emergencies of course.

It is in Excel format, but I will see if I can find it and you are welcome to it.

Another FYI.... if you are on all paper, keep you a milk crate type file system in your car with extra paperwork; ie verbal orders, admit packs, med profiles etc, that way you can take one out and do the order while at the home or as soon as you get the order, I would always make me a copy of it too.

I would keep a binder, alphabetized for each patient. It had their demographic sheet, a calendar with visits and recert plotted out, and a copy of their 485. As things happened during the 60 days, I would update the 485 at the time. Made recert time alot easier. I would make changes in red.

For example..... pt with DM.... exac on 2/5/06. Med changes, order changes etc. With that and my copy of the VO, I knew what was going on and could keep everything organized.

Oh, and if your pt has more than one MD, you need to include in the body of your 485 "May accept orders from Dr. Jones, Cardiologist" or whatever. Esp if that MD is not the one listed on the 485.

Does any of that make sense??? Worked 12 hrs today, and one pt tried to code on me while the resident was asking "You have been doing this longer than I have, what should I do" :uhoh21: