Missed alot during orientation, help please!

[DutchgirlRN]

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.

[DutchgirlRN, ASN, RN]

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.

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.

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???

Yes definately and Thanks so much. I would love to have a copy of the Excel sheet. I do keep a notebook with the demographics,485, etc. I didn't think about keeping copies of the VO's that is a fantastic idea also writting changes in red on the 485. How many times has the DON asked, did you write an order for this or that? Yes I did, well we can't find it. Wow now I can prove it.

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:

I read that on another thread. UNBELIEVEABLE!! Thank God you were there. Reminds me of when a doctor and I did CPR in the parking lot. I was doing compressions and he was yelling stop! stop! I said "what"? He said let me get my breaths in the rate is 2:7. Ah no doctor it's not, yes it is Dutchgirl RN, ok doctor we'll do it your way. The woman did respond and was rushed to an emergency CABG where she died on the table but I think Gee whose the doc here?

[steelcityrn, RN]

Just thinking of a few more tips for those new in homecare....If a person has even a small dribble of urine , this is incontinence. On wounds, a new pacer is a wound, a healed incision is not. A lesion can be a pimple, so 99.9 % of the patients will have a lesion, then check no for decube if not applicable. I'll add others later...such as ostomies, other wound tips and psych issues.

[jnette, ASN, EMT-I]

just thinking of a few more tips for those new in homecare....if a person has even a small dribble of urine , this is incontinence. on wounds, a new pacer is a wound, a healed incision is not. a lesion can be a pimple, so 99.9 % of the patients will have a lesion, then check no for decube if not applicable. i'll add others later...such as ostomies, other wound tips and psych issues.

thank you, thank you !!!

all this info will be sooooooooooo helpful... wow. you all are the best !