Need help with my 485

[redbird4058]

Our DON has instructed one nurse to have the frequency on a 485 as SN 1 x for 1 week then 2 x's week x 2 weeks then 0 x's for 2 weeks then 1 x for 1 week and then 0 x's for 1 week....I say you can not put 0 x's because that shows that nursing visits really don't need to be done and the frequency should flow from 2 down to 1 then discharge. Can anyone help me with this?

[momsnurse]

It is OK to skip weeks especially towards the end of the cert period but I think on the 485 I would write 1-2 wk9 then write a verbal order when I am ready to decrease to every other week, "SN visit 1 time every other week until end of cert. period"

[berube]

we are instrusted to write for example: 3wk1, 2wk2, 1wk2, 2month1

that pattern allows for the "skipped" weeks

[4evernrs]

I would write it like this: 1-2 wk 3, 2-4 mo 1, and always add a couple of PRN visits "just in case". There is no need to account for weeks without visits.... that would be kind of like saying Aspirin 81mg 0 times daily.... Besides, if I entered 0 wk 1 into our convoluted software, I'm pretty sure something would implode :)

[Kyasi]

I would write SN 1h/d, 1-2d/wk x 9wks. On the weeks there were no visits, we would have to write a missed visit note explaining why the visit wasn't needed. Writing 0/week would never be allowed.

Kyasi

[chenoaspirit, ASN, RN]

We were told we couldnt ever put a 0 as a frequency, ever. I agree with the others on how to write it.

[Kyasi]

I would write it like this: 1-2 wk 3, 2-4 mo 1, and always add a couple of PRN visits "just in case". There is no need to account for weeks without visits.... that would be kind of like saying Aspirin 81mg 0 times daily.... Besides, if I entered 0 wk 1 into our convoluted software, I'm pretty sure something would implode :)

Interesting how other agencies do this. My agency is so particular about how frequencies are written you would think God himself came down with stone tablets with the rules on how to do it. Maybe not accounting for weeks without visits is ok. I wonder if agencies who do this have ever been audited and how this was viewed.

Maybe the difference is that I work for a Medicaid only agency. An example would be: we write a Prior Authorization asking for a HHA 2hr/day, 3-4 d/wk to give a bath and provide ADL's for a client, saying this care is necessary to keep this client at home. If we then go for weeks with no visits, the state would be asking us who provided this care when the HHA was not there? Is there a family member able to provide this care? Is the care really needed if the person could go this long without a HHA?

Not accounting for weeks without visits would be unheard of. It just simply can't be done. I even have to account for why a visit is even 15 min. shorter then the frequency states. Is mine the only agency this picky??

Kyasi