New CoPs....

AtlantaRN, RN · Dec 11, 2008

"nurse the notes and not the patients" not funny, I know. I'm with you. It takes soooo much more paperwork. On our nurses notes, we not only have to measure all patients mid arm circumferance, but also have to document what their LAST MAC was (which is fine if you were the last nurse to visit that patient, but if you weren't and the copy of the last note isn't in the field file, it's a real ******)...

I find we are documenting, and redocumenting. linda

rngolfer53 · Dec 12, 2008

"nurse the notes and not the patients" not funny, I know. I'm with you. It takes soooo much more paperwork. On our nurses notes, we not only have to measure all patients mid arm circumferance, but also have to document what their LAST MAC was (which is fine if you were the last nurse to visit that patient, but if you weren't and the copy of the last note isn't in the field file, it's a real ******)...
I find we are documenting, and redocumenting. linda

Hardly a surprise. Government is the biggest bureaucracy of all, and bureaucracies thrive and grow on paperwork, not patient care. Expect this trend to continue and accelerate as Medicare, et al get more involved.

jerseyRN · Dec 13, 2008

What's a LAST MAC?

traumamom2002 · Dec 13, 2008

Andre,

You made my day, my week and my month with your post and your banging heads!!!!

I loved it!!!

We rolled our new paperwork out on the 30th of November; my boss announced at 9 am on the 1st of December that I had to have all 21 of my patients completely transitioned over by the next day's IDT meeting. This meant med sheets, IDT care plan grid and all new care plans. I thought that one of us had lost our minds and soon realized that it must have been me!

Slowly but surely, I am getting it. Can't stand the new stuff - haven't shaken the lost in the headlights deer look and wonder if my patients notice that I have been missing in action for days.

Thanks for your humor. :confused:

traumamom2002 · Dec 13, 2008

Oh and one last little comment, how about the clinical staff that work with you that doesn't really see the benefit of getting those all important measurements for you because it doesn't have anything to do with her paperwork???? Arrrggghhhh:banghead:

AtlantaRN, RN · Dec 13, 2008

What's a LAST MAC?

mid arm circumferance, and be sure to document WHICH arm you used and how many inches from the elbow you measured. What is a real *itch is this was previously only required on alzheimers dementia and adult failure to thrive ONLY if you were unable to weigh the patient...

NOW it is required on ALL patients, including those who experience edema in their upper extremities (which is REALLY gonna be confusing for the auditors i'm sure)...HOW can this patient be adult failure to thrive if they have 3+ edema to the upper arm and their mid arm circumference is increasing? (with a blank stare, of course).

I have found that the new methods of documentation are designed for the auditor, NOT for the person in the field who has to live with it day in and day out. It is really a *itch when it comes to the IDT meeting--one page is for the problems that are only, and one page is for the problems that is new (actually once the papers are completed they do read well, but it's just so time consuming to fill it out well).

linda

marachne · Dec 13, 2008

I'm not working in the field right now, so you can take my question w/a grain of whatever your pleasure but... The new CoPs have been known about for over a year right? Why do some places feel that they can put off anything -- training, dissemination of new forms, moving pt. data over, etc to the day it's due? The reason I ask (at least in part) is that I know of agencies where they have been rolling out the changes over the past while, making this not a deer in the headlights time.

jerseyRN · Dec 14, 2008

Thanks, maranache, my thoughts exactly. We got the new edicts less than a week before we were expected to gather all the newly required info and have it on the charts. (But somehow "last arm circumference" was left out of the handouts! Oh dear! And the cops are coming!)

Certainly there is a place for better regulation of hospices, and accurate measurements of the quality of care given. It's hard to quibble with measures that in the long run will standardize care and hopefully improve quality of care.

But what seems to be lacking, at my agency anyway, is a realization that all this additional measurement, documentation, careplan updating, etc etc etc, means that the case managers can't carry the caseloads they did before, and still get it all done. Instead, at my place, it just gets heaped on top of the loads we had previously, and honestly, not whiningly, or lazily, or complainingly, IT'S JUST IMPOSSIBLE TO DO IT ALL.

Can't deliver comprehensive, thorough, holistic hospice care to a caseload the same or (usually) higher than I had three years ago, and still keep up with all the new requirements.

Glad this post is anonymous because then I say how I cope...

It's the patient contact that keeps me coming back. It's the core and the root and the heart. If I skimp on that, I might as well do something else. So, I manage my caseload as I always have. And I try to keep up with the other stuff... but don't get crazy when the careplans are three weeks old, or (God help me) that LAST ARM CIRCUMFERENCE doesn't make it into the chart.

AtlantaRN, RN · Dec 15, 2008

It would have REALLY helped if my company would have "rolled out" the changes when the requirements were first known. It's easier to modify gradually instead of a one day change. We sat through a 2 hour conference call, and my office personnel didn't think it was "necessary" to print out all the changes for each individual nurse and aide, we could just "share" the handouts, because we weren't going to need this on the job......... We made copies of everything to keep with us in the field. it's like reinventing the wheel...

linda

indianahope · Feb 9, 2009

I was talking to coworkers about the MAC requirement in the new COP's and was told there was no such requirement....

Does anybody know specifically where this is in the regs so I can quote it to them? Thanks. By the way, I'm only a nurse, not a manager.....:)

aimeee, BSN, RN · Feb 10, 2009

There is no specific requirement to gather MAC in the new cops. What the new COPS require is a form for the gathering of data elements to be utilized in your QAPI program. It is up to the individual organization to determine what form will be used, and what data will be gathered on it.