Order for Assessment?

[James613]

I am going to be starting a peds PDN case once client gets discharged from hospital. I asked the mother of client (whom I know personally) if there will be a peds BP cuff there for him. She said that the (care coordinator?) RN at the hospital said that she doesn't see why he would need BP taken and if he would need it, that it would be ordered and would be sent home w a cuff. I find this crazy that a regular full assessment wouldn't be done each shift?? He's a new trach/vent patient btw. Is that really how it is??..if it is not ordered you don't do it?..not even assessing? For real??!!

[caliotter3]

Over the years, I have found that most peds patients do not have BP check ordered on their care plan unless there is a supporting diagnosis. When I asked a clinical supervisor about this I was told that it was too aggravating to the child if there was no clinical need for that information. You might want to take the BP on your first assessment to use as a baseline for your care of the child. A peds size BP cuff is a good investment for a nurse intending to do extended care for peds patients.

[Alex Egan, LPN, EMT-B]

Same experience here. No routine BPs, except for patients with cardiac background. Why do you think your patient we need this? Also just a heads up, if it's not care planned I generally don't do it. What say you play super nurse take your own BP. It comes back slightly abnormal, not critical, but definitely not normal. Now what are you gonna do with this? Are you going to not it in your assessment and then? Either do nothing and monitor, notify a supervisor who now has to make a judgment about a client they have not assessed, or call a MD who receiving this one bit of data they didn't ask for now have to dismiss it or work it up. It's a mess for what is likely a one off vital that's not incredibly valuable in pediatrics anyhow.

[James613]

Thank you for your responses. Client has not been discharged yet, so no discharge orders (nurse liaison for hospital is not familiar with a 485, just that all orders will be on the paperwork at discharge..is this normal?). I know they had a heart defect and are on some cardiac meds, so I thought maybe it would be pertinent. Just wanted to be prepared with necessary materials before first day. Thanks!

[Alex Egan, LPN, EMT-B]

Are you working with an agency? I'm just trying to figure out what's going on here, I have had fresh discharges before an I never get this much face time with the hospital staff. Usually a brief meeting with the family and a briefer one with the nurse who has them today.

485s are a physician approved care plan. The hospital will not generate it. The admitting RN will take all current discharge orders, add in specific home care orders, then get it signed by the physician responsible for the continued care of the patient.

so I'm really not trying to be rude here but what's your background? Do you have pediatric trach vent experience? I can't tell from your i first post, but i can tell you aren't native to home care. Is there an agency in place?

[JustBeachyNurse, LPN]

I've had dozens of new pedi & infant trach vent discharges. Exactly one had BP ordered and only because of comorbid cardiac & renal issues due to a congenital/genetic condition. One. BP is not a standard assessment in respiratory pediatrics. Temp, apical heart rate, respirations, SpO2 and pain. DME provides the pulse oximiter and initial emergency supplies. First trach bag comes home with the client. My agency supplies the back up once DME has extra trachs covered by insurance

Honestly you sound way over your head and very inexperienced to be working alone. I've never seen a hospital agree to discharge a fresh pediatric trach to a solo independent nurse always to an experienced agency that can staff the 16-24hrs x14 Days typical for fresh trach.

Are you taking the case because you know the parent or because you have experience in direct care pediatrics and pediatric home case management?

[JustBeachyNurse, LPN]

And if BP is needed it's provided by DME for consistency in reading. The $2 personal pulse oximiter aren't designed for clinical or pediatric uses

and absolutely if it is not ordered you do not do it. Period. Have you ever worked in home with a fresh trach vent kid? Do you have training on the typical home vents? Trilogy and CareFusion LTV?

[Have Nurse, ADN, RN]

Good call. If your client does have cardiac/medication issues, it's perfectly appropriate to put it on the care plan. As this is not an invasive procedure, you are well within your licensure to do it. And if you do manage to find something amiss, you had the foresight to plan ahead. Good for you!

[James613]

Patient does have a rare genetic condition with multiple other comorbidities. Just didn't want to give too much detail due to Hipaa. There are very few agencies around here..and are not particularly up to par with the high tech care, let's say. Around here there seldom is any 24hour PDN approved..only getting 8hr/day, initial period of 13 weeks. Yes, I took the case to help out since it is difficult to find any nursing services here. I do have experience, just not in the home setting. Any patient I have encountered in every facility I've been in has had BP ordered, that's why it seems strange to me to not take a BP. That's what great about nursing; the possibilities are vast, the learning never ends, and it's always a quest for knowledge.

[Kitiger, RN]

Are you working through a nursing agency? If not, insurance will not pay ...

[Alex Egan, LPN, EMT-B]

New York is pretty unique in that the requirements for the state Medicare billing include independent nurses to a much easier and greater extent then just about any other state. To my understanding.

[JustBeachyNurse, LPN]

New York is pretty unique in that the requirements for the state Medicare billing include independent nurses to a much easier and greater extent then just about any other state. To my understanding.

But does that extend to high tech pediatrics and Medicaid?