Orders in Home Health

[gmsr]

I am new to home health and having difficulty understanding "where the orders come from"... I have been told the RN creates the plan of care including the specifics for dressings/wound care. My previous experience was in a hospital where you needed a doctor's order to do things. I am feeling confused and do not want to get into trouble by acting on my own and not following doctor's orders. Please advise... Thank you.

[paddler]

Yes, in home health 98% of the time the doc orders HH to go out and make a recommendation as to what the appropriate wound care should be. Very rarely do I get specific wound care orders originating from the doctor. As the nurse, you are supposed to call the doc with your recommendation. 99% of the time you get his nurse, give report, give your recommendation and get the verbal order to perform the wound care. Those are your orders. The same follows for other care plan orders: ie, referral to PT, cardiac, respiratory teaching and assessments, etc. You document them as such and write the order in the doc's name and he signs it later. It's definitely a weird thing to get used to for sure! Sometimes the doc is nice and puts on the referral the reason for home health orders, like, "Diabetic teaching, low sodium diet, home safety eval" or other such general information as to why they want you there. Otherwise, it is up to you to go out and see what the patient needs and basically ask the doc (or their proxy) if it's ok.

[caliotter3]

Simplistically, the RN creates the original plan of care and the MD signs off on it. The MD will add, subtract, or modify the RNs recommendations. Meds and treatments already prescribed will be continued. You would get the meds from a list in the home or from the prescription labels and verbal instructions from the patient or family members. You will also implement the orders given to the patient as discharge orders from the hospital, typically from the patient's printout. Anything questionable can be clarified through a phone call prior to turning in this initial documentation.

[Akeos]

The orders will depend on what kind of home care you're doing. At my agency the patient's case manager does a care plan that's good for a few months, then now orders come from discharge notes from dr.s visits, med bottles, perscriptions or calling the md. nurses write out new orders and turn them into the agency.

[KateRN1]

Short answer: all orders are physician orders. We cannot do anything in home care without orders from the physician. How your agency obtains those is a different story. Many agencies just write what they want on the physician-ordered plan of care and expect the physician to sign off on it, and many docs do. However, that's really not how it's supposed to be and not really legal. What if the doc decides s/he doesn't want something done after you've already done it? Any changes to the signed plan of care must be via modification orders, ideally telephone orders obtained prior to making the change.