Please help--cystic fibrosis patients that don't meet inpatient criteria

[GiaRNCM]

I need help with a very sensitive subject. Our CF patients come in for "routine cleanouts". They usually stay for 14 to 21 days for IV antibiotics. After they stabilize they could go home with infusion services to complete their course of antibiotics. The pulmonologist writes an order that they can leave the hospital on a "pass" between their meds as long as they return in time for the next dose. They usually are gone for 4 to 6 hours at a time. My concern is we are giving insurance reviews asking for more days et they really don't meet inpt. criteria and this could be done outpt. in the home. Also, from a liability standpoint, what if they get into an accident while out of the hospital and they really should be in the hospital under our watch? These are adult patients who are practicing risky behavior such as riding motor cycles and smoking pot. To make matters worse, the floor nurses have started to NOT document when they leave the hospital on "pass". I think they know I am watching and I will take this to administration. Any advice from other CM's---I need feedback please:crying2: