Post Hospital....Orders

emilysmom,RN · Apr 28, 2012

I have seen plenty of patients that were discharged from the hospital and I did not have a copy of the discharge papers until I went to see the patient and read the patients discharge instructions in the home.

When a current patient is discharged home, does the hospital fax the orders to the agency ? (med changes, labs, etc)

Amelias · Apr 28, 2012

emilysmom,RN, unfortunately the pt didn't get any instructions/

d/c papers from the hospital. She got the short end of the stick on tthe whole deal.

AMN74 · Apr 29, 2012

I'm just curious, how did you know the patient was home from the hospital? If you had no orders to resume care on the patient, would you consider practicing without a license? Please don't get defensive with me, I just am missing something here. You said patient came home and you went to see them, they had no d/c orders and no scripts.

First of all, I work for a pretty large agency and we have hospital coordinators. We notify them when the patient enters the hospital, they follow the patient during the hospital stay, and they enter d/c orders into the computer for further care. If the MD does not resume home health post hospital stay, we discharge the patient. If the patient goes into one of our "non owner" hospitals and the hospital or doctor does not notify us upon discharge of what they want for orders then we have to discharge. NO ORDER=NO VISIT.

It sounds like you did get railroaded, and I'm sorry for that. I just don't understand how you went to see a patient that had no discharge instructions. I always ask to see the patient discharge instructions when I go do a ROC, so that I can make sure their discharge meds match and that they have the correct meds. But if the doctor doesn't order home health post hospital, then you can't go.. You have no orders.

Amelias · Apr 29, 2012

AMN74,

When we're on call we have a list of pts that are in hospital that we call to check on each day. we do the post hosp the next day unless there is a specific order to see same day.

But YES it is ideal to have orders faxed to agency on d/c. and thats usually how it goes ...(when the case manager has good communication with d/c planner ) most of the time everything goes pretty smooth...even get a call from the d/c planner letting me know pt is about to come home.

and technically there were no specific orders to see pt ...but its expected that we do a visit on pt when they come out of hosp and we write order for visit. our drs are very good about signing orders for visits. (we call md if any problems or need to clarify meds/orders)

but the way your company does it sounds legit. and that is the best way to do things so you don't get caught up the way i did.

LadyT618, MSN, APRN, NP · Apr 29, 2012

Amelias,

There in lies your first problem. You should NEVER go out to see a patient, whether it be a SOC or ROC, without an order!! The agency I work for writes hospital hold orders, which include a blurb regarding the RN returning to the home for a ROC visit upon DC from the hospital. As long as that order is signed, we are in the clear to proceed with ROC once the agency is notified of DC plans. Without that order, we cannot make the visit. IF that order isn't signed, then we call the PCP and get a verbal order. Oftentimes we do not get DC orders from the hospital so we do all we can to get orders to at least cover the ROC visit. Next time, insist on some type of order or call the patient's PCP yourself to get a verbal to cover you for that ROC visit. I'm sorry to hear of your dilemma....your agency is out of control for saying the patient only gets 1 visit a week and she's not getting anymore. I mean for heaven's sake, she just got out of the hospital. Meds are not always reconciled during the initial visit, especially if the visit takes place on a weekend. I'd love to live in the perfect world in which that agency exists. Best of luck turning in your timesheet on Monday :)

Amelias · Apr 29, 2012

Thanks LadyT618. and you all give some good advice. i've worked in home health since '97 and honestly, i've never worked at a place that did things by the book...and most all of the time things have worked out just fine, but this one didn't. and thats one too many for me.