mommazac

It is a Medicare regulation to have a physician order for an O2 sat, at least in the CHHA, the agency I worked for underwent a Medicare survey and were cited for performing O2 sats on pts without an order. You must also have parameters requiring MD notification. It has nothing to do with billing.

Our agency made the decision last year to incorporate CHHA and Hospice case loads. Unfortunately the productivity expectations remain 5 patients per day. The average case load is 27 patients, of which 2-4 are hospice patients per nurse. Unfortunately, with the shortage of nursing recruiting is difficult. Home care of any sort is hard to staff for a variety of reasons, experience, case management, travel...... Incorporating CHHA and hospice has cut down the on call shifts of nurses during the week. I believe we hospice nurses have to find a happy medium to support the family and allow the family to support each other, we don't have to be the "all" of the patient being home. They can receive "support" from the SW, clergy, HHA and the volunteers. What they need from the nurse is symptom management, and support, but we can share that role.

My agency has just gone to a computer system, I find that getting as much information as possible on the computer at visit time is useful, however, I do find it difficult at times, especially on admission when trying to get to know the patiet and family, there is usually alot of small talk. We document by exception in our system, and use the care plan for the basis of our documentation. Many of the nurses are struggling with this, keep at it, it gets easier.

I would agree that the best way to answer the OASIS questions is thru your observation and assessment, one needs to observe the patient in their environment and answer the ADL questions appropriately, without these observations a correct answer is impossible. At our agency we teach, observe, observe, observe. Reimbursement is always a concern, but ethically, we are bound to be truthful in our assessment.

At our agency our productivity for RN's is 5 patients per day, LPN's is 6. Caseloads vary from 25 to 50, some of our part time nurses pair up and co case manage a larger case load. Unfortunately, our agency productivity is at 4.9, with some of the nurses pulling more than others. We use a PDA for OASIS entry, but rest is on paper. Our nurses travel anywhere from 25-100 miles a day, depending on the area they cover. There is alot of paper work and PDA entry done after hours on your own time, the nurses are salaried, so overtime is not an option. This being said, our nurses are burned out, no doubt you are. Also, our nurses are required to work every 3rd weekend and take call 2 evenings every 3rd or 4th week. We are in the process of going to a completley computerized system, start training in 2 weeks. I am hoping this will save some of the time that is wasted looking for missing papers and charts.

Sounds like she was in flash pulmonary edema, suctioning would not have helped. You did the right thing getting a Roxinal and Levsin order. Seeing to her comfort and providing her with the care you did was all you could do.

In order to fulfill your responsibilities, it doesn't matter if the parents have heard the smoking lecture multilple times, reinstruct, provide supportive evidence of the danger of second hand smoke for healthy individuals, as well as the negative effects of second hand smoke for a baby with CP. If you feel there is some other kind of abuse going on it is your responsibilty to talk with the Dr. and discuss with DSS (child protective services) YOU are the babies advocate, not the parents.

At our agency we pay a per diem rate of $75 per admission on the weekend. An admission is a lengthy visit 1-1 1/2 hrs long, then follow up paper work and phone calls. Depending if the agency is computerized or not will also effect the amount of time. Once trained and have some practice time, the total amount of time should be 2 1/2 to 3 hours. An OASIS is an assessment tool that is aprox 16 pages long that looks at patient health status, ADL status and family support. It sounds overwhelming, but it really isnt.

At our agency we offer an evening position to cover the pm drsg changes, IV cases, overflow from the day, and/or admissions for those q 12 hr injections or IV cases. Typically normal visits done by 10 pm, then on call until 8 am the following morning. While on call you need to be available for those emergent situations ie: plugged foleys, infusion problems. It is a rare occurence that nuses are sent out in the middle of the night.