Abbies

I forgot to add, that when I worked at a facility with computerized systems, the nurse could go into the orders and make time changes there.

A nurse can change med times if they are not ordered at a specific time. I draw a line through the time and initial and date & note "time changed," write in the new time/s and make a copy for medical records so they can print out the correct times the following month. For example if the order is for a BP med BID it can be given at: 0700 & 1900, or 0800 & 2000 or 0900 & 2100. You can move daily supplements , bowel care, etc. to different times as well. Ideally your patient care manager should be able to go through their patients' MARs & and spread the med passes out better. Just saying... sometimes you have to be the one to make the change. The grass may look greener on the other side but often it is only the distance from where you are viewing it that makes it appear so. (Loose quote, something like that.) I haven't worked anywhere yet where I could get my work done, take breaks, eat, drink and empty my bladder all in the confines of my 8 hours shift.

5 routine or 2 starts on a good day

edit: it could also be because there are a lot of cna's who run around whining all day about nurses and how cna's work harder and yadda yadda. i've seen that. cna's bouncing between rooms while the lpn is working at the nurses station and the cna is convinced the nurse is just a lazy sob and she should be fired! that cna clearly has no idea what it is to be a nurse. i think people are just focusing on that and assuming that is the case instead of giving me facts based on the information i gave. it's kinda like nclex- they need to answer based on the information given. instead, everyones just been adding to the scenerio because i must be wrong because i must have no clue. lol. if they don't feel comfortable with admiting to the fact that there could be a lazy nurse out there taking advantage of an alzheimers unit then they should answer the question hypothetically instead of just telling me how i probably have no clue. :eek:hypothetically or not, from either perspective you should not remove a dressing or unna boot from a patient. you could cause harm and you would not want that. report what you see to your nurse. if nothing has been done by the end of the shift, be sure to mention it in your report to the oncoming shift so the patient will get the needed care. it is about the patient. it is your job to keep the nurse informed about the patient. if you feel the nurse is ignoring your reports and you have serious concerns then you should give your reports to her in writing. put the date, time, and the problem and sign it and give copies to her supervisor. i would suggest discussing the situation with the nurse first before coming to any conclusions. there may be a very good reason why the dressing or unna boot was not removed in the first place. you may feel you know better but unless you have that conversation with the nurse, you really don't know for sure... and yes, i have seen many lazy employees.

Our office staff sends out continuation orders the same day they received the signed referral for eval. and treat. We usually have revisit orders back within 1 to 2 days. If we need to revisit on day 2 we must have a VO from the doctor. We cannot touch a client with saline or even a band aid without a verbal order. If I can't talk to an RN or don't get a response back after calling, my office staff will fax (or re-fax). I let the person on the other end of the phone know I can't take care of the patient until we get an order and if the doctor is occupied, they will usually stick a fax under his nose for sig and fax it back to us. Otherwise......the patient has to wait. Most docs & their staff respond quickly, it's the surgeons that I have the most trouble with because they are usually only in 1-2 days a week or must be paged during surgery for urgent matters.)

You certainly called that one. I wish the doctor had placed pt. in the hospital to begin with. Have a great weekend!

WOW, what ever happened about this? I'm pretty sure my administrator would not feel this client was appropriate for home health if that was his only treatment option.

We use a laptop with a medication validation program installed and have always had to do that and fax MD. It will be interesting to see how we elicit required response from MD. Fortunately my first client had no medication issues.

Yes, 2 SOC would be a full day but rarely are 2 starts assigned to one nurse in a day. They have always asked me first and given me the option of saying no. I know our expectations seem reasonable but when adding travel time, doctor calls, coordinating between team members, patient families/caregivers, documentation required when visiting facilities (and now our added marketing duties while in those facilities), ordering and tracking supplies, faxing, scheduling, or whatever it can be challenging. (and not to forget to keep track and code every second under the proper charge for payroll as well as keep the master schedule updated) I would have to cut way back on patient time if required to meet expectations I see from these other agencies. Or... they could always buy me a faster laptop.

We do all documentation in the home on the laptop. The clients are understanding. We are discouraged from working without documenting the actual time spent because it is important that Medicare have an accurate account of the time required for each patient. We can never hope to receive adequate compensation for our work if we under-report. It really helps to be realistic about what I can accomplish in one visit. I tend to front-load heavily and focus on priority issues, later I complete less urgent goals. It is the scheduler's duty to fit any new assignments into my schedule without overloading me or causing me to go into overtime. They really have to be aware of this now that the focus has shifted more to outcomes. I have to hustle to meet expectations: start of care 3.5 hours (which I cannot do and it has never been an issue), routine 1.5, routine with lab 2.5, evaluations 2.25, DC 2 hours. All associated tasks including travel need to be included in these time frames. No reasonable time spent outside of these expectations are questioned. We would be questioned if we did not document and record time spent on a patient.

I completed an OASIS-C discharge today and it was not hard. Tomorrow will be my first OASIS-C start of care. We were well prepared but I'm a little worried about completing it in a timely manner. Any impressions from those of you that completed one today? Do you feel you received adequate training? Abbie

The elderly patient that suffered an acute MI and was not expected to make it through the night might have wanted to say to you, if she could: "Before you and your partner :angel::angel: came into my room my old bones and joints were getting very painful from being in the same position for so long, my skin was wet and burning, and I was beginning to feel ill from the smell of urine and feces. Thank you so much for making my last hour comfortable and peaceful!....."

If you find a way discourage back biting, please let me know. It seems to be on the rise!! Abbies

I had the shot, I didn't even feel it, no SE

sounds perfectly reasonable and well organized. these basic pathways could easily be personalized for each situation.