sammarai

Thanks for the ideas and options! Vicky

I admitted a patient today who fell and received 2 bad skin tears. My usual dressing change is to cleane the wound, cover with petroleum gauze, 4x4s and/or rolled gauze. The issue is that the patient is on oxygen so petroleum gauze is out. What type of dressing and what frequency would you suggest so that medicare will cover the nursing? TIA Vicky

Thank you for your response. I have a bit of obsessive /compulsive personality and I am constantly thinking of mistakes I have made or could make with a patient. So you call just the local ER - to get orders on the weekend? I didn't get a great orientation so I feel like I am flying by the seat of my pants.

I am a new HH nurse and had an admit this weekend that is weighing on my mind. This patient had a TKA done on the 30th and went to a rehab facility until she was discharged on Thursday. I saw her Saturday midmorning to admit to home care. She told me that she was to start taking coumadin and had a 30 day supply from the rehab hospital. She also said that she had 3 days of lovenox injections. Which I questioned her on at the time (even though I know sometimes they overlap until the coumadin can get into therapeutic range). She had started taking the coumadin on Friday and lovenox on Saturday. Well I called into the surgeon on Monday to give report and confirm about the meds. The nurse said they didn't prescibe it. So after repeated phone calls, the rehab facility finally admitted that yes they gave the pills to her but they didn't tell her to take them. I told them that was a major liability because this little old lady thought she was supposed to be on them and if HH hadn't been in there then she would have been on 30 days of coumadin without any PT/INR's done. So my issue is that she was taking both lovenox and coumadin for a few days and maybe I should have stopped her on Saturday but I can never get any answers on Saturday from doctors. I guess I get so many admits where the information isn't in my packet, that I assumed they just didn't inform us of the coumadin at the time. I had already scheduled a PT/INR lab on Monday even before we found out about the coumadin issue and her INR as 1.4. I talked to the surgeon's nurse and I am having a nurse go out on Wednesday to draw a final lab just to check the INR one last time and also to make sure that the patient threw away the meds as I instructed on the phone. I am constantly worried about harming patients and this has me worried. Have I covered all my bases for my and my patient's protection? TIA