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aimeee BSN, RN

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aimeee's Latest Activity

  1. aimeee

    RN Case Manager "characteristics"

    There's a long list.... strong assessment skills, ability to "connect" with a wide variety of people and yet maintain boundaries, good listening and communication skills, teaching skills, time management and organizational skills, team player, critical thinking skills, ability to prioritize what HAS to happen today and what can wait, ability to leap tall buildings in a single bound... oh, wait, sorry. Got carried away.
  2. aimeee

    Discharging pts?

    Patients should be discharged as soon as it is determined that they are no longer appropriate for hospice and a plan for supporting their needs can be put together. If you wait until the end of a cert period you might not be reimbursed for that care if you are audited. Be careful how you chart during the transitional period. Once you state in your charting that the patient is no longer appropriate, you will be vulnerable for reimbursement should the chart be audited. Better to state that their status is being closely evaluated while weaning them off services to see if their status declines.
  3. aimeee

    New CoPs....

    There is no specific requirement to gather MAC in the new cops. What the new COPS require is a form for the gathering of data elements to be utilized in your QAPI program. It is up to the individual organization to determine what form will be used, and what data will be gathered on it.
  4. aimeee

    Palliative Bowel Care Question

    Even when feedings stop, waste material continues to be produced. I would give the meds unless there is an indication that intestinal distress is being caused by them. I have had people who had impacted stool that were dying. There's never a GOOD time for disimpacting someone, but it seems to wrong to have to do it during that sacred process. Keep those bowels moving as long as you can.
  5. aimeee

    Pain Not Controlled With Dilaudid Pum

    That's terrific news! Got 'em crossed that it continues! :yelclap:
  6. aimeee

    need help-turning off LVAD at end of life

    The latest Fast Fact concerns LVAD's: http://www.eperc.mcw.edu/fastFact/ff_205.htm
  7. aimeee

    Pain Not Controlled With Dilaudid Pum

    Sounds like a very challenging case. I hope you are able to achieve comfort for her soon. Sounds like her whole CNS system is super sensitized to all stimulation at this point.
  8. aimeee

    Pain Not Controlled With Dilaudid Pum

    Wow. That is a huge dose for IV dilaudid. What is the pain source? Is she on any adjuvants?
  9. aimeee

    Compensation and Job Structure for Hospice

    12-15 is a full caseload which will vary in its manageability with the acuity of the patients and the amount of windshield time needed to see them. It is by no means a "low" caseload, especially when you enter having to do your own admissions into the mix. I can't speak to the compensation for the on call visits. Its not the model we use. Drive time not counting would certainly not fly here! If your patients are "well managed" I would expect to see evidence in your charting and practice of preparing for expected issues before they happen....bowel regimens in place for patients on narcotics, medications ordered before they run out, families knowing what to expect of the dying process, pain and other symptoms managed at a level which the patient considers acceptable, patient has an ATC med AND something for breakthrough pain, etc.
  10. aimeee

    average # of nursing home patients

    14? Huh. That's a new number to me....I'll have to check with one of our gals who used to work in the admissions department of the nursing home. I have never read the nursing home skilled care regs myself so I can't really speak with authority on it. Maybe there are ways to automatically activate additional days to stretch it out....like getting an order for some sort of IV?
  11. aimeee

    average # of nursing home patients

    Its my understanding that following a "qualifying" hospital stay, Medicare will pay for 5 days of observation under the skilled care benefit.....after that they would have to be able to show that the patient would benefit from PT or whatever else might "skill" them. We frequently get patients referred on day 6....if they last that long. Hard to blame families for not wanting to pay that room and board out of pocket when it can be avoided. Most cannot afford it. There are some rare circumstances where a patient could be under the Medicare skilled benefit for one diagnosis and yet be qualified for hospice under another unrelated diagnosis. While this can theoretically happen, I have never actually seen it occur and it is little understood and fraught with difficulty to figure out how to actually do the billing and coding so that everybody gets paid without a hitch.
  12. aimeee

    Help

    Ditto what doodlemom said. You can find it at Amazon. She has a pediatric version too.
  13. aimeee

    implantable defibrillators/pacers

    You really can't make generalizations about defibrillators because there are different models and they can be set up with different parameters for firing. We have had a time or two where the patient has been repeatedly shocked during the dying process and it is very difficult for the family to witness this. It can definitely interfere with a peaceful exit but that is not the norm. Still, who wants to take that kind of chance? Even the magnet solution is not 100% because the defibrillators CAN be set so that a magnet will NOT deactivate it. You have to call the rep and check on the settings of that particular device. One thing that can be done, short of deactivating, is to ask for the parameters for firing to be set so that the conditions are much less likely to cause firing. Sometimes patients and their families are much more comfortable with changing the parameters than with "turning it off". They have been told they need this device to live so its often very hard for them to think about turning it off completely. So here's my tips: 1. Get the info from the card with the specific device and the emergency contact for the device rep. 2. Call them and find out if a magnet will deactivate the device 3. Find out what their protocol is if it needs to be turned off in the middle of the night or on a weekend. (Some demand to see an order from the physician before they will go out) 4. You may be able to get medical magnets from your local cardiologists office that are specially made just for this purpose. (We were gifted with 2!) If you can't, see if the device rep will tell you what strength magnet you need. 5. Figure out a good place to keep the magnets that everybody agrees on so you will have them at the ready so when it happens at 3 am on a Saturday night you know right where to go for them.
  14. aimeee

    roxanol in neb treatments

    The few studies that have been done don't seem to provide clear results. It seems to be one of those things though that is worth a try. Above quoted from http://www.medscape.com/viewarticle/498328
  15. aimeee

    Hospice nursing

    You really need experience to prepare you for all the situations that you will encounter. I don't have data to support this statement, but I am venturing a guess that green nurses who start in hospice don't last in the field. I think few hospices can give them the level of support and mentoring they would need to truly succeed on all levels without coming with a breadth of experience.
  16. aimeee

    Medical Supplies Question

    The physician must certify the patient under the diagnosis that is the one that appears most likely to be driving the terminal process. End of story. Anything else is unethical. If its a toss up I am fine with choosing the one that is financially most advantageous, but this case sounds like it is pretty clearly misrepresentation, which would be, MEDICARE FRAUD.
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