tburrell

Jay, I think the protocol you have is excellent, but it is not designed for home care in the U.S. We would be going by Medicare Standards or some other private insurance company and the insurance company would require us to teach and get out. I have been very scared many times when I have had to leave a patient on his/her own. With the new payment system for PPS (Medicare) the nurse would be able to stay in longer and supervise the admin of the injection. We would have requested an order from the MD getting the Sub Q injection type versus the IM. Then the teaching goes so much easier and faster. Jay, from what I have gathered thus far, I would love to have you as one of my nurses. It is not often I find one as dedicated to the patient. It is an honor to meet one. P.S. I am sorry it has taken me so long to respond. I have been busy with home visits (my nurses are completely full), plus trying and preparing lectures for classes. Thanks for your reply.

I agree. It is much easier for the patient to give a SQ injection versus IM. It will depend on the base of the B12. Is it an oil based injection, which must be given IM or is it water based? The goal remains the same. Eliminate the self-care deficit the patient current has by instructing him/her to self-admin the B12 injection. Another aspect to this situation: I hope the patient/caregiver understand that B12 injections are for LIFE, and are not going to be given for a short duration then discontinued.

Our responsibility in home health care is make the patient once again independent. We can also look at this another way. The practice of the art and science of Nursing is based on Theories. One of the most used theories that nursing is based upon is Orem's Theory of Self-Care Defcit. The patient currently has a deficit -- the inability to give the IM injection of B12. By teaching the patient to give the injection we have eliminited the deficit. That was our goal.

Hi. It really does my heart good to see a new home health nurse who is willing to go to some length to find out how to do something; in this case documentation. I am the Director of Clinical Services for a home health agency. Documentation is one of the most important things you will do. I always tell my new nurses (those new to home care) that this is the most autonomous you will ever be. You must enter the patient's home and immediately assess the entire environment, family dynamics, potential for abuse, exploitation, etc., the patient's financial situation and if you need to call in a MSW contract. Then you get down to documentation. The old saying applies even more in home care "If it is not documented, it was not done". You need to document what you taught the patient/caregiver, their understanding of the instruction, your plans for further instructions, any abnormal findings upon your assessment, as well as documenting the normal findings such as Lungs clear to Ascultation. As the other nurses have pointed out, hopefully, you have a check off visit note which guides you through the head to toe assessment. Remember, you must assess the whole patient each time you make a visit. That means an assessment for the Cardiopulmonary, respiratory, integumentary, GI, GU, Neuro, and musculoskeletal system. Many nurses make the mistake of only documenting on the systems which were sited in the original referral (i.e., the patient is diagnosed with CHF, therefore you do not have to assess any other system. ) This is WRONG. You must assess all systems. Remember to do your supervisory visits for your LPNs and HHAs. LPNs every 30/60 days depending on Medicare/Medicaid guidelines. If HHA, every 14 days for Medicare and every 60 days for Medicaid. Document every time you call the MD. Make sure you write communication notes everytime you call anyone. The office may tell you they are writing the communication note; you write one also. Hopefully this will be helpful to you.