certwndnrs

i've used the venturi negative pressure by invacare and I'm getting ready to try the medella machine. I've had great results with the venturi.

Ok, Stop the foam dressing. Try an old school duoderm so the scab can gel up. You may see some maceration for a little while but that'll have to be ok for now.

Are you sure this wound doesn't have an arterial component?

Does anyone have a policy and procedure for photo-documentation? I am heading up a wound care program for my home health agency and would love any insight. I am starting from the bottom so I need ideas. HELP

I recently left the field to do office work, recert review, note proofing, and all the scheduling. I sure miss the field. The only upside is the fact that my pay is guaranteed whereas in the field, sometimes big, sometimes small depending on the census. I miss the freedom and flexability however, when I live in a small rural city, I didn't do much traveling. Always finished with seeing visits by noon. I don't miss the paperwork though. Just weigh the good with bad. If I could back into the field, I probably would. No, I definately would.

There are ups and downs in homecare, you may very well get 30 pts a week but during the summer months, the census could fall and you could drop down to less. thats a risk you take but if your new, you can usually ask other nurses to let you see some of their patients when your schedule is slow. I have to disagree though with the previous post about no weekends or nights, Most hh nurses have to take call, which means you will be working on weekends, holidays, nights. Not much but you could. If you are needing extra money, i'm sure a fellow nurse would love to allow you to take their call sometimes. No matter which way you look at it, you'll still make more money than working in the hospital and you have your freedom during the day and loads of flexability. good luck

The patient has the right to refuse care. If he refuses the visit when you call him then do a missed visit, this is proper nursing practice. It seems your agency wants you to harrass this patient. I would call the doctor myself and tell him that this patient refuses care. You are right in refusing. The agency is setting itself up for a liability issue if they continue this type of practice. There is also an issue of medicare fraud, if you aren't providing a nursing skill then the visit is non-billable. If he doesn't receive 5 visits during his cert, he becomes a LUPA. I would have to question the morals of the agency and why they insist on harrassing this patient who has refused service on numerous occasions. They are tampering with his rights. :imbar

Hi, I'll offer what I can!! 1. Most home care skilled nursing notes are mainly a head to toe assessment, a check off with the typical stuff, like last BM, GU status, Pulmonary status, etc. , with a small area for a narrative to record skilled teaching. You'll also need a thorough wound care note if you'll be providing wound care. 2. Filling insulin syringes is usually listed on our 485 simply as prefill insulin syringes for 1 wk 3. We carry a small cannister of clorox wipes to clean our instruments after each patient. 4. We don't use portable vein finders. If I can't get blood after a few tries, another nurse tries the next day, if no luck, we tell them sorry, you'll have to go to the lab. 5. In the home folder we have a simple flow sheet for v/s with a very small area for any narrative such as a new med etc. just enough room for the next nurse to have an idea of any possible changes. 6. We uses crappy oral thermometers but if i had my choice, i would get temporal scanners. 7. After years of home health, i can tell you that we carry the least amount of supplies possible. i use to fill my bag up with every little thingn possible, now it contains a b/p cuff, a therm, and a stethoscope, a few bandaids, hand sanitizer, and some lab supplies. Most of our nurses carry a box of gloves in their car and just put a few in their pockets before going in a patients home. 8. We supply only our illiterate or learning impaired patients with mediplanners. Only because patients get too used to us filling them which is not a skill. If a patient can take his meds from his bottle unassisted, we keep it that way. You probably won't run into this problem because medicare probably won't be your payer source.

That would be 4 patients a day for a 5 day work week, or 7 visits a day for a 3 day work week. Visits alone, I would estimate no more than 24 hrs. An Lpn doesn't do OASIS packs, so you should be able to complete a note during the visit. This is all considering a 5 mile radius, spending 30 minutes with the patient.

Home Health is full of ups and downs. Some days, you may see 10 visits, and some days you may only see 4 visits. Its a risk you take with home health. One thing you can't beat is the flexability of home health. I have always dropped my kids off at school and picked them up from school. If you have an emergency, visits can be moved to another day for example sick kid. I wouldn't leave home health for anything.

The biller should catch all missed encounters during pre-edit. They can then print a list of all missed encounters along with the clinician assigned. Each clinician should be responsible filling out a missed visit note. Its easy to forget to fill one out but it can be caught and there is no excuse for QA to be responsible for this.

I failed to mention that coding for home health is geared toward increasing HHRG. PPS changed in January, so finding suitable codes by reviewing SN notes can take a while, but not that long.

Is he getting paid hourly? Because I can code 10 recert review charts in a day if I'm steady. If the frequency of SNV is 1w9 or qow9 then he's only reviewing 5-8 skilled nursing notes for changes in dx codes.

Typical wound measurements are Length (head to toe) at longest length, width (hip to hip) at the widest point. Depth is measured at its deepest, tunneling and tracking is measured according to the clock method with 12 being toward the patient's head. wound measurements are usually documented in centimeters.

If you have at least 3 years of direct wound care experience then check out the CWCA certification. http://www.aawm.org The exam is offered twice a year, no classes to take. Its difficult to study for this exam because it is based on personal experience and evidence based medicine. If you become certified, and offer your expertise to agencies, then you are considered a consultant. Talk to your employer about your interest and ask if they would be willing to support you with it. Good luck.