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Home Health Nurse

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  1. dmdrn73

    Surgeries listed on 485?

    I have been in Home Health since 1995 and I have always been under the impression that you were supposed to put surgeries that the patient had on the 485, in that Box 12. We have an outside company that does our coding for us and I have had the hardest time getting them to put surgeries in. Some of them will enter them into the OASIS but then not put it in the place in our system that it needs to be to go onto the actual 485. I'm not talking about just minimal procedures, most recently I had a guy who we were seeing fresh from a CABG x 3 and an Aortic Valve Replacement (Mechanical) and neither procedure is anywhere to be found. These are not old procedures (I remember the days when you listed ALL surgeries they had) but the whole reason we were referred. I sent responses back to the coding message requesting that these be added and was told that supposedly they are doing away with M1012 but that is not the 485 it is OASIS. Am I the only one that thinks this is a problem? Is it not a big deal that these surgeries aren't listed on the 485?
  2. dmdrn73

    On Call rate

    At my current job we have on call supervisors (one it is her full time job and one is part time) who take the actual calls and then the case managers and on call nurses (there are a few of us) rotate the on call days. Us on call nurses are so the case managers can avoid on call or at least do minimal time on call. We do from 5p to 8a. We get paid $2 an hour during the week and $5/hr on the weekend to be on call then we get our per diem/per visit rate if we go out. It is about $35-45 depends on if weekday or w/e. Also we are paid milage door to door
  3. I worked for Immediate Home Care, based in Bensalem, Pa, just outside of Philly when I lived there. they cover the whole 5 county area, majority right in the city from what I know. I left quite a while ago (in 2002) but if I hadn't been moving I would probably still be working there. They were really good people to work for, and I still somewhat keep in touch with them. Any complaints there may have been at the job are actually the same types of complaints there are at the job I am in now, so it is the nature of the field. There may even be some mother baby cases there, they did them when I worked there.
  4. dmdrn73

    Pay per visit rates....what is the usual

    I live in Western NY (Rochester/Finger Lakes area) and I am Salary but Per Diem's get $30-$40 for a regular visit and then it is more for an admission and then if it is on call or a weekend or weekday. It can be about $70-$90. A recert or D/C OASIS visit is the same as a regular visit and there didn't used to be any extra for an ROC but there is now, (I don't know what that is, it just recently changed). We work or do "On Call" about every 3rd weekend and then 1-2 regular nights/month and we do get the Per Diem rate for those visits.
  5. dmdrn73

    Help with dressing choice

    I also question if it is a Kennedy Terminal Ulcer. But in any case the alginates are good for the drainage:Kaltostat, algisite, aquacel, Sorbsan, etc. The Ag would be better if infected. Can use an Allevyn adhesive foam dressing, it comes in a sacral shape but the square ones work nicely too. The Allevyn Gentle border is good too, doesn't adhere as much, sometimes the regular one will tear fragile skin when removed.
  6. I started out in Home Health as well. When I graduated in 94 in Philly there were actually very few jobs for new grads even in nursing homes, I was out of work for almost a year after I passed my Boards so I took a job as a HHA at a newly forming agency. They gradually worked me in as an RN, gradually letting me di private duty assessments, B/P screenings, etc. Also giving me more complicated patients to see as HHA. Then when I actually was hired, I had orientation and they kept me with my preceptor for a few weeks longer than the usual orientation, maybe letting me go out on 1 or 2 visits/day on my own after about 2 weeks. They made sure to send me with someone for any "firsts". I did that job for about 6 years then when I moved to Va, I decided to try Hospital work, I actually had no problem getting a job, they actually saw it as an asset that I had that much HH experience as it was very varied, some cardiac, some ortho, lots of wound care, etc. (FYI I am back in HH again)
  7. dmdrn73

    shift differentials not as common as i thought?

    When I worked in Virginia the shift differential started at 7pm and it was about $3.50/hr, then when I moved to NY the differential was for the whole shift but was only $1/hr.
  8. dmdrn73

    how many on computers

    We started with computers in late 2006. They gradually worked us all in a few at a time with the computer training classes and we were all "Live" by end Nov, early Dec. We use Cerner's HomeWorks/RoadNotes system. It works OK, I am used to it now but I hated it when we first got it, it is not that user friendly of a system. You have to go through too many steps to get to where you need to be.
  9. dmdrn73

    Falsification of records?

    I think in this situation if it has to be done by the RN who saw on 2/10 (our agency has the case manager do it if that 2/30 phone call is an LPN) that nurse should make a phone call so that the d/c OASIS info reflects what is going on now rather than what is going on from 3 weeks ago... That way you would be able to reflect the outcomes. Doing the OASIS based on the 2/10 visit would only be needed if no one had contacted them since 2/10 and in this case (I am assuming it is a hypothetical one..) the patient was seen 3 times since 2/10 and there is documentation to reflect the fact that there is no Foley in place.
  10. dmdrn73


    We are on about every 3rd weekend, alternating "working" and "on call". When we are "workers" we usually get a day off in the following week, (depending on how staffing is) usually we see 3-4 visits each day (Sat and Sun). When we are "on call" it is Friday to Sunday and we may or may not have an assignment then in addition get sent out if there is a call. We get some pay for being on call (between $2 and $5/hr). There are times I may get only 1 or 2 calls the whole weekend, or when I have to do 2-3 scheduled visits or admits and then get sent out extra. Then there are weekends like the one from He-- I had end of September where it seemed I was called out day and night all 3 days. We don't get the day off when we are "on call," but believe me I made sure I got one that time.., We also have to do 2 nights during the week on call a month.
  11. dmdrn73

    Pediatric HH Nursing

    It depends on the agency you work for. I am home Health nurse and we see patients of all ages, I currently have 2 patients who are infants, preemies, one who was failure to thrive and one who is getting monthly Synegis injections. We do coordinate/supervise LPN's who do the day to day shift work you described as well. I see one girl with Rett's syndrome every 2 weeks for RN assessments and LPN supervisions.
  12. Is it feasable for the daughter to take him home? Are there any Hospice Comfort Care homes in the area that he could be transferred to or is his condition not good for transport?I agree with a PP who said that your Hospice Med director needs to have a chat with the pt's doc or LTC doc.
  13. dmdrn73

    I need Information

    A small plastic tackle box is good for lab supplies. the different size sections are good to separate Alcohol preps, needles, vaccutainers, butterflies, etc. You can get them at K-Mart, Target, etc and they come in all different sizes.
  14. dmdrn73

    Do you care if they want you to remove your shoes?

    I generally don't mind. I live/work in Western NY and a lot of people live in areas where you have to walk up gravel or dirt driveways and the way the weather is here (lots of rain and snow) we may track in a lot of snow and mud so out of consideration I will usually take off the shoes especially if they have a light colored carpet. I had one this week tell me it was OK and I just wiped them as well as I could and I noticed my shoes left marks on their carpet, they didn't say anything but I felt awful!