dmdrn73

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?

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

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.

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.

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)

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.

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.

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.

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.

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.

hope this helps.

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.

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.

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!

I started in Home Health as essentially a new Grad, I had graduated from nursing school and passed Boards and there were no jobs to be found. Finally after a year I took a job as a HHA and did that for 8 months, they gradually worked me in doing private duty assessments during that time and I started working as an RN in June, 9 months after I started. My salary was half that then and I still don't make that 12+ years later (different agency/State). As other posters have asked, I m curious, which agency is this? (and do they still need help?? LOL)

We currently use Cerner RoadNotes/HomeWorks. It has bith Home Health and Hospice aspects to it. When we were deciding what to use. I personally oreferred the McKesson system but Cerner does the job.

We don't have "standing Orders" but we have protocol that we use. This is our "Comfort pack" We don't have it prepackaged nor do we have a specific pharmacy that we use, we just get regular Rx's from MD and use whatever pharmacy that the pt prefers. Roxanol 20mg/ml 0.25-1 ml Q hr PRN pain, SOB, Ativan 0.5 mg 1-2 tabs Q 1 hour PRN anxiety, restless, nausea Atropine drops or Scopolamine patches for terminal congestion/excess secretions Also usually we will get senna-S 1-2 tabs QD or BID PRN for constipation We will also use Compazine or Reglan for Nausea, sometimes Haldol for anxiety or nausea of other things don't work Sometimes will use long acting pain meds like MS contin or Oxycontin if pt taking pills (can give these rectally if need be)

The one hospital where I worked did taped reports but we had 5-6 tape recorders and each nurse did a tape for all her patients, Ideally she would be passing her whole assignment to one nurse. It worked fairly well. THe outgoing nurse would be on the floor finishing up and would wait to see if the next one had any questions, or we could fill them in on anything that came up sice we taped or anything we forgot. If we didn't have time to tape we did verbals. We also had a Kardex sheet that had a quick rundown of why the pt was there- total hip/knee, post op day__, etc and the a printout of all the orders and we would put in the margins what IV fluid and rate they had or if they had a heplock, if they had a bed alarm, restraints, traction, etc.

I've always used alcohol swabs. I know for Central and PICC line dressing changes I much prefer the Chlorhexidine.

At the hospital where I used to work there were 2 or 3 nurses who still wore their caps every day.

I had a cap but my mother bought it for me to take pictures in for graduation. We didn't wear them in school (did wear the white uniform dress, though). We graduated in black cap and gown. Our school had pins but we had to order them and pay for them in our own time and there was only limited time the guy was there (like an hour or 2 on one day) and I never got a chance to get one.

I had 75 questions and passed FYI My friend had the max 250 I think it was and she passed too.

Our Productivity requirement is 5/day, but on average we see 6 (5 plus an admit) or more. There have been days I have seen 8-9 (with one of those being an admit). They count a ROC almost the same as a SOC but a recert or an OASIS D/C is pretty much considered a regular visit. We do get a bonus if we are over productivity but it is tied into the productivity of ALL FT nurse/case managers. For example, they average out the visits for all of us and if the average is over 5/day (25/week) then the ones whose individual average is more than 6 or 7 get a bonus, I think it is $35/visit over. But even if someone's productivity is 8 or 9 and the average is not over 5 then that nurse gets nothing, which I don't think is fair because they usually don't take into consideration if someone had a paper day or other reasons for the low productivity.

We get $20/month reimbursed if we hand in a copy of the front page of our bill. They do provide a beeper but they rarely use them, most of the time the triage department calls us on our cell phones. We have been trying to get them to change the amount reimbursed or at least to not require is to remember to hand in the bill but so far no luck. They do give us a calling card for us to use but I have yet to use it.

Depending on the patient, I use these perameters... HR >110-120, BP >160-170/90-100 RR > 30 Temp O2 sat