Sana2007

Thank you for your response. The Conditions of Participation, 484.4, define a progress note as "a written notation, dated and signed by a member of the health team that summarizes facts about care furnished and the patient's response during a given period of time." A progress note is not same as visit note or a clinical note, which is defined as "a notation of a contact with a patient that is written and dated by a member of the health team, and that describes signs and symptoms, treatment and drugs administered and the patient's reaction, and any changes in physical or emotional condition." There is no frequency in the condition of participation but the definition for a summary report in 484.4 is, "the compilation of the pertinent factors of a patient's CLINICAL NOTES and PROGRESS NOTES that is submitted to the patient's physician", which probably means there should be at least one progress note so that it could be included in the summary.

Thank you caliotter3. Yes, 60-day summary is written at recert and sent to the doc. I am particularly questioning about Progress Notes. I am hoping we get more responses here. But thanks for your input. I really appreciate it.

Are you required to write Monthly Progress Notes in addition to regular visit notes at your agenciy? If yes, is it on a separate form or is it done on a regular visit note? Please let me know either way. I am reading that it is a condition of participation to have Progress notes yet any nurse I talk to from other agencies say that they do not write any progress notes. Some say that their regular visit notes are called progress notes but that's about it. Any input will be greatly appreciated. Thank you very much.

I haven't found any therapist yet who calls to get verbal orders. We have contract with big therapy companies and then some smaller companies but they all think we are asking them some thing completely out of their realm when we say if they call the docs themselves. They are much highly paid than us nurses but sadly do half as much we do. I am cornced about there revisits too without any evidence of verbal authorization. "Eval and Treat order" is only good for that one eval visit not the revisits. And sometimes by the time we get our hands on their evals, they are already into there third week seeing the patient. Technically intermediary can deny all these visits!

That's exactly my problem too. We all know in most of the cases physicians do not care about the exact frequency/duration and stuff like that, so it's not like we can have them paged or the covering physicians paged to get these non emergency orders. Yet we can't revisit without showing an evidence of verbal authorization. The first order that the agency gets is usually "eval and treat"and that order is only good for the first eval visit not the revisits. This is especiallly a big problem with therapy evals. They eval and start seeing patients even before turning in the evals and never ever call the physician to get a verbal authorization for the plan. However, there is box on the physician's order form that a clinician can check off if whether an order is a written order or verbal order. I see lot of nurses checking off the verbal order box but I doubt that they actually contact the physician. But then I haven't seen any PT orders with that option so I don't know how they get away with this requirement? I guess I am trying to figure out a way I can get out of contacting a physician, and still be compliant and not run the risk of Medicare denying these visits (of course there is no exception if it's something important like med verifications, invasive testings/treatments including Blood sugars and so on.. )

Wondering how other agencies handle the requirement of getting authorization for orders prior to implementing the order specifically at start of care? From talking to a lot of nurses and therapist I have come to found out that they do not call the physician after assessing the patient unless there is something really unusual. And we know that referral orders almost never address any orders like frequency/duration....But that means that they start revisiting patients long before 485s/POCs come back signed and I have read several places that Medicare sometimes deny these visits; the visits after the eval until the date MD signs the POC, because there is no evidence of verbal authorization. So I am wondering if clinicians just sign there orders as verbal so that it looks like the MD was contacted or do they ask the MD to back date it because I can't think of any other way of handling this except to actually just pick up the phone and call. Please help. Thanks

caliotter3, by shift work, do you mean you have patients who need nursing 24/7 and you stay with them for however long your shift is?

Congratulations!!! Just one question, did you have to wash hands with soap and water before the start of the procedure or was hand sanitizer OK?

Very helpful information. But can you tell me if a progress note is different from a Summary report? The previous entry says that it is the same, only calls different depending on if used at Discharge or recertification. Is that right? Thanks fo your input.

Thank you, HmarieD fro your response. So what do you suggest writing for frequency if I admit a patient on Friday; Should I write 1 da 2 for first week and then the appropriate frequency for the rest of the 9 weeks or 8 weeks? I am not sure if that first week should be counted as week 1 or not? If I count it as first week, then there are too many days left over in the certification period but they fall in the 10th week, so I can not schedule any visits for that week? Once again thanks for your help.

What does 1 da 1 read? And what do you guys recommend for writing frequency if I admit on a thursday or friday (we have a calendar week; sun thru sat). It seems if I count it to be the first week then I am left with a lot of days left over for the 10 week! Thank You very much for any suggestions?

Agree 100%!

How do I write an order on POC for something like daily dressing change that nurses do not have to do daily after some time but the patient or the care giver needs to continue daily on thier own. Nurses are only to monitor the overall progress and teach family to do dressings on their own. For example, if I write SN for daily dressing change until 07/15/09 and then 3W3, it sounds as if the dressing does not have to be changed daily at all after 07/15/09 even though it needs to be changed daily but not necessarily by the nurse. Would really appreciate any suggestions?? Thank You very much.

Hopkins has a lot of variety. But be sure to think twice before ordering the roll ons with wheels because there are some issues of how to keep the bottom clean if you are rolling it on the ground.

Go for BSN. I know it will be harder but you would have endless possibilities with BSN or even an Assosciate degree. LPNs are very limited in where they can or cannot work. Especially I think if you want work in hospitals your best option would be to become a RN. Do not be nervous about your age, in my 11+ years exp. I have worked with many great nurses who started later. In fact much better than some younger ones. Good luck!

You said you love the patients, but hate cleaning up poop and dealing with infections. News for you, their infections and poop is all part of them being a patient. If they didn't have these problems or issues they would not have been your patients. Maybe you are right nursing might not be for you.

Thank you DKS3132! Helped me tremendously. I indeed had the feeling that there was something not right using the wheeled bag. Thank you for the information.

We are seeing a patient for IDDM who is recently put on dialysis. We are not doing anything related to her End Stage Renal Disease/dialysis but yesterday I went to see her and she had missed her dialysis and requested me to change the dressing on her permacath which was clearly soiled and very loose. What should a nurse do in this situation? I thought agencies get cited even if a home health aide does ROM exercises if it is not ordered. Please help. Thanks.

Does anybody know what is exatly the point of using a barrier underneath the bag when placed down in a patient's house? Is it to keep the patient's surroundings clean or is it to keep the bag clean? I am confused bc I just recieved a nursing bag from Hopkins with wheels and I am afraid to use the wheels as that will certainly make the bottom dirty. But if the barrier is used to keep the patients surrounding from getting dirty then I am safe for using the wheels. Please help, this bag is really heavy to carry on my shoulder. Thank you.

What is the best way of documenting a change in primary diagnosis and all the changes in treatment and meds as a result of this at the resumption of care. Is there any specific form that anybody can recommend? I want to make sure that all the team members or if a new nurse is assigned to the case, can see this information clearly. We do not write a new plan of care(485) at ROC, I doubt if anybody else does it?? Thank you

Can anyone please help me with this lab related question. I have a private insurance pt who had recieved an order for labwork from another doctor/specialist, and the pt went ahead and got it done from a lab. Now, does anybody know if the insurance is going to deny payment to the lab and we will be responsible to pay for this. And what is the best way to handle a situation when such an order is given by a physician who hasn't signed the POC. Thank you very much in advance.

Can you please help me with this lab related question. I have a private insurance pt who had recieved an order for labwork from another doctor/specialist, and the pt went ahead and got it done from a lab. Now, can u tell me if the insurance is going to deny payment to the lab and what is the best way to handle a situation when such an order is given by a physician who hasn't signed the POC. Thank you very much in advance.

Can any of you experienced directors tell me how I can do inservices online. I am a Director of a start up home health agency and all my employees are working full time elsewhere and therefore it is very hard for me get them all here at once to do in-services in a traditional way. I have to do it seperately with all of them and wondering if there is any easier way where I can use technology to help me do a part of it. Also if you can tell me of any good place where I can find videos on age old topics like infection control, saftey issues, HIPPA and so on. Thank you very much in advance.