homesrus

we were always taught to do the abdominal thrusts on a bed bound patient who is in a reclining position. The wheelchair patient we try to get our arms around from behind the wheelchair. Neither is perfect.

Very unsafe! Lots of other ways that agency could have handled it and supported you!

There is also a web based training program for it and a book called OASIS in Detail-a Clinicians pocket guide. They may help cut through that OASIS fog!

I think that we continually add to the work and paper load but rarely take anything away. We have an afternoon LPN that has two hours free. We think that with a form that has a set list of questions she may be able to make some of the calls. Then she will have to report the findings to the primary nurse. Don't know if it will work.

In addition to front loading visits we are also making phone calls to the patients on the days the first week or so after discharge that we aren't in the home. I think you can reduce your rate but everyone, nurse, doc and patient need to agree to making the program work. That's the hardest part, I think.

We are starting with a chart audit for a quarter. We will start from there. Some agencies are making more frequent visits in response to calls from patients . We have 24 hour call but do not encourage visits after midnight. Ocassionally we have to go out but most things can be taken care of on the phone. Maybe we will have to consider increasing those visits

Actually, I really value our psych nurse and the work she does. She does not go on routine med-surg visits and probably for the type of wound that you are talking about it would be ideal for another nurse to manage the wound care. your skills are very much needed in home care . Our small agency can hardly keep up with the referrals for psych. we have one part time nurse for psych and she has two full days seeing just referrals for some type of homebound mentally ill patients. depression or such. When she goes on vacation we scramble to find another qualified RN to make those visits. There is no one else in our agency that has those skills.

Our psych nurse does simple med surg assessment skills during her visit No phlebotomy because she works part time for us and doesn't have the opportunity to keep that skill sharp. Our med surg, maternal child or ET nurses do not ever do psych visits that have been specifically ordered by the doctor as such.

We went back to careplans after carepaths. The paths were bulky to get to the nurses for use and we had trouble keeping on schedule with older population also. However, i cannot say that the care plans that we use are effective either. We do them because they are necessary but have not come upon a way to make them really useful for the nurse or patient.

We place a disposable barrier under the bag before we set it on a hard surface. we carry those in an outside pocket of the bag where they are easily reached. we carry the disposable hand wipes in the outside pocket also. always clean hands into the bag and clean the equipment before it goes back. We got very carried away at one point trying to make this process work. It was too difficult for anyone to remember and looked silly to the patient so we pared it down to the barrier and clean hands and clean equipment Good Luck!

We use 2-3 LPN's to see parients on a daily basis. They cannot do IV's or central lines or OASIS assessments. They are excellent at lab work, CP assess, wound care and follow up the teaching that the RN has done. They are really valuable to our agency and could do alot more but are held back by regulations.

Our average daily census is 260 and there are at least two other people beside myself to do those jobs(and I feel overworked!!) I think about staff nursing alot. I think all the downsizing has hit you hard and your mental health is so much more important than the job. You need a vacation!!! Then make a decision.

Thank you Thank you Thankyou for all your help!

Does anyone have a list of the case mix diagnosis for home care?I know the three main are ortho,diabetes and neuro but I would like to see the classifications in each. With the use of the new V codes our agency is struggling to fill out the OASIS correctly. I have searched the government sites on the web but can't come up with an answer. Can anyone help? :)