GiaRNCM

I need help with a very sensitive subject. Our CF patients come in for "routine cleanouts". They usually stay for 14 to 21 days for IV antibiotics. After they stabilize they could go home with infusion services to complete their course of antibiotics. The pulmonologist writes an order that they can leave the hospital on a "pass" between their meds as long as they return in time for the next dose. They usually are gone for 4 to 6 hours at a time. My concern is we are giving insurance reviews asking for more days et they really don't meet inpt. criteria and this could be done outpt. in the home. Also, from a liability standpoint, what if they get into an accident while out of the hospital and they really should be in the hospital under our watch? These are adult patients who are practicing risky behavior such as riding motor cycles and smoking pot. To make matters worse, the floor nurses have started to NOT document when they leave the hospital on "pass". I think they know I am watching and I will take this to administration. Any advice from other CM's---I need feedback please:crying2:

Just curious what the d/c planning models would be in other Children's Hospitals. It has been my experience that RN Case Mgrs. do the discharge planning and home referral. Would appreciate hearing from other CM's in other Children's Hospitals. Thank you for your help!

I work in a Children's Hospital as the Clinical Case Mgr. doing complex discharge planning. I am getting pressure to hand over my IV infusion referrals to SW staff. Sending babies and children home with IV infusion is very complicated when nursing consideration needs to occur as to size of PICC, duration of drug, changing to a more reasonable home regime, etc. Also, a 2Fr PICC would require a continuous infusion etc. I run around all day getting verbal orders from the Docs. as well. I have not had one bad outcome thank goodness. Do other CM have this issue? This seems to me to be out of their scope of practice and they are gradually taking on nursing duties. The other issue is the outside agencies who come to the hospital to coordinate the care to their agency often are not nurses either. Would appreciate any advice with this! Thank you in advance:nurse: