QA nurses and missed visits

Specialties Home Health

Published

I work as a QA nurse in Tx for the first time and I am being asked to write "missed visit" notes for the nurses that don't turn in their notes so that the frequency is met and the home health can bill for the cert episode. They say that it's a very common practice for QA nurses to do that. Is that true? Am I risking my license for writting a "missed visit" note? Thanks.

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Specializes in LTC/hospital, home health (VNA).

Not sure if it is a common practice or not. If I miss a visit, the QA follows up with me...and I write a note/message on why visit was missed if ( pt cancel, MD appt, snow, etc). She does not write them. Routinely we write a message/note at time of missed visit...but things do get missed!

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I am a QA nurse and it is not unusual for a QA staff to write a missed visit note, I would recommend indicating on the note that the missed visit was noted on chart audit and be sure to date it appropriately (the day you are actually submitting it).

However, I have found you should take these types of errors back to the clinicians repeatedly and make them fix their own mistakes (with a missed visit they may actually remember why the visit was missed). Eventually they will figure out that they can do what they're supposed to at the time it's supposed to be done or do it later, but eventually they WILL have to do it, so most will remember to do it up front.

I have found some clinicians who claim to not even be aware they have to do certain things until you return something to them, but that excuse will only work once. Then they either have to do it or look like a slacker. It's not as if I never overlooked or forgot something when I was in the field but some people are habitual. If you always clean up after them they'll never take responsibility themselves.

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This problem is really very simple. Do not let your nurses turn in notes that were scheduled for the day without an explanation for each visit not done. If someone is not seen, they either need to write in comment section that visit was moved, or write an omit for that visit. Do not let them turn in a note unless one of these is done. Make the rules and stick with them. The person checking the notes in needs to report to you if a days worth of notes are turned in without some kind of explanation for each visit that was not done as scheduled. This will make it much more easy to track. Omits at a later date should rarely...if ever, need to be done.

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One more thought....Make each nurse, HHA responsible for their own actions!!!!! They need to be trained to ALWAYS write their own omits. Always make them call the office and document who they spoke to as to WHY the omit or moved visit was ABSOLUTELY necessary. This should not routinely be the QA persons responsibility!!!! Only on a RARE occasion. I have become very strict on this issue, and it has taken alot of the load off of me. This should NOT be your problem. Each person needs to take responsibility for their own actions and/or problems. Otherwise, you will use your own valuable time fixing others problems!!!!!!! Don't do it!!!! As a QA person, you have plenty on your plate!!!!!!!!!!!!!:wink2:

Good luck!!!!!!! QA is a very frustrating aspect of home health. Why can't nurses just do the "101" stuff without being told or reminded over and over????????????????????????????????????//

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I also wanted to update this post with a story that one my Co Workers told me. There was a patient that was not seen for two weeks and that patient complained since they were sick at the time. State came to audit and address that patient complaint and it turns out there was a "missed visit" note written by a QA nurse. They questioned the nurse as to why a missed visit was written when the patient was actually home since they were sick at the time. The nurse replied that they wrote the "missed visit" note so that frequency could be met. Apparently that QA nurse got in a lot of trouble. I'm just wondering if a situation like that has happened to anyone?

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I also wanted to update this post with a story that one my Co Workers told me. There was a patient that was not seen for two weeks and that patient complained since they were sick at the time. State came to audit and address that patient complaint and it turns out there was a "missed visit" note written by a QA nurse. They questioned the nurse as to why a missed visit was written when the patient was actually home since they were sick at the time. The nurse replied that they wrote the "missed visit" note so that frequency could be met. Apparently that QA nurse got in a lot of trouble. I'm just wondering if a situation like that has happened to anyone?
!!!

very good example of why people need to be responsible for themselves...!!!

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If you were a QA nurse would you write a missed visit note knowing that one day you might be called on it? I'm still struggling with this (if I should write a missed visit note or note). Just would like some advice. Thanks.

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Specializes in Home Care, Hospice, OB.
if you were a qa nurse would you write a missed visit note knowing that one day you might be called on it? i'm still struggling with this (if i should write a missed visit note or note). just would like some advice. thanks.

i am the clinical director, and imho you have no business writing a note about a missed visit unless you were the nurse who missed the visit!!

if the nurse can tell you what happened (severe weather, no answer to locked door, pt just returned from md appt..) they can write it as a note themselves. how can you write anything if you weren't there???? that's just nuts to me, and i've been in hh a long time....:twocents:

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I am also a QA nurse and I do not write missed visits notes. I take all of them back to the clinician it involves and have them write them. I was not there, did not talk with the patiet etc. I don't write orders for extra visits either. All corrections go back to the clinican involved for clarrification etc.

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I am also a QA nurse and I do not write missed visits notes. I take all of them back to the clinician it involves and have them write them. I was not there, did not talk with the patiet etc. I don't write orders for extra visits either. All corrections go back to the clinican involved for clarrification etc.

i agree with you!!!! now what do you do if that clincian no longer works there?

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I send a FYI note to the physician (dated the day I write it) that on chart review it was noted that a visit for this day was missed. I double check billing to make sure we didn't bill for something we didn't do or have orders for.

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