485 question

[nurseinmo]

I have worked for the same HH agency (hospital based) for 2 years now. In that time we have had 6 directors... we recently had a survey that apparently didn't go like they thought it should. One of the issues that was brought up was our 485's. Now the director is telling us that we have to teach EVERYTHING on the 485 with EVERY visit. Prior to this our 485 would say something like

Teach: Disease process - Diabetes (foot care, self assessment, when to call, diet...)

so then our computer based charting system would give you a drop down with the things in () to select from to teach a different one each visit. She gave me back 3 485s today to change. Some things were duplicated because of the system and did need to be taken out; but she also told me I can't put "standard precautions" in because there is no definition??? Excuse me? That's why it's STANDARD!!

I learn more and more every day that most of what she tells us is not right but I just wondered on this issue how everyone else does it? TIA for any input.

[Isabelle49]

It is not possible to teach everything listed on the 485, disease, meds, safety, diet, etc. The patient wouldn't remember anything because of information overload. There is such a thing as Standard Precautions, you might get a definition for your manager from the CDC. Sounds like you have managers and directors that don't know much about the nursing process. Unfortunately you will probably run through about 6 more in the next 2 years with the attitudes and information they are projecting to staff.

[homehealth_rn]

Does she not know what standard precautions are??? And I really don't understand how you could teach everything on the 485 in one visit.

[nurseinmo]

That's what we have been trying to tell her!! I thought maybe something had changed as far as the 485 was concerned; I think she is just mis understanding what the surveyor meant. There is no talking to this woman, I have tried and it has just gotten me in trouble. I asked her today about a new policy she had written and a couple of places were wrong, just minor things and she got very defensive, pulled the papers from me then shoved them at my arm, essentially shoving me in the process and tole me to "write the policy then, you be the director". I said I thought she was being hateful and she said "well I said it nicely"...

I am soooo ready to get out of that department with everything that has been going on!

As far as the "standard" question goes; I was trying to explain to her today that this is...well standard on every patient. She asked how I teach it...really?? I said, well, I go over it at every admission, this is why we put a barrier down for our bag, clean hands before getting into bag, wear gloves, clean hands, clean equipment...etc. She really is tough to deal with!

[caliotter3]

It is plain stupid to expect everything to be taught on every visit. Charting that would be a red flag for false charting.

[nurseinmo]

It is plain stupid to expect everything to be taught on every visit. Charting that would be a red flag for false charting.

[Isabelle49]

Added to say, if you teach everything in one visit, you better make it a really long visit. Your superior surely has never worked in the field and I think this is a big, big mistake.

[KateRN1]

If you teach everything in one visit, where is your justification for going back again? Not good. Really not good.

Standard Precuations do not need to be defined within the 485, they are universally understood to all healthcare providers and should be included within your agency's annual blood-borne pathogens training.

If your director doesn't get this, perhaps s/he needs further training in the role.

It never ceases to amaze me how often agencies will put a person in the role of "director of nursing" just because that person is a nurse. Yikes. No home health experience, no business experience, doesn't know the first thing about Medicare, doesn't know the first thing about home care-specific issues--no problem! I believe that is why we have so much fraud within the system--some of it is intentional for sure, but I believe that most of it is simply a matter of ignorance of the rules. No exucse for owners/operators to offer or for those people to accept the position that they are not qualified for.

[Isabelle49]

Medicare Conditions of Participation specifically outline the requirements for a DON and an individual who has no field experience cannot be a DON! I believe the minimum requirement is 1 year as field RN.

[KateRN1]

There is no outline of requirements in Medicare CoPs for DON that I've ever seen. Would love to have a reference for this.