"Evaluate and Treat" question

[AtlantaRN, RN]

Do your doctors write orders that say "evaluate and treat" without giving you a hospice diagnosis? patient is 95 with recent hip fracture, hx of afib, dvt, diabetes, and bakers cyst...only on 3 medications....

I evaluated a patient today, but either myself or another nurse will admit the patient once we have a written order to evaluate and treat with an md written diagnosis.

linda

[mc3, ASN, RN]

Not sure what your question is...do you mean on new :nurse:hospice referrals, or for existing hospice patients that the MD has seen. For new hospice referrals, you must have a hospice diagnosis. Otherwise, what would you be treating for?

mc3

[rnboysmom]

Yes, some physicians will write "evaluate and treat". WE only evaluate with that order and will NOT evaluate a patient for service without that order--as you are practicing without an order if you don't get that intial okay to lay a hand on a patient. After the evaluation, we call back to discuss findings and then ask for the verbal certification of terminal illness to be allowed to admit the patient to service. Sometimes the diagnosis is apparent, but we always get the physicians input and the "admit to hospice with diagnosis of_______, life expectancy limited to 6 months or less provided the disease process advances as expected" type of order.

[aimeee, BSN, RN]

Evaluate and Treat is an open ended order that is used for the Nurse Practioner to make a Palliative Care visit. Perhaps they have some confusion and are working with multiple programs?

[jadelee]

I am confused, how it works in Australia (well at least where i am) is once a doctor has made a referral to hospice at home, phone contact by the on duty RN is made, then admission time is planned and at that admission permission for the service comes from the client NOT the doctor. then that RN lets the hospice doctor now about the admission and how urgent it is, and they assess. but even in between that time the nurse can be called back and treat the client with over the phone orders if required.

? is an an evalationan and treat order the same, then as that initial doctor referrall.

thanks Lee

[rnboysmom]

In the US, hospice is usually reimbursed under Medicare which is a "physician driven" system. The physician (or NP) has to give the evaluation order, then the hospice contacts the patient/family to explain the service. From the information that the hospice contact gathers, they may initiate the "sign on" or get the written permission from the patient or family to elect the service (these consents are good for up to 14 days). Many hospices send a nurse to do this in order to obtain a needs assessment and determine eligibility. After the patient assesment, the physician is contacted for the "certification of terminal illness" order and an okay to admit the patient to services order. All orders for the patient have to be written and approved by the patient's primary physician and become part of the plan of care for that patient. In the US, physicians rarely make house calls , in fact, probably the only time any patient ever sees a physician in their home is in the event the hospice medical director goes to the home to visit. Some very small communities have physicians that are very involved with their patients and make home visits, but this is very rare in larger communities. Most hospice in the US is done in the patient's home or in long term care facilities. We don't have as many in-patient facilities and day facilities as you do.

[jadelee]

thanks for the good explaination. everyone in australia is entitled to free medical care, including hospice, the doctors bill 'medicare' directly but all other services are free, not funded by the particular case. but maybe being smaller population, we can afford that. plus i forgot to say, that the inital referall must (by our hospice policy not law) already designate diagnosis and that it is terminal.

lee

In the US, hospice is usually reimbursed under Medicare which is a "physician driven" system. The physician (or NP) has to give the evaluation order, then the hospice contacts the patient/family to explain the service. From the information that the hospice contact gathers, they may initiate the "sign on" or get the written permission from the patient or family to elect the service (these consents are good for up to 14 days). Many hospices send a nurse to do this in order to obtain a needs assessment and determine eligibility. After the patient assesment, the physician is contacted for the "certification of terminal illness" order and an okay to admit the patient to services order. All orders for the patient have to be written and approved by the patient's primary physician and become part of the plan of care for that patient. In the US, physicians rarely make house calls , in fact, probably the only time any patient ever sees a physician in their home is in the event the hospice medical director goes to the home to visit. Some very small communities have physicians that are very involved with their patients and make home visits, but this is very rare in larger communities. Most hospice in the US is done in the patient's home or in long term care facilities. We don't have as many in-patient facilities and day facilities as you do.

[AtlantaRN, RN]

mc3: Yes, new hospice referrals...

I love when MD's will write "evaluate and treat for adult failure to thrive" or the like.

Alot of times it's not clear that patient has end stage anything.

linda