Responsibilities and Liability of Case/Care manager

[rn718]

I know this is a pretty general arena, but I am used to working very closely besides the MD's and other providers in Hospital settings or at least having access to charts.

However case manager in Home Care assess or enroll a patient in a care plan for an insurance company and it is very difficult to confirm, verify, or otherwise collaborate with MD's and others within the time of assessing and submission which is usually a few days.

Agencies have varying guidelines. For instance on confirming medications or diagnosis. Do you as a case manager at home rely on what the patient says and what you see in their home for assessment?

What is the best way to confirm if the MD is never available? With a nurse or staff? Ask for a fax or email and it will rarely come in a few days if at all. Impossible to physically go to each MD.

Faxing, verbalizing, or emailing an assessment to an MD does what? To me that seems like confirming with office is covering yourself and not really the patient. And I am concerned with both.

So as a case manager who is doing an enrollment assessment in a brief time seeing a patient once what guidelines would you case managers adhere to?

It seems to me like the RN's I speak with are split:

1) some will not hand in assessment without written confirmation from MD which they compare to getting a script.

2) others feel sending your assessment subjective/ visual assessment of diagnoses and meds to MD and confirming receipt is better because you are informing what patient actually knows and has in home.

i.e. if the patient isn't aware of his diagnoses or meds the PCP should be aware and this is better than getting a fax and updating a diagnosis while you will never see patient again.

Please help on best guidelines??

[KelRN215, BSN, RN]

I don't share my assessment documentation with the MD. It's a nursing assessment.

The diagnoses should be on the referral or on the discharge summary that comes from the hospital. As should the medications. If there is a discrepancy between what the patient believes he is taking and the orders, clarify with the MD. I can usually reach MDs directly either by fax, email or page. If I can't reach them, I can almost always reach a nurse in the office who will help me.

[Isabelle49]

I have decided that I will no longer accept an admit or resumption of care if I am not provided with a History & physical or Discharge Summary with a medication list. Going in without this information is too much liability. Sure, the MD eventually signs the Plan of Care, but that may be weeks or as much as months later and the liability is on the nurse until the MD does so. Luckily I am 99% retired and can pick and choose as a PRN nurse. Further, as nurses, I don't think it is within our scope to be psychic too!