Responsibility after Med Sheet Documentation

[gmsr]

I am new to home health and feeling overwhelmed by all the paperwork and responsibility. I am trying to find a way to "feel comfortable" while going through the "learning curve". I have been told that home health is to be looked upon as something that is short-term and intended to provide a specific skill (which I understand) but a great deal of emphasis has been put on the medication profile... which has caused me to question how much the RN completing the initial OASIS assessment can be accountable for all of the patient's medications and their administration??

I find determining and writing the frequencies of visits very confusing and challenging.

I also find the two pages of diagnoses/coding very confusing.

Any assistance/advice regarding these concerns would be appreciated.

Thank you.

[Isabelle49]

You have some good concerns. As far as the diagnosis and coding, it is your responsibility to determine the diagnosis/es that are impacting the patient's health the most and one must be the primary, then all other diagnoses can be listed by order of severity. Someone in your office should be helping with the coding.

Frequencies: A home health episode is 60 days long (not 2 months). There is a circular thingy that can help you determine the end date of the episode, or you can count 60 days on a calendar, and day number one is the day of admit or for a recertification the first day of the new episode. It is then you responsibility to determine how often the patient needs to be seen. Fresh out of the hospital may require as many as 3 visits the first week and for some only 1 visit the first week. Your assessment of the patient's condition and caregiver's abilities will help you determine what you feel is needed. You can then plot your frequency for the rest of the 60 day period. It helps to have copies of blank calendar's that you can mark on to set a frequency. I can't do it without a calendar to write on. There are blank calendar sheets that can be found on the web and printed out, just make sure you have the right year - sometimes you can get the whole year on one page.

Example: Patient admitted today 11/15/11, episode will end 1/13/12

Week starts on Sunday so all visits for any week must be done between Sun and Sat

of the same week. If I need to see this patient 3 times the first week, 2 times for 2

weeks, then weekly to the end of the episode here is the frequency:

3W1 (3 times a week x 1 week), 2W2 (2 times a week for 2 weeks), 1W6 (1 time a

for 1 week). This frequency would look like: 3W1, 2W2, 1W6 (the weeks generally

add up to 9 weeks, but not always. A calendar you can mark on is really helpful.

I once copied a calendar off the internet that had the whole year on one page, had it laminated at a Kinko's and bought a write on, wipe off marker and I could use it over and over again to figure frequencies. I think most nurses new to home health get confused about frequencies, cause no one really teaches you how to do it.

Wish you luck.

[gmsr]

Thank you for such an informative reply.