Should I recertify this patient?

[tinybbynurse]

Fairly new to home health. Wondering if I should recertify this patient - as far as I know, there are no specific guidelines in place, it’s based on clinical judgement. However, I was told sometime next year Medicare will have a specific guide to go by, which I’m ok with.

my patient was admitted to HH with a primary dx related to gait abnormality. Another major issue was frequent running of her eyes from both macular degeneration and corneal dystrophy. While her right eye causes some blurred vision still, they rarely run or cause her anywhere near the major discomfort her eyes used too. Gait wise - she’s been working with PT, and feels she is getting stronger. I do think she could still benefit from further PT visits. Eye wise - I think she’s been taught all she needs regarding that.

She also has a dx of HTN, and that’s my main concern with her right now. It’s been high the past few visits - systolic 150-160, diastolic up to low 90’s. So it would make sense to recert her, right? This would be her FIRST recert, so it’s not like we’ve done all we can do quite yet.

thank you for your help!! I’m hoping to continue to gain perspective on when I should discharge or recertify patients so it’ll get easier with time!

[Kaisu]

Do you not have case conference with your peers to help you decide that?

[Emm_RN, ASN, BSN, MSN]

I would probably recert this patient and put in a spaced out visit pattern, perhaps 2week1, 1week3 and encourage her to get a cuff to check on non-visit days and to call into the agency/doctor with abnormal readings. Once she is comfortable with that, BP is stable, and she is taking appropriate actions to maintain BP, discharge would be appropriate.