skilled charting

[nrsbetrn]

For Medicare Skilled residents charting does your facility chart every shift or daily charting? The requirements say the resident must need a "daily" nurisng assessment or therapy 5xweek. So are we required to chart every shift?

[Nascar nurse, ASN, RN]

Daily charting meets the medicare requirement, but your facility may have a policy that requires charting every shift.

[Rascal1]

Many facilities chart every shift. And most struggle with getting the nurses to document the critical information required for medicare reeimbursement.

[CapeCodMermaid, RN]

Right....the requirements are once daily but most places require once a shift. Seems it would be easier to teach the nurses how to right a good skilled note than to have them write nonsense 3x/day.

[caliotter3]

When I was in LTC, our DON was trying to get us to go from the nonsense notes to good notes meeting medicare standards. Not much headway was being made at the time. We charted each shift.

[Rascal1]

By charting every shift there are three chances to get it right ! Do the nurses understand that their notes play heavily into how much the facility is paid by Med. A.?

[CapeCodMermaid, RN]

Apparently since they don't think their salary is tied into the financial health of the facility, they don't much care if we make money with the Med A patients no matter how many times they are told.

[achot chavi]

Apparently since they don't think their salary is tied into the financial health of the facility, they don't much care if we make money with the Med A patients no matter how many times they are told.

This is why we are constantly reminding them this important detail- chart or we will close the unit!!!

[Rascal1]

What if we tack on a "little extra note" to the Med. A documentation cheat sheets at the nurses' station, it could say,"Just a little food for thought in this tough economic time--How do you Envision your next raise?"....

[achot chavi]

Nice! :-)

[nrsbetrn]

Our nurses are not good at charting on skilled therapy residents. They think only therapy should deal with this part but it all ties in together on the residents recovery. I would like to have some cheat sheets for areas for nursing documentation. It is how we get paid in the end! They just don't get it! Does anyone have good cheat sheets for what needs to be covered in documentation pertaining to specific skills that you would share?

[Rascal1]

Our nurses are not good at charting on skilled therapy residents. They think only therapy should deal with this part but it all ties in together on the residents recovery. I would like to have some cheat sheets for areas for nursing documentation. It is how we get paid in the end! They just don't get it! Does anyone have good cheat sheets for what needs to be covered in documentation pertaining to specific skills that you would share?

Yes, ask your MDS. person. Ooops, Don't tell her I said that !! Post cheat sheets containing Dx. specific observations and related testing done by nursing for the resident and what they did or need to do to remedy the situation. Don't forget any other pertinent observations/actions necessary specific to the patient. Maybe,the hospital d/c summary describes some other problems very often unrelated to the primary dx's.,which got them admitted to the hospital in the first place.(Diarrhea,med. reaction,rash). Surely,these events warrant further observations if they are not resolved completely upon hospital d/c.to LTC. Let's face it ,these very fragile, sick patients are shipped back from the hospital so quick,still, soooo unstable and how many end right back there within the first few of shifts and are admitted again. And the hospital gets to bill the insurance co's for another admission. If hospital d/c planners would get after the MD's to include the more specific info. re: IV's,amts., dates, (started ,d/c'd) it would help us drive up our medicare reimbursement because we can capture on the MDS. Hope this helps a little....:typing