Skilled Need?

[JessLPN2RNASN]

I am new to home health, and have been through the crash course on my own. Much of what I know comes from all you wonderful people who post information and answer posts from floundering fools like me. Here comes another question: I recently admitted a pt who needed IV hydration for one week, basic fluid. Pt states that he is well versed in administration as he has been through it before and his wife has as well for about 7 months out of the last year. Does he have a skilled need? My administrator said we can't admit if we aren't going in every day for the 7 days of the ordered fluid administration. She hadn't had HH training either and we are learning as we go. If a pt has a need that is considered skilled, is it okay for them to do it on their own when they feel confident and are safe doing so? Any advice?

[KateRN1]

The skilled need isn't always a task, it can be education or assessment that only an RN can provide. If the patient has a peripheral IV, will it stay in for seven days or will the nurse need to change the IV site? If the patient has a PICC line or other central line, who will monitor for infection and change sterile dressings? In either case, the patient and caregiver can always benefit from teaching and monitoring for signs/symptoms of infection, dehydration, etc. What is the underlying disease process that has lead to the need for IV fluids for hydration? What can be taught/monitored in relation to that? What teaching can you initiate to prevent what lead to the dehydration?

However, if the patient is refusing home health care and feels that the situation is manageable, consider homebound status as well, and determine if he is really appropriate for home care.

[cathrn64]

I fully agree with KateRn1. In my agency we would expect someone to learn to give the daily hydration IV. You are there to teach and assess on IV site care, s/s to report, and disease process teaching. If the pt has private insurance you probably would not get approval for that many visits. For medicare, unless the pt is not home bound, you may need to stay in longer than the 7 days anyway. Also, teaching on prevention of future dehydration