Standing orders

tewdles, RN · Jun 5, 2011

Anyone using HomecareHomebase on a Droid? We are switching from McKesson where we used a set of standing orders and management tells us we won't have them in HomecareHomebase and will have to get orders for all symptoms as they arise. How does your agency handle? I know they don't have a clue how impossible it would be, hoping someone has a better way.

First off, Homecare Homebase is not a hospice application. It is designed for homecare and adapted to hospice.

The absence of standing orders in hospice may mean that your patients do not receive timely changes in the medical plan of care.

Good luck...I sure wouldn't want to have to do all of my hospice documentation on a droid!

ErinS, BSN, RN · Jun 6, 2011

We do not have standing orders, as my company has interpreted Medicare guidelines requiring an individualized plan of care as not allowing standing orders. This does not lead to a delay in symptom management. What it does require is admission nurses and case managers that are very good at predicting symptoms based on diagnosis. So when I do an admit for someone with dementia who has arthritis, I generally get some pain medicine, anxiety medicine, and agitation medicine, where as someone with cancer may only need the pain and anxiety medicine. Also on admit we get orders for things that may be needed down the road- catheter insertion, dme, etc. Hope this helps.

tewdles, RN · Jun 7, 2011

We do not have standing orders, as my company has interpreted Medicare guidelines requiring an individualized plan of care as not allowing standing orders. This does not lead to a delay in symptom management. What it does require is admission nurses and case managers that are very good at predicting symptoms based on diagnosis. So when I do an admit for someone with dementia who has arthritis, I generally get some pain medicine, anxiety medicine, and agitation medicine, where as someone with cancer may only need the pain and anxiety medicine. Also on admit we get orders for things that may be needed down the road- catheter insertion, dme, etc. Hope this helps.

Let me jump onto my soap box about medical standing orders and individualized POCs.

There is NOTHING about standing medical orders which makes a POC generic. The standing orders are relatively generic, although the MD may exclude or include whatever orders he/she desires. The medical orders are only a small part of the hospice POC. The full POC IS individualized as we initiate the appropriate MD S.O. at the appropriate time to palliate a symptom. In the absence of standing orders it is entirely possible that treatment of a symptom will be delayed while we attempt to obtain basic medical orders for things frequently common at end of life. Standing orders = no delay = improved pt comfort = improved customer satisfaction.

Hospice management who do not fully understand the individualization of the POC are too narrow minded to see MD S.O. as a tool or a piece of the pie, rather than as "the POC", or the whole pie. Those managers need to be refreshed on who owns the POC, who is responsible for updating it, and what constitutes "individualized"...IMHO.

Hospice Nurse LPN, BSN, RN · Jun 7, 2011

We have standing orders in our hospice. Most docs will hand over the care of their pts to us w/ admit. One onc. doc who refers prefers his own standing orders...actually quite a bit more liberal than ours. It saves a lot of time getting the needed meds to the pt. No more waiting for the doc to return your call.

As far as using the droid, I wouldn't like that at all. I'm finally getting comfortable texting w/ my iphone.

jyhn · Jul 4, 2011

Thanks for the replies. Not a big fan of Homecare Homebase especially on a Droid. I feel like it is very narrow viewing before we were on McKesson and a laptop. Our company has not decided on standing orders so in the meantime we have to call md for all orders I like Tweedles answer re SO and hope my company will understand and realize how important to timely care they are.