Start of care orders

[wossaa]

I'm an RN and relatively new in hh. I'm having issues managing time, visits, md calls, paperwork. One main thing I seem to have problems with is getting orders to start care eg for wound care, pt/inr, cath care, etc. What suggestions or ideas would y'all be willing to share with me?

Thanks.

[KelRN215, BSN, RN]

Where are you getting your referrals from? I'm having a hard time understanding why you'd have trouble with SOC orders as SOMEONE must have referred this patient to your agency for nursing for a reason. Is the referring source not sending over paperwork?

[toomuchbaloney]

I agree with above post.

You cannot visit the patient without provider orders to see them including the purpose of the visit. You need to request those provider orders before you engage the patient. Be mindful of the laws regulating your practice in initiating home care services.

[RN4life08]

Wossaa I too have to verbally notify soc was completed and what plan of care is by speaking to an RN or MA regardless if I received orders from them. So I just ask to speak to MA/RN and if i get voice mail call back and and explain I need to speak to someone!

[wossaa]

Most referrals come from hospitals. They do send us paperwork; but more often than not, they don't include wound care orders which seem to take awhile to get. I get on a roll calling MDs, leave messages, call again, leave messages, and I wonder what I could be doing. Also, for pts that have foley caths or need pt/inr, these orders are not usually included in the referral materials, and calling aroud to get them is a mess. Do y'all call the referring MD for these orders or the specific MD? Eg, do y'all call urology MD for foley cath orders, cardiologist for pt/inr etc or do you call referring MD for these initial orders?

[toomuchbaloney]

I call the admitting MD for all orders. If he/she does not want to give me orders for some portion of the obvious care I allow them to direct me to the responsible provider.

[kiszi, RN]

For wound care orders I would tell the MD office what orders I would like to implement and ask for a yea or nay. If in doubt what to ask for a WOCN consult may be in order. If someone is on Coumadin and PCP doesn't personally want to manage it I would ask if I can set the pt up with a coumadin clinic.

For a long term foley I would ask when making the SOC call for orders to change foley q month or whatever the typical orders are.

The take home point here is that you may get further asking for specific orders than expecting the MD to come up with the specifics.

[Sterlink]

persistence. and we're told to follow SBAR when communicating with MDs: Situation/Background/Assessment/RECOMMENDATION!!!!!!!!!!

[rachel0609, ADN, RN]

Where I work most of the time the physician wants recommendations for wound care. I usually call PCP state that we have admitted so in so who has this wound and I recommend treating this way , pt has foley cath to be changed q30 days. I will be sending POC are u willing to sign? I also leave my number and office fax in the event he prefers something different. Seems to work well.