Start of care question

Hello,

I have just started home health nursing and have questions about start of care orders?

1)If the nurse goes out for initial visit and all he/she has on a refferal is Evaluate for home care, what is she supposed t (o do on that first visit? You do a full assessment, gathering up all the info needed, you develop the POC for what that particular patients needs are, difficult in the beginning to decide frequency, but it gets easier.

2)And when can the next visit be made? Does a nurse have to have verbal orders cosigned by the physician before the next visit? The next visit can be made the next day if needed (say daily wound that you need to teach, or something of that sort) after you make the initial visit you call the MD office to let them know you opened the patient to services and give them a summary of what is needed (we opened ms jones to HH today and we are putting in SN, PT HHA, etc) , you do not have to have the verbal orders signed to make the next visit, all the info you put on the oasis will be transfered to the 485 (plan of care) and sent to the doctor for signature,,,believe me if we waited for all orders to be signed before we did anything we would never do it

3)How soon are the plan of cares supposed to have been signed by the physicans? I believe the general rule is orders are to be signed in 14 days, tho no bills can be sent out until signed orders are in, i have reviewed some records where it is past 30 days and the POC is not back signed yet, some docs are really bad about signing them timely

3) Is it OK to just have the POC signed by the physician or the Verbal orders before the POC have to be cosigned seperately too? sorry i don't understand this

3)And what about all the meds that I find on the first visit. Am I supposed to write each and every med on a physician order form or is writing continue all home meds enough? is there a med sheet in your start of care pack? , you write all the meds on that, that gets transfered to the POC, we are not allowed to write continue home meds

I guess I am confused about the events lthat ead up to the point when plan of care gets signed by the physician. in general, you get a referral, you go out do the admission, gather up all the info, put it together on what ever forms you use, that gets transfered to the POC (485) and sent out to the doc, sometimes that pt is discharged before that original POC evens gets signed, basically you write a verbal order when you get a new order, and just document, who you spoke to, to obtain that order,,,i will be honest , there are alot of times you write a verbal order say apply duoderm to (just an example) to sacral decubitus, as you found the decub on assessment, you put it on the patient because you know it is the right thing to do, you write the verbal order and send it to the MD, I will call lthe MD office and let them know i did it, because the MD doesn't want to find out after the fact that his pt. has a bedsore, but if you wait to actually speak to someone it could be days and the patient suffers, i don't know it i am clear when i write this, but let me know if you get the general understanding. I am getting some confusing information on this. So today I decided to register on All nurses and post my first question. Any help will be greatly appreciated. Thanks

Cookie102,

Than you from the bottom of my heart! I wish I had posted my question earlier. I was so confused and have been reading a lot of litraure but it did not make any sense. They make it sound like the doctor is always available right there to sign the orders. Thank you for making me understand how things work in real life.

Cookie102 or anybody else out there,

Should the medication list that the nurses fill out during the first visit be sent to the doctor to be signed too? I feel like what if something is not right w/ the meds that patient is taking at home, and waiting for the POC to be returned like you said might take a long time. How can I know for sure that I will not get in trouble if the patient has been on some med at all this time that he/she may not have been supposed to be taking?

Cookie102 or anybody else out there,

Should the medication list that the nurses fill out during the first visit be sent to the doctor to be signed too? I feel like what if something is not right w/ the meds that patient is taking at home, and waiting for the POC to be returned like you said might take a long time. How can I know for sure that I will not get in trouble if the patient has been on some med at all this time that he/she may not have been supposed to be taking?

the med list that is complied on the first visit is in turn put onto the POC (485) that the MD signs, if the pt is d/c'd from the hospital they will send a list with the pt (maybe) otherwise you are using your knowledge, like it was stated a patient with double of the same med, if you have a real concern you do the best you can, call the MD office explain it to them and i would make a visit back the next day.

hope that helps