485 Summaries

KP RN · Apr 30, 2002

Topaz, I'm not sure I understand what you mean by "summaries on the 485"??

The info included on the 485 have been pretty standard at the different agencies for whom I've worked.

What kind of information do you summarize on the 485??

kids · Apr 30, 2002

We do the 485 every 60 days and put only the physicians ordered meds, treatment, therapies, tube feedings, etc on the 485 (and continue onto the 487 if needed). We include a copy of the current careplan when we send it out for signature. It goes to the PCP. If a kido has multiple heavily involved specialists we send a courtesy copy to them also.

Monthly summaries are done on a form that addresses each system and is a series of check boxes and comment lines (takes about 10 minutes to do if you know the client). These are copied and mailed to the Doc.

I work for a "national" pediatric home care agency, we have done it this way for as long as I can recall. This method has been acceptable to JAHCO, CHAP, Medicare and the various states in multiple surveys over the years.

It helps that the forms are in template form on the computer...when the new one is due it is just a matter of updateing it with new orders/changes, saving and printing.

hoolahan, ASN, RN · May 1, 2002

Oh Topaz, what a great idea!! Why didn't I think of that??

I am sure you meant to say 487 though, as in when doing recerts. Our agency requires the OASIS, a client summary on the 487, detailing why the client needs ongoing care, and the orders, which are formulated from the OASIS and a copy of the previous orders for us to make changes onto, so we don't copy meds etc on the 487, since the new orders will be generated from the changes made on the copy of previous orders. ON the previous orders, we always change the goals, usually change visit frequency, erase disciplines that are finished, change, add, delete meds, etc...

On the 487 we write a systems summary, then write why they need ongoing nursing care and/or HHA or whatever.

Eg. This is how I would write mine off the top of my head for one of my clients....

Client A/A/O MAE apporpo to commands with equal strength. Pain in RLE related to wound, controlled on current pain med regimen

Ambulates using two canes, gait unsteady at times. Hands deformed by rheumatoid arthritis. Client able to perform own ADL's with use of assistive devices, but is unable to reach, or render care to RLE wound. Lives alone, has one caregiver who provides wound care on weekends only.

Dyspneic with ambulating 20 ft, resolves with 10 min rest. Lungs clear, no use of accessory muscles of resp. RR 20

Apical regular s1 s2 aud, no murmurs/rubs. Peripheral pulses easily palpable, +1 edema RLE. Color good, lips and mucosa pinl, cap refill

BS heard in all quads, abd soft, non-tender, LBM 4/30/02 appetite good weight unchaged at 161 lbs

Voiding clear amber, denies s/s UTI, usual quantites

RLE wound 6.2 x 5 x o.5 cm, wound bed red, mod amount serosang drng, peri-wound skin reddened, edemetous, cracked a weeping. Current wound care cleanse wound w NSS, apply fibracol, then tielle dressing, moisture barrier to intact peri-wound skin, q 3 days

Continue SN 1-3 W9 for wound care as client unable to do own wound care due to deformities of hands and limited CG availability.

That's it. I would add HHA to assist in ADL's if he wanted one, but he doesn't want a HHA, though I think he could use one. Oh, forgot to note, I added on this one...

Please note client has been self-treating wound in various ways, such as rubbing legs with a wire brush and applying betadine, or applying olive oil to broken peri-wound skin, and possibly other methods he has not shared w SN, despite warnings not to do so.

...I almost forgot I put that on there. But it sure does take a lot of time! I would love a check list type of summary form. I don't see why we can't just write our usual notes and send a copy of them! If I write all that on my 487 on recert day, I only write in my note "see 487 and OASIS for assessment" and a tiny blurb on teaching and plan for next visit. I used to write it all out, until other nurses at a meeting said they do it this way, and sup's said it was OK, now I will add B-12 inj given to R deltoid if it is something extra like that, or foley chaged, etc...

I have 4 recerts this week, and some days I have 2 recerts and a new in one day, can you stand it, 3 OASIS in one day??? When I have days like that, I usually take them home and work on them the night before, so I don't have so many to do in one day!!!

lawsrnmom · May 1, 2002

I work for a hospital based agency. An entire 24 hours is charted on one piece of paper for inpatient patients. Why do Home Health patients require this massive assessment? They wonder why agencies were committing fraud and never discharging people. The assessments we have to do.....it is hard not to find a skilled need.

Why can you not just address the skilled need and homebound status?

Disability due to Carpal Tunnel is in my future I am afraid.... :eek:

Home Health Columnist / Guide · May 1, 2002

Why the massive assessment: MEDICARE REQUIRES IT.

If you don't do it, you don't get paid.

The reasoning behind OASIS is to gather information for a few years to gather patient statistics related to diagnosis groups and regional characteristics then pay flat fee for episode of illness (not the same as current payment). The goal is to do heavy teaching at front end to prevent rehospitalization. It is focusing on OUTCOMES measurements--trying to find best visit patterns and caremaps to give adequate care at controlled reduced costs.

TopazStone · May 1, 2002

O.K. everyone-- yes it is the 487:imbar . I just tend to flip it and keep writing LOL. We work with mainly with the chronic mentally ill Medicaid patient. Every 60 days, we send a summary to the physician that addresses VS range, physical status, and behavior/ mental status for that cert period. Our clients do not usually make much progress. Right now, our summaries are very disorganized. Some of us write "VS WNL. Remains noncompliant with meds and diabetic diet. Frequently misses visits and reports to mental health center that her nurses 'never show up'. Pt con't to speak in short phrases and occ has auditaory halls." Then we have some that will write a VS range, progress for the cert period towards goals, abnormalities consistently noted, etc. We need to get something in place that will put everyone on the same page.

There is no way to really make this easier. We will still have to write it all out by hand but at least a form will remind us to hit all the info that needs to be there. That is where the question comes into play-- what to put on the summary form . . .

Oh how I would love a copy of the checklist form. Right now I am the OASIS specialist. I do all recerts & admissions for the psych department and 15 visits a week. This week it is 7 recerts, 2 admissions and my regular 15 . . . Anything that scales down my writing, I want to do!

hoolahan, ASN, RN · May 1, 2002

Topaz, don't be embarrrassed!!! We all knew what you meant! :) At least your not calling your new dog by the old dog's name, like I have been lately!

Didn't realize you were working w mentally ill. I think if anything significant happened during the previous cert, I would include it in the summary. Like my friend Harry, was diagnosed w rectal ca in between cert periods, so I did include the testing he had done, the placement of the port, etc along w assessment findings.

OH you lucky lucky person to do all the OASIS's, how I envy you..... NOT!!!!!

kids · May 2, 2002

Another benefit of working with Peds...no OASIS:D

juliesosarn · May 2, 2002

Topaz,

I'm sorry that it appears that you have to "write" all your 485s and 487s. Ours are computerized and much easier to do since I would rather type than write. They are similar to what everyone else has said: done at 60 days, state the reason for admission, what services have been provided and what has gone on during the 60 days, as well as a justification for why the patient needs recertification, if he/she does. We also do summaries at 20 days and 40 days, which are directed at the progress toward the goals established in the 485. The 60-day summaries are then easy because we just have to read the 20- and 40-day summaries, then add in whatever happened in the last 20 days.