5 Things Your Home Care Quality Assurance Nurse Wants You to Know

Melissa Mills, BSN

If you're a home care nurse, there's a good chance that your agency has quality assurance nurses (QA). They might be in-house, or they may work for another company. No matter where or how these nurses work with you, they have the same role - to ensure quality and cost-effective care for the agency.

Quality assurance nurses apply policies, procedures, or regulatory guidelines to the work of other nurses. They might work as a liaison between you, the patient, the agency, and the payer sources. They are often part of quality-improvement teams and may lead quality improvement initiatives or plans.

Often, these nurses have been in the field and know just how home care works. Here are a few things you should know about the role of the quality assurance nurse in the home care setting:

We are on the same team

The QA nurse might send work back to you or send messages asking you to complete or clarify the information you provided in your assessment. It could feel like you're continually getting notes or having to "re-do" work. We realize this and just want you to know that we are on the same team.

When the QA nurse sends work back, it is to maximize payment and ensure that care is provided per the guidelines and regulations. They are not trying to question your work - but instead, want to make sure that it is easy to understand and supports the care that the patient needs

We really want to educate others

One of the things I personally love about being a quality assurance nurse is the opportunity to educate other nurses. I can teach about documentation, regulations, assessments, and quality while I audit charts. As new rules and regulations are passed, I get first-hand information that I get to share with others.

If we can't figure it out, neither can the auditor

I remember the days of seeing 6 or 8 patients each day and attempting to keep my charting clear. It was a challenge some days to keep the patients straight as I finished up my notes. However, mistakes happen. You might think you're in Mr. Jones' chart, but you're really in Mrs. Smith's chart and before you know it - the OASIS is incorrect.

We get it! Those are the mistakes we want to find. Remember, that if we read your notes and validate the OASIS and still can't figure out what needs to be in the chart - we need to ask. We want it to be correct. We need to ensure the best payment. And, we know that if we can't figure it out - neither can the Medicare or accrediting agency auditor.

We want to maximize the payment and serve the patient well

It's easy to think that management and quality staff are all about the money. While we do see the bigger picture, we also know that if we provide the right care - the money should come right along too.

We aren't all about the money. But, we do understand that healthcare is a business - even if we don't like it.

There is an objective science to OASIS

OASIS is a patient-specific assessment. It's used to create the care plan, determine reimbursement from the payer, and measure quality measures. Each M item in the assessment correlates with the severity of illness and ultimately to reimbursement. Sometimes, the QA nurse might ask you a few questions to make sure that the assessment is completed correctly.

You should never be expected to change the assessment to increase reimbursement or document something that isn't true about the patient's abilities. Interpret the questions from the QA staff as just that - questions or inquiries - to ensure maximum payment. If what you documented initially is correct - great! Just let the QA nurse know that you have no needed changes to your documentation.

If you're just starting out in home care, you might have a lot of questions about the OASIS assessment. Find education courses to understanding the intent of each question. There is a science to completing the OASIS correctly and interpreting each M item. Ask questions of your QA nurse or manager if you're not sure how to interpret a question. Or, if you are getting feedback that doesn't make sense, be sure to ask for clarification. While there is science behind OASIS, it doesn't always make sense.

The QA staff are there to be buffer between you and the regulatory bodies and payers. Ask them questions. Talk to them so that they understand the barriers you run into out in the field too. To get the most out of your work and deliver the best patient care, we all must work together.

5 Things Your Home Care Quality Assurance Nurse Wants You to Know

We are on the same team

We really want to educate others

If we can't figure it out, neither can the auditor

We want to maximize the payment and serve the patient well

There is an objective science to OASIS

About Melissa Mills, BSN

Share on other sites

More Like This