tube feed and skilling

Nascar nurse, ASN, RN · Mar 4, 2009

I take it you mean discharged.. as in discharged to home/community? If he has been at home/community for 12 months then he has had a break in the spell of illness.

We actually haven't skilled anyone on tube feedings for several years. Our consultants insist then is just maintance care once they are stable and requires no special nursing care/skill (but I know that not all LTC companies see it that way).

CapeCodMermaid, RN · Mar 4, 2009

Didn't 'they' say at one point in time that if someone received 51% or more of their calories through a tube feed, that was considered a skill and wouldn't ever be off skilled services if they remained in a facility? I'm with you...tube feeding is hardly a skill but when did the rules change?

BEDPAN76 · Mar 4, 2009

Hi Cape! Good question... they should be skilled but I've only been doing this about a year so will ask my boss (14 yrs. experience) in the a.m.

achot chavi · Mar 4, 2009

Didn't 'they' say at one point in time that if someone received 51% or more of their calories through a tube feed, that was considered a skill and wouldn't ever be off skilled services if they remained in a facility? I'm with you...tube feeding is hardly a skill but when did the rules change?

The skill is in the ability to REMEMBER to flush the tubes, not to give meds through the bag but using a syringe, to put ice in the pouch in the hot summer when the rate is 50 cc/hr, to keep the head of the bed up and remind the CNA who is doing T&P to return the bed to an upright position after... to check for residuals etc.

While not up there with trach care, lets not diminish the work that we do as unskilled. Yes a layperson can be taught to do it but I can change my cars tires, water and oil- doesn't make me a car mechanic.

I had an RN BSN young nurse who constantly left me with clogged tubes that she just opened her eyes wide and said: I have no idea how that happened, and I have to run so I cant deal with it, SHe was fired, went straight to a DON position in a small SNF, where I understand she does no nursing duties and just works her nurses like slaves. So much for her skills.

Talino · Mar 4, 2009

The regulation hasn't changed. Once the 60-day break is attained, the resident is entitled to a new benefit period even for the same tube feeding as long as the criteria is met.

30.2.2 - Principles for Determining Whether a Service is Skilled p21

"If the inherent complexity of a service prescribed for a patient is such that it can be performed safely and/or effectively only by or under the general supervision of skilled nursing or skilled rehabilitation personnel, the service is a skilled service."

Same link above, p26

"30.3 - Direct Skilled Nursing Services to Patients: Enteral feeding that comprises at least 26 percent of daily calorie requirements and provides at least 501 milliliters of fluid per day."

When in doubt, issue the denial notice promptly and encourage the resident to appeal. Meanwhile, set up a 5-day MDS so you won't miss the ARD window in case your decision is overturned.