Visit Pattern Frequency

I work for a home care agency as an LVN. I code the recerts and QA the charts, and make corrections for the nurses.

Regarding the frequency, missed visits, and reporting to MD.

If a frequency is given 1wk5, visit are 1 visit per week for 5 weeks. If you are unable to do a visit for whatever reason, patient cancelled let's say, you have to write a missed visit report for that week and yes ideally you have to report to MD (our missed visit reports have check box if notified to MD). I prefer to use a MD order/Communication note together that way MD is notified via the order and signed - I don't feel that it is necessary to notify the MD verbally on a missed unless it's something that needed to be done specifically like a lab, injection, or IV. You do have to write an MD order IF you decide to extend the frequency. In this case, since you missed a visit, you probably plan to go an extra week to make up the visit, MD order would be to continue 1wk4 starting week of so and so. If you decide not to make up the visit, no need to write an MD order, a simple missed report should be sufficient, but remember to document well why the visit was missed, because if the patient goes to the hospital that week when a SN visit was scheduled, you don't want any questions to be raised. That's why they want the MD to be notified.

Our daily patterns end Saturday, since Sunday is the start of the week. If freq is daily x 4days and visits start Thursday, freq can be written qd x 3days (thurs/fri/sat), 1wk1 (sun/start of new week).

My employer has ben asking for corrections to the medical record in the form of verbal orders to the physician. for example, they asked me to correct visit pattern frequencies after the original orders and 485 have already been returned. I was always told in my experience that once the task is completed you cannot write correction orders, even if it puts you out of compliance. if your out of compliance you are out of compliance. i am really uncomfortable with this process.

in addition, with regards to visit patterns that go from daily to weekly, if the daily pattern ends say friday , then the weekly pattern starts the following week, they are telling me it cant be written, lets say 1d2, 3w8, because the 3 time a week will start on a saturday. are they right? I can't understand why this matters.

any feedback

Why can't you write correction orders? You have to document that you notified the MD that you missed visits, do you not? We do this by sending an interim order to the MD.

Say you admit a patient and you think you are going to see him 1-2x/week. Well something changes and now you only need to see him every other week. Would you not d/c the 1-2x/week order at that time and put in a new order for 2-3x/month? Or you go to see a patient for your scheduled weekly Wednesday visit and he doesn't answer the door. Nor does he call you back to reschedule the visit. What do you do then?

If I was going to see a patient daily x 2 days then 3x/week x 8 weeks and SOC was on a Thursday, I would just put the order in for 2-3x/week for the entire cert period. Then you're good for the 2 visits you provided the first week and the 3 you will provide for every subsequent week. I'd probably even make the orders 1-3x/week so I didn't have to be entering missed visit orders every week when my patients inevitably do not call me back or are not home.

Since the week ends on a Saturday, if your agency considers the week Sun-Sat, you would be out of compliance in the week where you entered visits 3x/week starting on Saturday because you did not provide 3 visits on Saturday. It's stupid because you will provide 3 visits by the following Friday which is the week since the order started but I know that's how my agency views it.

we normally use "qd x "x" amount of days if there is a need for consecutive visits - daily injections x 4 days, or daily IV x 4 days

Front load your visits then decrease as necessary. There is nothing wrong with decrease SN frequency to.....effective week of....., pt responding to treatment. May need to HABN, that's up to your agency.