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Discussion

What about these?

I started my new job today and have a couple of questions I'd like to bounce off ya'll, see what the opinions are.

1. Med sheets in the patient's home. I've always been told that the med sheets in the pt's home are for the pt's reference and therefore need to be completed in plain English, rather than nurse-speak. "Coreg 12.5 mg one tablet 2x daily by mouth for blood pressure" rather than "Coreg 12.5 mg i tab PO BID for CHF." This new agency is using nurse-speak and I don't think it's a good practice but can't find any specific rules addressing it. I've been told many times in the past at several different agencies that this can be a "ding." What say you all?

2. Notice of Medicare Provider Non-Coverage (also known as Expedited Discharge Notice). This is the form that must be given to pts at least 2 days prior to discharge, but this agency is having nurses complete it at SOC with the end of the cert period listed. I can't find anything that states how long before the anticipated discharge the form can be given, but this seems to fly in the face of the spirit of the law, rather than the letter. Comments?

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    • Featured Replies

    the notice of discharge for medicare patients, needs to be given anywhere from 2 - 14 days before the discharge,,,,,i have heard of agencies having the patient sign it at soc so that it is not forgotten at discharge (don't think you are actually suppose to do this) but not with the end of the cert date,,,how do they know the patient won't be recerted.?

    the med sheet,,,,i will usually write the one for the record and if the patient needs a simpler one in the home i will write more of a chart for them and also leave a copy of the one i have for the chart.

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    • Author

    Thanks for the quick response, berube. Do you know where in the regs I can find the 2-14 days rule? I looked today, but could only find the 2-day minimum, no maximum time before the anticipated discharge date.

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    • Expert

    My agencies have started putting plain English on the med sheets since the emphasis on the prohibited abbreviations list since about 2004 or so. It has nothing to do with the patient families, because the med sheets are for the use of the nurses and the nurses only. I don't know how many times I've had to politely tell the family members to keep their paws off the med sheets, as well as other parts of the field chart.

    Sorry but I can't speak to the other matter.

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    • Expert

    my employer also gives notice of non-coverage at start of care and amends date if discharging sooner.; new one generated with recert.

    see home health advance beneficiary notice (hhabn)

    what the surveyors are looking for:

    http://www.cms.hhs.gov/guidanceforla...07ap_b_hha.pdf

    nothing specific in the regs regarding how medication list documented --do have regs on drug medication review, reporting drug interactions and plan of care development.

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    • Author

    Thanks, ladies. Karen, that second link on the meds is broken.

    In the case of intermittent home health visits under Medicare, the med list is for the patient to review, as it is used for teaching and has major side effects listed for med. I'm fairly certain that we are required to have a med list in the home from SOC throughout episode, at leas that's what I've always been taught.

    It's funny, how all the things I've been taught, now I'm finding it hard to find rules, regs, and COPS to back it all up. I'm wondering how much of Medicare HHC is really mandated and how much of it is a herd of sacred cows. It's driving me crazy and I can't seem to find a really good resource for cold, hard facts.

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    • Expert

    In most agencies we use both a med sheet, commonly called the MAR, and the list of meds, commonly called the medication profile. What you described in your second post was the medication profile. While it can be referred to by the family, they are still not the individual who writes on, or makes changes to the form.

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    • Author

    With Medicare home health, the nurse is not administering meds routinely (with the exception of IV antibiotics), so no need for a MAR. Yes, it's the medication profile, which it's my understanding must be kept up to date, in the home, in plain English, for the patient's reference. The patient doesn't make changes to it, but it is there as a reminder for the pt for what meds are being taken and when and how.

    I've gone through the auditing regs (ASPEN) and can't find anything specific to the med list. I'm wondering if it falls in that catch-all of "pt must be involved in development of POC" and if the pt cannot understand the lingo, it prevents pt involvement?

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