Where do I get guidance?

[ardeasnest]

I am working in a private home as a PDN in Ohio along with another RN and LPN for a wealthy gentleman who is private pay only. Does anyone know where I get guidance regarding rules, regulations, and laws? I feel like I am flying by the seat of my pants. For example, we keep notes, but we don't chart q2 hours like we did at the hospital, especially when he is doing well and all we are providing is ADLs. We also don't chart meds individually or do vitals daily when he is well. We don't have a Nurse Care Plan, etc. We do operate under the guidance of his personal physician, but said physician never signs off on orders we take, etc. Granted such orders are for things like meds and blood draws for which he must write a script. Grateful for any guidance you all may have, especially as it relates to law. Thank you!!

[caliotter3]

When I have worked private duty, I do things the way I would otherwise while at the same time following instructions from the client. I do not contradict sound nursing practice. Of course, everything is directed by the client. You do not need a record unless the client wants one for their own use. If I were to have any reservations about what is expected or asked of me that can not be reconciled, I would simply leave that employment. And as with other nursing employment, I maintain my malpractice insurance.

[SDALPN]

Medicare/medicaid (in my state and most states) require a note every two hours that must reflect the care plan has been followed. You can google the rules/requirements.

[brillohead, ADN, RN]

Medicare/medicaid (in my state and most states) require a note every two hours that must reflect the care plan has been followed. You can google the rules/requirements.

Did you even read the OP's message? This is private pay, no insurance, no Medicare, no Medicaid. Therefore, there really ARE no rules/requirements to be followed, because the only ones dictating care are the patient and his physician.

For me, I would still do some narrative charting listing what I did or didn't do each day -- ADLs, medications given/held, activities in or out of the home, treatments (even something as simple as a bandaid).

If something happens down the road and you end up in court, having a record of your activities might be the only thing that saves your bacon.

[JustBeachyNurse, LPN]

Did you even read the OP's message? This is private pay, no insurance, no Medicare, no Medicaid. Therefore, there really ARE no rules/requirements to be followed, because the only ones dictating care are the patient and his physician.

For me, I would still do some narrative charting listing what I did or didn't do each day -- ADLs, medications given/held, activities in or out of the home, treatments (even something as simple as a bandaid).

If something happens down the road and you end up in court, having a record of your activities might be the only thing that saves your bacon.

If you use a standard to chart like aim for q2h and write like above you should be a bit safer. Carry personal professional malpractice/liability police. Make certain your carrier knows you are working private pay PDN.

I was offered a private pay case. I checked with my carrier. As long as I have an employer /receive a W2 I'm covered for $100/ year. If I take a private pay or contact job (1099 independent contractor) my rate jumps to nearly $800 a year. Not worth it.

[bb007rn]

Apparently OH really has no laws set forth for private pay nursing, all I could find was for Medicaid/Medicare reimbursement. But, I guess to CYA, I personally might apply some of those to this situation. I would chart q2 hours, even is it's just, "patient in no apparent distress, voices no complaints. companionship provided" and SOAP notes at least once a shift and prn. If it wasn't charted it wasn't done, be it private pay or insurance! (I chart EVERYTHING, no matter how inconsequential it seems at the time)

I would use Excel, make a med sheet template for the month, let the patient know you are doing it for his benefit and for ease of his staff and MD. (am sure there are med admin templates free on the Web.

I might talk with patient about getting basic MD orders to the effect of vitals prn, (if there's no medical reason for taking them once a shift, with MD statement to such), but I am an over-organizer,

Drawing up a few simple care plans for him doesn't sound like it would be difficult, if you and he are so inclined. (Technically, I work with my patient without care plans, even though his care is rather extensive, but I am employed by his private company,)

read up on OH nurse practice act: Lawriter - OAC

and here are OHIO codes for private duty nursing, such as they are (it all relates more to medicaid/medicare via agency nursing rather than private pay nursing: Lawriter - OAC - 5160-12-02 Private duty nursing: services, provision requirements, coverage and service specification.

If I were so inclined, i might even call the BON and find out what they recommend/require (just to CYA)

[danarooo, BSN, RN]

I would use your BON regs. You could always contact them and ask that specific question and see if they can point you in the right direction. Also, doctors orders are your guidepost as well. If your patient is private pay, talk to the PCP and ask for a written POC from him/her for you to follow and discuss your concerns w/that PCP. Although the patient is your "employer" you are still beholden to the BON and legally required to have orders to follow to do anything outside your scope of practice as designated by your BON. If your patient doesn't like that then I'd have serious thoughts about staying, because if anyone discourages you in your efforts to provide safe and LEGAL care in your designated duties then they don't care about you or the possibility of your losing your license/going to jail...