1wk9

[twokidsmom,rn]

In my new company MANY patients are 1wk9 to monitor C/P status. In my old company we always had to see our pts 2xwk unless we were going to discharge soon. Do other companies have many pts with 1wk9 and stay on service for a very long time? As a case manager is this an OK practice?

[HealthyNurse]

I would agree that "1w9" is not an acceptable frequency for the majority of home health patients. Current best practice is to frontload visits, so that the patient is seen more frequently at the beginning of the episode and then the visit frequency is tapered as the patient becomes more independent in their care and self management. If a patient is only receiving a visit once a week, I question how much skilled care they truly need and how much information can they gain and retain from that one visit.

As far as seeing patients on your own time and/or not charging the agency, KateRN gives good advice. Besides the Stark law implications, you have to consider the liability issues as well. I've personally seen a very unfortunate thing happen to a nurse who felt she was doing the patient a favor by seeing the patient on her day off, so an on-call nurse did not have to see the patient. During the visit, the nurse made an error that ended up leading to a sentinel event. Although it wasn't necessarily all her fault that the error occured, the nurse ended up being fired and having to deal with BON disciplinary issues because of it. Follow your agency's policies and make sure you purchase Liability Insurance.

[mommy1975]

I was also under the impression that you always had to have an order to be in the home, so if the frequency changes because one decides an extra visit is needed, one must write an order that addresses why and discuss with CM & Physician.