Home Health Hangout

Handhelds vs Handwriting

2006-03-10T18:07:00.000-08:00

Our company is field testing handhelds for charting. I understand our goal is a paperless chart. I would be very interested in hearing the good, bad, and ugly from those of you that are already out there doing this. How do you handle the computer "illiterates"? Does it improve the goal of charting in the home, or do those same clinicians still end up charting late at night and on the weekend? I have never understood how you can accurately chart what you did 5-7 days after you did it. My goal has always been not to leave the driveway until your note is completed.
Do handhelds improve a clinician's ability to accurately complete a discharge Oasis because they have the ability to see what the Admission Oasis looks like? Also, when a different person is doing that d/c, doesn't having the ability to look at the Admission Oasis help to make the info more accurate?
I am assuming that with handhelds, the clinician would be able to view any of the patient information from the home. Are you able to see previous nurses notes, etc?
I, for one, really look forward to the day when we are up and running! I can imagine that getting it all in place and training all the clinicians can be a challenge, but the advantages must be awesome!
Let me hear your experiences......

Coding

2005-08-01T19:21:00.000-07:00

Coding is the bane of my existence. So much depends on how accurately a patient is coded. I know that home health is not the only one that is affected by this, but it sure seems like we spend an inordinate amount of time figuring out what the actual ICD9 code is and if there's a V code now to go with it. I would love to know the secrets ( I know, I know there really AREN'T any secrets), but it sometimes seems like I am having a scavenger hunt when I start looking for a code. Actually, I'm pretty good at it, just frustrated.
And what's with the Oasis question about where the patient was discharged from-hospital, rehab, etc...Mark all that apply. How many of you think the patient knows what they're talking about and trust them, only to get a down code from Medicare later, because the patient was in BOTH hospital and rehab during that last 14 days?
I just don't think we realized how good we had it about 10 years ago when Home Health was so simple. Patients were on service forever, we took care of ALL their needs (made their MD appts, ordered their meds). I guess we kind of took them on to raise! And they liked it too! A lot of these people don't really Want to be independent. They like it just fine if the home health nurse will take care of everything! Oh well, that's progress. This is supposed to fix it so that when I get ready to use my medicare (that's not as far off as it seems), it will still be there.
Now that we have PPS about figured out, it's on to PAY FOR PERFORMANCE! Brace yourselves....

Digital Charting

2005-07-25T19:20:00.000-07:00

There are so many companies out there providing electronic/digital charting that it's difficult to tell what method is the best to use. Our company does not currently use electronic charting, however, it has long been discussed and piloted. When it comes right down to it, we just haven't made the huge risk/investment/leap of faith.
Personally, I look forward to the day when we actually go "paperless". I love computers and how smart they can make you. BUT, I can see our good ole boy therapist, and a couple of our nurses that don't know how to check their email having a bit of difficulty. The great thing is that everyone in our office will be willing to try it. I know that sometimes there is a lot of resistance to new things, especially to something as totally different as this will be.
What do you guys see out there in your own practices? Are you doing electronic charting? Whether it's home health or hospital or nursing home. I'm curious to see how it's working and what you think. Do you still have problems with uploading data like happened in earlier years, or has that been solved. How about clinicians that don't type, has that been an issue?
Hmmmm.......

ADN vs BSN

2005-07-21T20:06:00.000-07:00

What's the big deal about the BSN? I know, I know, if I had a BSN I probably wouldn't even be asking this question... So, you rock along 10 years or so with a great job, using your ADN and decide, well, maybe I'll just peek out and see what's available in the Nursing Job Market. Now every (well, ALMOST every) job I look at wants a BSN. Now, I'm doing a fine job with my ADN and have lots of good experience, but not that 'ole BSN. So now at ALMOST 50 years of age I guess I'm goin' back to school.
But seriously, can anyone tell me why most of the management jobs now require the BSN? Think I'll just go right on and get the MSN at the same time. That'll solve that problem!

Money & Health Care

2005-07-15T19:08:00.000-07:00

Do you ever wonder what happens to people who can't afford health care? We had a referral this week for a patient needing Lovenox injections for a week or so. Patient is normally on Coumadin for a clotting disorder, but is having surgery and of course can't be on Coumadin. Now this patient actually HAS insurance, and prescription coverage. However, the prescription coverage won't pay for the Lovenox. Don't know if you have checked, but that's a pretty expensive drug. The patient can't afford it. I would love to know how they manage this patient's care. Don't shoot me, but it's times like these that I really wonder about a National Health Plan.
I have a friend who recently acquired a serious head injury. She had no medical coverage, spent 2 weeks in the ICU and was given 2 hours notice before they sent her home-directly from the ICU. She has severe headaches from the head injury, a very large clot in her brain (still!) and a shattered leg with several plates in it. If she had insurance, she probably would have had some home health orders. I wonder how she'll afford all her medicine, doctor's follow ups and probably repeat CT scans.
Heck, I even HAVE good medical coverage. And the deductibles, copays and out of pockets just about eat my lunch. We're pretty healthy around my house. Just imagine if one of us had a serious medical problem.
Well, enough gloom and doom. One of my nurses has a new grandbaby born on my birthday yesterday. Life goes on.....

Tourists!

2005-07-02T22:20:00.000-07:00

OK, I know this has absolutely nothing to do with medicine, much less home health, but I gotta tell you, there's nothing like a couple of idiots to give tourists a bad name. I live in a beautiful, fairly small town. Most of the year it's just right, and I am SO glad we live here. But when summer rolls around, I just want to live somewhere else...
Picture this: you're driving down the road and just in front of you is a truck with two guys being thrown around in the back of it. You start to slow, so if one of them falls out you won't run over them. About that time, one of the boys stands up, pulls down his pants and moons the surrounding, congested traffic. As we continue to travel the mile long stretch of road, this future rocket scientist continues to stand up in the back of the truck and moon the audience that didn't get a look the first time. I bet his momma is sure proud of him!
During the summertime, the roads in this peaceful little town are like driving through Houston at 5:00. We have found some really interesting routes to evade the tourist traffic. As for eating out, well you might just as well forget it! Oh well, enuf gritching....

Foley Catheters-Help!

2005-06-25T20:59:00.000-07:00

I've had my third call in two days from a patient that is having problems with her foley. A MS patient who, about every 2 weeks or less, has to have her foley changed because it either a)won't drain or b)is leaking around it. They are supposed to be irrigating it every day-and say they are. I've had 90 year old women who wouldn't drink ANY water who did better with their foleys than this. Unfortunately this lady is pretty much chairbound, so it can be a real problem when she's leaking.
I would really love to hear any ideas that are around out there.

That's why we do this!

2005-06-23T19:25:00.000-07:00

As I mentioned in my previous entry, Home Health is truly the most rewarding nursing that I have found. Today is a superb example. About 5 pm today my office got a call from a local physician office. The caller wanted to know if we had a nurse named Angie working there. Well, as the story goes, a gentleman went to his doctor's office today to talk to him about his wife. She is too weak and ill to be taken to the MD office. When the doctor wanted to order home health through another agency, this man said "No, we want Angie". Of course it's been 6-7 years since I had seen this man's wife and he couldn't remember the name of our agency (the name has changed anyway!). Anyway, with a little work, the doctor's nurse found my office. It's so rewarding to find that you made such a difference so many years ago, that someone would specifically ask for you all this time later. But you know, it happens all the time. Not just to me all the time, but we have such awesome people that work with us, our patients and families remember our names. I can't tell you how many times someone has called my office asking if "this is where Wade works?". Now Wade is an almost 50 year old, good ole boy, with a receeding hairline who just happens to be one of the absolute best PT's I've ever seen. Little old ladies don their brightest red lipstick and fouf up their hair when he's due, and the little old men LOVE to talk sports and hunting with him. Most of all, they know he truly cares about them. I could go on and on...
Anyway, today's little reminder brings into sharp focus why I do what I do. Not that I get to see these wonderful people much anymore. My job as a Clinical Manager consists mostly of bird dogging the paperwork. But I DO get to hear about them regularly, and try to support the wonderful clinicians that see them for me!

Newbie

2005-06-22T19:40:00.000-07:00

Well, this is my first attempt at something my husband spends hours per day on. Kinda makes a girl feel left out, so I figured "can't beat 'em, join 'em"!!!
A little about me: I am a second career Nurse. I mean, that Nursing is my second career. It's a great field, one that has a little something for everyone. Kinda made for people with short attention spans. If you get tired of being an L&D nurse, well, just move right on to Home Health Nursing. It's what I did, and was a great move.
As I have meandered around some of the medical blogs that are out there today, I find that my chosen field is, for the most part, not nearly as exciting as others. Home Health is, however, one of the most rewarding things you can do every single day. There is just no substitute for truly knowing your patients. This can only come with spending a few hours with them whist completing an Oasis assessment consisting of about 15 pages. Most of these patients are over 65, so when you ask them if they have any significant health history, you might as well get a cup of coffee and put your feet up. These same sweet people plan their whole day around when the nurse, the therapist or the "bathing girl" is coming.
In some homes, I have been made to feel like one of the family. Back in the old Medicare days, when seems like you took your patients to raise, I had a patient that I saw 2 times a day for a very long time. This family would send me home with homemade Mexican food, vegetables from their garden, and all the grandchildren knew my name and wanted to watch when I came to see their Abuelo. When he died, it was like one of my own family had died.
Home Health allows you to be creative. No, not artsy. Like learning how to stand on your head to dress an obese person's cellulitis to her lower legs. You can't run down the hall and ask one of your nurse buds to come hold her leg up so you can see under it. Or what you're going to hang that IV bag from (seems like pharmacies no longer know what a pole is). You wouldn't believe all the things I've hung bags from. How about creating a way for that 80 year old to put his TEDS on when he can't bend over, lives alone, and has severe arthritis in his hands. I'm not artsy, but I've sure learned to be crafty.
Well, I guess this is my introduction. I'd love to hear from other Home Health people or anyone with thoughts on nursing in general. It's been good to me and I am always interested to hear another perspective.