Wound Care Education
October 12, 2009
As we work through the new OASIS-C Guidance, it is becoming more evident that if an agency had to choose one thing to improve their financial and clinical status in the coming year, it would be to improve the overall wound skills in their agency.
With time being short and budgets being strapped with training and holidays on the horizon, we took some time this time this morning and researched available online information. The first four links will take you to education that you can complete online or to a vendor who will come to your office at no charge to provide education. The last link is something we found on the internet this morning. It has numerous articles that guide nurses through the assessment and documentation of wounds. I even managed to snag some CEUs this morning!
http://www.globalwoundacademy.com/
http://www.molnlycke.com/com/Services/Education-and-consulting-services/
http://www.hill-rom.com/usa/proedu_InService.htm
http://www.hollisterwoundcare.com/connect-ed/
http://www.thewoundinstitute.com/
Most of you already know that the full OASIS-C manual was released today. A link will be posted on our website this afternoon. Training will be offered at our office on Nov 12 and 19 and we are happy to make arrangements to visit your office for onsite training.
As always, if you have any questions, ideas or comments, please feel free to email us at haydelconsulting@bellsouth.com or call us.
How to Drive a Consultant Crazy
October 6, 2009
If you want to drive a consultant crazy, be inconsistent in your wound care documentation. Document conflicting sizes, wounds that mysteriously migrate from the left buttock to the right and stage wounds according to stage of the moon as opposed to the degree of tissue involvement. That will do it. I promise.
But it seems that there are going to be even more reasons to improve your assessment and documentation of wounds even if you don’t care about the mental health of your consultant. The OASIS-C Integumentary Status is far more specific than the dataset we are currently using. It goes so far as to require actual measurements of all things. It also investigates wounds that develop while the patient is under your care and could conceivably hold you accountable. Epithelialization of wounds will be a key factor. Do all of your nurses recognize granulation and epithelization? Are they able to chart it accordingly?
Without these skills, your OASIS data will be useless at best and at worst, your outcomes will make you stand out like a pariah in the regulatory and referral worlds.
Wound assessment and documentation is an investment all home health care agencies should make now. We do not offer classes on Wound Care but there are many available. A good place to start is with your wound care supply vendor. Often companies who sell wound care products offer inservices to their clients at no cost. The WOCN might be a place to look for wound care classes. If you know of any really good sources, please write about them in the comments section so that everyone can be aware.
All nurses should be taught how to assess and document wound status. Registered Nurses should be taught the intricacies of staging and how to determine the level of healing. Don’t bother wait. This is something you can do now!
OASIS-C training will be held at our Education on November 12 and 19. Please contact us for more information or for questions about this or any blog post at haydelconsultingservices@bellsouth.net.
Beneficiary Elected Transfers
October 5, 2009
Most agencies at one time or another admit a patient to the hospital only to find out that the patient has been discharged post hospital to the care of another agency. There are even reports of agencies actively soliciting patients in the home environment and ‘stealing’ them from other agencies. Obviously, there are legal avenues to pursue. Hospitals must notify patients of all agencies in the area who have requested to be put on the hospital’s list of discharging. Actively soliciting patients is unethical and in many cases, against state and federal regulations. Agencies should file complaints with the appropriate regulatory bodies and seek legal counsel but the question is often, “What do we do now?”
And the answer, quite frankly, is nothing.
In order to receive a patient from another agency, three things must occur and be documented. You will find these outlined in the Medicare Benefit Manual – a publication not frequently referenced by agencies who ‘steal’ patients. There are as follows:
- The receiving agency must contact the prior agency to let them know of a beneficiary elected transfer.
- The receiving agency must inform the patient that the prior agency will no longer be responsible for any care or supplies and will not receive further Medicare payment.
- The receiving agency must document that it accessed the RHHI inquiry system to determine if a patient was under the care of another agency.
In the event of a dispute, the RHHI will look for this supporting information. It must be present in order for the receiving agency to be paid. In the event of a dispute, the initial agency must call their RHHI who is responsible for working with both parties.
It is not our job to educate these unethical agencies. Therefore, my suggestion is to do nothing. Do not discharge the patient prematurely and receive a Partial Episode Payment unless you are quite certain that the beneficiary ‘elected’ this transfer. In the case that your patient truly did want to change agencies, it is important to cooperate. In any other case, do not make it easier for the receiving agency to violate patient rights of choice. Do not share this information with the patient thieving agency. An agency that ‘steals’ patients may also be willing to manufacture documentation!
If you have questions, please email us at haydelconsulting@bellsouth.net. As always, we welcome your comments and questions.
