Do the Right Thing
This isn’t some super moralizing appeal to your conscience to stop forging signatures or lying about visits you didn’t make. Those kinds of people do not come here for news and information. This is more of an appeal to nurses and clinicians to follow orders.
In the past several weeks, I have read many instances of nurses charting about why they did not do the right thing.
One of the most frequent excuses for a weight that is out of range and the nurse writes in parentheses that she used a different scale. What does that tell you? Here’s what it tells me:
- She does not know what the patient should weigh
- She has no idea if the patient is better or worse than before
- She did NOT follow orders
- She may be costing the agency money by setting her employer up for denials
I read a note last week that state the patient’s blood sugar was 370 but the son had only just now given insulin. There was a note that the patient ate breakfast but no MD notification. I suspect the patient eats breakfast regularly. The question is whether or not the son is always able to give insulin timely. If not, maybe a different kind of insulin would be better for the patient.
I have read may notes where the blood pressure exceeded either the MD parameters or just common safe practices and the nurse charts that the patient hasn’t had their medications yet.
In other words, nurses are spending time explaining away why they did not follow the care plan when they should be notifying the MD. Maybe the blood pressure is extremely high every morning before medication. It certainly is more convenient if the patient strokes out in the morning but that is not a reason to let a patient’s pressure pound against their arterial walls every morning.
In order to get paid you must do the right thing. If you do not communicate with the physician and if the care plan does not change, your patient is no longer eligible for services. Explaining why YOU didn’t follow orders is not a billable skill.
Again, here is the language that I read repeatedly when appealing denials:
The records provided do not support that the skilled nursing services were reasonable and necessary for the treatment of an illness or injury. During the last certification period, there were no exacerbations, injuries or new diagnoses that would require continued skilled services.
Any questions?
Remember, answering to us is a lot more fun than answering to Palmetto or the Zone when you get ADRs. And if you do get ADRs after reading this, I respectfully reserve the right to say, ‘I told you so’.