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Posts from the ‘hospice’ Category

Jan 4

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Edging out the Competition

Yesterday I posted about what I thought would be important to home health and hospice industries in 2k11. Today, I am going to focus on staff development because I believe it is critical to all other goals that we may have.

When Toyota makes a car or Apple makes an iPhone, it is almost guaranteed that a newer improved model is already in the making when the latest version is released. Other industries who sell services similarly are always striving to be a step above their competition. The Google of today looks very different from the Google of yesterday and I think it is amazing the way you can find UPS packages online. Depending on your bank, you can scan a check using your telephone and deposit it without leaving your office. Will wonders never cease?

We sell nursing care, though and sadly I do not find the zealous drive to improve our ‘product’ on the top of our priority lists. The nursing shortage has made nearly anyone with a license employable and whether or not skills are developed is left largely up to the individual.

Obviously I am not talking about coding skills and OASIS skills that are crucial to our cash flow. I am talking about basic and advanced nursing skills. We have a right to expect our nurses to be able to check blood pressures and capillary blood sugars and teach about the signs and symptoms of hypoglycemia. But, what about after that? What sets you or your staff above the competition? Does your agency offer the Lexus or the Moped of nursing care? Why should a referral source choose you instead of your competitor? If you are still dependent on sweetheart relationships with physicians, your agency is facing a perilous future. BFF’s are all too shallow when their own outcomes (read: payment) is affected by your nursing care.

A budget for education is crucial. You absolutely have to plan for it, make allowances for nurses’ time and pay for at least some of your staff to attend regional meetings. But without breaking even a modest budget, you can begin adding to the knowledge base of your staff right now (using technology that didn’t exist a few years ago.)

A brief search on YouTube yields an enormous amount of quality information that can be shared during case conference. Even though these lectures are informative on their own, I believe that a staff member should be present to answer (or research) questions. Given as group activity where discussion is welcome staff have the added benefit of learning from each other.

Here is the short list of what I found on YouTube:

  • Dr. Michael Miller discusses heart disease in a two part series in a conversational format with a hostess. This is very good refresher information for the LPN and RN and is appropriate for home health aides as well. Part One; Part Two
  • A short film on recognizing the signs of a heart attack. Suitable for all staff. Remember, it could be you having a heart attack one day and wouldn’t it be nice if the biller recognized that you needed help? Signs and Symptoms of a Heart Attack
  • It has been long established that all patients with a history of heart attacks and most patients with heart disease benefit from beta blockers. What we don’t always recognize is that Beta Blockers are more than just medications to ‘treat high blood pressure’. Here is a short film for nurses to watch on the extensive effects and side effects of beta blockers. Beta Blockers
  • Medication errors, committed by patients or staff are deadly and yet human error can never be eliminated. Here is a great but long (1 hr 23 min) lecture on medication errors. If it isn’t feasible to share with all staff, it should be part of remedial action for any nurse who makes a medication error.
  • Alzheimer’s is a tragic illness for both patients and caregivers. Here is video that focuses on caregivers that will help all patient staff be a little more sensitive to the family members affected by Alzheimer’s disease.

Your patients, your staff and referral sources will thank you for making the effort to improve the quality of care given to your patients. If you need help setting up an educational program, I can be reached by email or by calling 225-253-4876. As always, your comments are appreciated and if you have other YouTube sites you want to share, please help out your colleagues by posting the link.

Oct 19

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Flu Season is Here!

Are you interested in saving a few lives? If your aspirations are less lofty, what about improving your outcomes?

You can accomplish either or both of these objectives by gearing up for flu season if you haven’t already. Since it is officially flu season, the OASIS dataset questions about the flu will no longer be answered as N/A on admission assessments.

Last year, everyone got excited about H1N1 flu. There was good reason to do so but the threat to our patients was less than that of the regular flu. It seems that elderly people had some resistance related to a 1950’s flu epidemic. This year, the flu shot combines protection against the ‘regular’ flu as well as H1N1 eliminating the need for two injections. How easy is that?

Each year between 30,000 and 40,000 deaths occur as the result of the seasonal flu. The overwhelming majority of these deaths occur in the elderly. Our Medicare patients can receive the flu vaccine at no out of pocket cost. If you have patients who have to pay for flu vaccines, be aware that the cost of a flu shot is less than one trip to the drug store to buy Nyquil, Advil, chicken soup, Gatorade, saltines, etc.

So get busy! If your agency does not administer the flu vaccine, encourage your patients to find someone who does. Get a list of providers. It may be as simple as a trip to the local Walgreens. And don’t stop with patients. Encourage family members who reside with your elderly patients to be vaccinated as well.

Me? I think it is cool to be able to offer immunity. It kind of makes me feel like a federal agent.

Sep 7

Job Opportunity

So you think you want a new job? Check out the CMS Recruitment Video.

Sep 6

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60 Minutes takes on Medicare Fraud

How much fraud detection can 200 million buy? I suspect we will find out soon as that is the amount that Obama promised Medicare for Fraud and Abuse detection.

Thanks to Michael McGowan, Medicare Appeals Guru, I got that information from the 60 Minutes segment on Medicare Fraud. Please take a few minutes to view if you missed it on television.

And should you find yourself being scrutinized by Medicare in the near future, remember that Michael or myself can help you in an appeals situation.

Aug 19

4 Comments

Fluff and Stuff

There are many reasons to write a thorough and complete care plan but thorough and complete doesn’t always equate to long. This is especially true where orders are concerned. There exists an overly cautious attitude among some nurses that drives them to include every possible order and intervention that the patient may ever need in this lifetime or the next. The end result is a six page document with crucial information buried between the ‘fluff and stuff’.

Here are some orders I see that make me wonder how they ever hit the care plan.

  1. Draw Lab per MD Orders. Why put that in your orders unless you have orders? If you have orders, simply write them. If you do not, then you will when you get the orders. Who else besides the MD would write lab orders?
  2. Teach Diabetic Care including use of glucometer, diabetic foot care, sick day care, rotation of insulin sites, diabetic diet, importance of Hemoglobin A1C, causes of diabetes, importance of exercise and rest, signs and symptoms of hyper/hypoglycemia to report to MD and SN and to report blood glucose levels greater than 300 or less than 50. That is the abbreviated version. It is my opinion that if we include in orders to teach Diabetes care, a responsible, educated nurse acting according to best practices will include all aspects of diabetic care relevant to the patient during the episode. Notice the reporting parameters are buried at the end of the order, easily missed or difficult to locate. The worst part of this order is that it is a daunting task to perform in a single episode assuming the patient has comorbidities. Our patients are not enrolling in nursing school. It seems to me that the nurse who wrote this order didn’t consider assessment data and limit orders to the patient specific needs.
  3. Weigh patient weekly. Generally speaking, this is a good order for a CHF or renal patient. It only becomes a problem when the patient isn’t seen but once every other week. A better order is to weigh the patient each visit and to teach the patient to weigh self on days between visits.
  4. Report weight gain of 3-5 pounds. Which is it? Three pounds? Five? If I were playing semantics, I could argue that the only weight between three and five pounds is four pounds. But, surveyors do not enjoy word games as much as I do. A better order is to report weight gain of greater than X pounds with X being determined by the original weight of the patient, the stage of heart failure and prior history.
  5. Report weight gain of greater than X pounds. While this is decidedly a better order than one with a range it is still not perfect. Consider my client who called me crying. Like me, she was an old Cardiac Intensive Care nurse. Her patient had strict parameters to call for a weight gain of three or more pounds in one week. Over the course of the episode, the patient put on one or two pounds a week. When the patient was admitted to the hospital, the patient had gained over 15 pounds. By placing the baseline weight on the care plan near the parameters, the nurses have additional information to make decisions. Additionally, a weight chart posted near the patient scale will show trends.

I like clear and concise orders. But truthfully, what I like is really not important. What is important is that our care plans are useful documents for guiding the care of nurses taking care of patients. Even surveyors can’t top that reason for writing clear, concise and individualized care plans.

As always, your comments are welcome below. Any other orders you find useless and can add to my list will help both me and your colleagues.

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