Posts tagged ‘care plans’

Oct 19

14 Comments

Medication Competency

Vicodin

Zocor

Lisinopril

Synthroid

Norvasc

Prilocec

Zithromax

Amoxicillin

Metformin

Hydrochlorothiazide

Xanax

Lipitor

Furosemide

Metoprolol

Ambien

This list of the top 15 drugs prescribed in the United States thus far in 2011. The good news is that they are all generics meaning they are available at a lower cost. The bad news is that because they have become so common, we forget that these are major pharmaceuticals that can cause major problems.

If you’ve been paying attention, you will realize that the key to doing well in 2012 is directly related to your ability to keep patients out of the hospital. In reviewing hospitalizations and Reason for Transfer OASIS assessments, I would bet the farm that medication errors are a direct or indirect cause of a lot more hospitalizations than are reported.

When I read charts, I also see very vague medication teaching. In reviewing clinical records it is not unusual to see ‘teaching’ such as:

Taught patient to take meds exactly as MD ordered.
Call MD for any side effects.
Take insulin at the same time each day.
This medicine helps to lower your cholesterol

I understand that patients have different learning abilities and that sometimes the best we can do is teach the patient the bare minimum. But whether we teach a lot or a little about medications, it isn’t working.

The first step in providing really effective teaching about medications is to know your medications.

To see how well you or your staff know your meds, click here to take a basic medication competency test. Until you are able to answer the questions with complete confidence, keep researching.

Of course, not every can know every medicine but there are tools that can be used. My favorite for when I work offsite is the Medscape app (available for iPhone, Droid and Blackberry) which has two options for download. One is a smaller download and the larger download includes the entire database for use offline. Using the larger download option, nurses are able to look up drugs and interactions on their phone even when the internet isn’t available. It is amazing the things I find when I use it. The downside of the app is that it does provide every possible drug interaction in the world. I try to focus on the most serious interactions and read through the remainders to see if they apply to a particular patient.

By really looking at meds and planning teaching as you write a careplan, you can gather all sorts of appropriate teaching materials for the patient. Medications are also my favorite hunting ground to see if any diagnoses have been missed.

Let me know what you think about the competency test and how you scored. If you have any other questions to add, please feel free to email them to me or to post below. Heaven forbid I made an error in the test. If that’s the case, please post below.

Nov 17

3 Comments

Home Health Physical Therapy

Update: The Louisiana DHH clarified on Friday afternoon that even though they expect orders and goals to be included on the care plan, it is recognized that this is not always possible. In these instances, a separate verbal order containing all of the physical therapy goals and orders is satisfactory. We apologize for any confusion. Please feel free to comment below or email us at haydelconsulting@bellsouth.net if you have any questions.

It is common for agencies to order a Physical Therapy evaluation on home health admission and wait until the paperwork has been submitted to the office to write orders for frequency, treatment modalities and goals. These orders have traditionally been sent to the physician as a separate verbal order. Well, most of the time:)

During a recent client survey, a state surveyor informed us that CMS now expects the orders for frequency, modalities and goals to be on the 485. Because this was contrary to the advice we have traditionally offered to our clients, we called the Louisiana Department of Health and Hospitals. Louisiana DHH also informed us that CMS expected all orders and goals for physical therapy to be included on the 485 and failure to do so will appear as thought the agency simply didn’t complete the care plan.

So there you have it. Managing Physical Therapy has always been a challenge in Home Health. We would like to hear your views on these changes. Is this how your agency already does therapy? Will changing to this process improve or impede coordination of care in your agency? Or is this change so insignificant that it can be integrated into your current process without much trouble.

To leave a comment, click on the link below. To resond privately, email us at Haydelconsulting@bellsouth.net