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Posts tagged ‘Home Health Education’

Test Results


We keep receiving results from the Medicare 101 quiz.  What interests me most isn’t the scores that people in general are receiving.  Individual low scores could be the result of any number of things besides knowledge.  What I find interesting, and occasionally  amusing is the number of questions that a whole lot you answered incorrectly.

Understand that green represents correct answers and pink represents wrong answers.  Here is the result for the question that reads:

Teaching and training is a skill only if the subject matter taught would be considered skilled care by a nurse.

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And yet, isn’t that what we do every day?  We teach and train on medication administration but giving meds is not a skill.  We teach a patient how to eat a nutritious diet altered specifically for individual disease processes.  The real question to consider is whether or not the teaching is required to improve the patient’s condition.

The problem with teaching is that we never seem know when to stop.

Look at question 34.  The question read:

Your patient was admitted 7 weeks ago after being diagnosed with CHF and continues to refuse to adjust his diet resulting in multiple hospitalizations. He is able to verbalize all the components of a sodium restricted diet. As you knock on the door, you see him through the window eating a hotdog and some french fries. What do you do?

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Most of you got it correct but a full 30 percent of you were ready to ditch the patient as soon as you could.  Could it possibly be that compliance with diets and meds might require more than education?  I used to think so but look how my peers answered the next question which read:

Which of the following is a skill?

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So let’s get this straight.  The patient knows all about a low sodium diet and yet you find him eating my two of my three favorite foods (chocolate is the third). And 43 percent of you said that teaching the patient a low sodium diet would continue to be a skill.  He knows the diet.  He is not compliant for a reason.  The reason for non-compliance is where your skill needs to be directed if possible.  It could be that the patient wishes to die and wants to prolong the process because it’s a once in a lifetime event.  Or, it could be that he cannot afford the food or is completely dependent on his son who spends most of his father’s money on crack cocaine for food so he is stuck with hotdogs and fries.  Social workers come in handy in these situations.  Revisit post about teaching versus coaching.  Try something new.  Teaching has already been tried and it apparently didn’t solve the patient’s problem.

The overall scores for the Medicare 101 quiz was 75 percent.  There are a couple of questions that I must have written poorly.  78 percent of you think that verbal orders should be cosigned by the physician prior to billing if at all possible.  There’s no ‘if at all possible’ about it.  Orders MUST be signed prior to billing.  When 78 percent of you think otherwise, I either posted this on the Federal Prison blog or the question is just too confusing.  Forgive me.  I wasn’t trying to trick you.

We are planning a two day conference which just so happens to coincide with the LSU/Alabama football game on January 8 and 9th.  The first day will devoted exclusively to the fundamentals of home health including coverage.  If you feel that you or one or more of your nurses should have scored better, consider joining us.

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.

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