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.
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?
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?
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.