Perfecting Home Health Documentation
Documentation That Stands Alone
Starting a new job; even if it is in the same field; is always difficult. The people in the office will test the newcomer. The field staff will see what they can get away with, the boss will see how much pressure you can take before you run screaming for the hills.
The thing that is constant about home health is the astronomical amount of paperwork that is required in order to pass muster for the government.
As it is, every home health agency worth its salt must be Medicare certified; regardless of how many HMO or different insurances they accept, they all must abide by Medicare rules and regulations.
This means that even though you (hope) know that nothing but Medicare charts will be audited by the government you must treat every patient as if they are just plain Medicare. The reason for this is clear.
Medicare has the most stringent rules and regulations about the care you deliver and the documentation you submit to support the justification of that care, The moment you let your staff become complacent about their documentation that is when you better be looking over your shoulder, because the auditor or the surveyor or the consultants will be on their way to your office!
The longer you let the sloppy documentation go on, the harder it will be to get the field nurses back into the habit of charting what they are actually doing and saying. The longer you allow cookie cutter documentation to go on the more assured you can be that your nurses are going into patients homes, shaking their patients hands, asking how their children are and walking back out again!
Because, due to the fact that most home health agencies pay by the visit instead of by the hour, most home health nurses want to do as many patients as possible in as small a radius as possible in order to make the most money as possible. It is these types of nurses that give home health a bad name. It is these types of agencies that want as many visits per month, therefore as much money as possible that causes the bad reputation of home health agencies across the board. Just as it was in the 1980 and 1990's, with the home health agencies being paid by the visit, they made millions by seeing the same patients for decades, pre-filling med boxes and syringes and now, with PPS, they are still finding ways to make the most money in as short amount of time as possible!
And it is still nurses, old ones, like myself, who feel nursing is a craft, that believes the more we learn the more we will be able to give our patients, that the better we document the better our skills will become, that the more skills we learn the more we will be able to teach our patients; that the more our patients learn, the less likely they are to end up back in the hospital!
Whew! Long run on sentence eh?
All of this to lead you up to the fact that I, mean ole nurse, am a clinical supervisor and I have been told to gently roll over the nurses documentation and to gently lead them into the correct way back to the light.
Today, the darkness fell on this clinical supervisor.
In very loud, dramatic, in the open way of nurses this nurse had another nurse adamantly refuse to follow the instructions that had been put onto their notes. This nurse even spoon-fed the correct information to write on the nurse note!
The nurse said loudly and on the way out of the door "I won’t do it and you better back off because I won’t do that and if you put any more notes back into my box I will kill you!"
The fact that the nurse is very dramatic and flamboyant aside, I knew it was not a heartfelt threat. Still, I checked to be sure all my tires were intact before I drove home!
Moreover, if I turn up murdered all of you are witnesses of course lol
The most discouraging thing is this nurse is not the only nurse who documents in this manner. The nurse notes are all alike...their favorite blurb as far as instructions go is "instructed on diet, nutrition, sign of infection and CP distress." What does that mean EXACTLY?
If it isn't written...
That means that anyone, nurse or not, that feels they are superior, that they do not need instruction or are unwilling to raise the bar on themselves and to hone their craft to the ninth degree is stagnant.
In addition, stagnant means they are stuck. They are not going anywhere. They will never excel more than they already are. They will not become better at what they do. They are in it for exactly what they getting today.
They are in it for the money.
They are not in it for the patient nor their nursing profession
The saddest part was another nurse, my peer, and my equal; felt it was her right, her duty in fact, in front of everyone in the office to loudly say that the things that nurses write on their notes are "assumed" and perfectly acceptable. That she had seen my power point I gave to our supervisor and really it was what nurses learned in nursing 101 and the nurses did not need to be that specific on their nursing notes.
That what is written are assumed to be what we learn in nursing school is not only ludicrous but a lawsuit waiting to happen. That what you write is not all that you do and everyone needs to get over it is a blatant statement that nurses are above their own creed. That whatever we write is good and perfect and that anyone who differs to agree is a troublemaker is a perfect example of what I have been saying since 2006.
The nursing profession today does not want to be instructed, they do not want to learn, they want to get in and get out with as little effort and as little documentation as possible and god help the nurse who thinks she or he can change it!
The most important part of all of this comes from my David.
Any Nurse who feels they are superior, that their nursing skills and notes are perfect; are therefore stagnant.
And anyone who is stagnant will never learn.
Do NOT waste your time or your notes on them. Just document that you made the effort to assist them in perfecting their craft of nursing and move on to someone who is more worth your time and effort.
Thank you my David. I love you so much.