This group meets in Concord for briefings on clinical topics. Past topics have included: Medicare certification survey requirements, predictive analysis by ACOs, care transition projects and Provider Orders for Life-Sustaining Treatment (POLST). Contact the Home Care Association of New Hampshire for more details.
- Clinical Directors' Affinity Group
February 13, 2020
9:30 am - 11:00 am
Attention: The Clinical Director’s affinity group is not meeting Set. 12. Instead they encourage members to attend the: Episode Management Training with PDGM, offered by Gina Mazza on September 26 in Concord. Registration will be available at: https://homecarenh.org/wp-content/uploads/events/episode-management-training/. The next regular Clinical Director’s meeting is: (more…)
- Agenda 4-8-2015
- Discharge Medication Form
- CHF Hospitalization Audit Tool
- Emergency Call Sheet
- Face to Face Encounter Slide Show
- Quality Assurance Incident/Unusual Occurrence Report
- Adverse Events: Falls/Accidents Audit Form
- Face to Face Encounter Implementation Checklist
- Quality Assurance Incident/Unusual Occurrent Report Instructions
- Otago Tools to Implement
- Otago Tools to Implement
- CHF Hospitalization Audit Tool
Members Helping Members
QUESTION #1: What do other agencies do when they have a client that uses more supplies than the average client, for example ostomy supplies, 15-20 flanges and bags in a month.
1. We focus highly on education and sending patient as needed to a wound clinic/ostomy nurse outpatient to help. We also engage the ostomy companies as we can to provide “sample” packages, training on line or in person, etc. Involving the family is also very important
2. If this is a new colostomy and we find that they are using too many supplies we would do some more teaching from the agency or to the ostomy nurse to see if it is perhaps a sizing issue but and try to correct the issues but until we can come up with a resolution I believe that we are responsible under Medicare to provide what is needed
3. Our certified wound/ostomy nurse works with patients and their caregivers, as well as the clinical field staff and physicians, to resolve overutilization problems. The goal is for the certified ostomy expert to teach patients and clinical caregivers how to identify the factors leading to overutilization of supplies, such as leaking appliances, peristoma skin breakdown, etc. The wound nurse will also work with clinical staff and physicians to transition patients to alternative wound care frequencies, such as every 3-5 days using the appropriate dressing, rather than daily or every other day. Once problems are identified, we facilitate solutions by making physician approved changes to the care plan. Changes in types and frequency of dressings, types and brands of appliances or supportive products, and application techniques can frequently be improved to help control utilization of supplies. We also have some controls in place with our drop-ship supplier. Off formulary orders, as well as high invoice amounts, trigger holds that require manager approval. In the case of specialty wound care products, orders are placed on hold when the dressing count exceeds the maximum (for example, clinicians are allowed to order seven pieces of Mepilex, but orders of more than seven are held for manager approval.) These controls have assisted our agency to correct over-utilization problems in many cases.
4. If it’s medically necessary for the patient we supply what is needed (within reason). I have had patients that want certain ostomy supplies that they have used and I try to accommodate that if we can. The complex wounds, and daily care I have monitored and reviewed by our WCC or ostomy certified nurse. We evaluate that what is ordered is appropriate for the patient’s specific need. Our WCC will call the MD office/wound center if we feel a product is inappropriate or if a different product would be better.
5. The first question is a tough one since ostomy supplies are bundled payments under Medicare, yet you can get those occasional patients who go through a lot of supplies. What we have done is to try to control it as much as possible and work with the patient on improving the issues causing them to go through so many supplies, such a better fitting products and work with our WOCN nurse for suggested improvements. For private insurance patients, we have had to make the case and document the issues to request more supplies. Sometimes it works and sometimes is doesn’t.
6. If a patient is using more ostomy supplies or wound supplies than usual, the WOCN or the WCC goes out to see what the alternative choice would be. I have found that overage of supplies is generally because what is being used is not appropriate. Also in some cases we need to call the Doc and recommend alternate wound care.
QUESTION #2: Does any agency have WCC certified LPNs? If so, how does the LPN job description differ from the RN job description? In addition, does your agency allow for LPN’s to do the initial wound consult visits?
1. As to a wound certified LPN, we do not employee one here.
2. We only have RN certified WCC nurses and the RN always does the initial consult and then an LPN may be able to assist the RN with the wound care throughout the cert period.
3. No certified Wound Care LPNs.
4. I do not have LPN’S wound certified, I have had RN’s PT’s and OT’s certified. I appreciate the LPN’s role and they can be a member of the wound team.
5. I have never used an LPN that was certified on wound care. I would not think however that they would be able to do the initial consult visits for the same reasons the COP’s do not allow LPN’s to do Admission visits that is related to their scope of practice for assessments, but I would be interesting to know how those agencies that have used LPN’s do this.
6. Do not have any LPN WCCs.