Dear Nurses, I’d like to take this opportunity to introduce myself. My name is Britney Brazell. I’m your new Director of Nursing here at Advocate Pediatric Home Care. I’m also the Case Manager for several of our homes. I am available by phone, in person, or via email any time for any questions/concerns you may have. I quickly want to touch base with everyone in the field on a couple of “housekeeping” issues that has recently come up during a Quality Assurance/Performance Improvement review. 1) It is very important that all nurse’s notes are completed fully and accurately prior to the end of your shift. We ask that you write your time in and time out to the nearest 15 minute increment and it is imperative that this be honest and accurate. We use these times to bill Insurance and Medicaid for services provided. Inaccurately documenting your time is considered Insurance and Medicaid fraud. This is a federal crime and we are required by law to report fraud to the Office of the Attorney General.
2) Nurses notes are legal documents and require ERRORS to be documented a specific way. When you need to change your documentation, you draw a single line through the error, initial and date. DO NOT completely black out the error, draw multiple lines through it, scribble it out, etc. This implies to the QA nurse, and subsequently, to the state inspector that you have something to hide.
3) Patient’s schedules are created based on Physician orders and subsequent approval from the Insurance company and/or Medicaid. We cannot legally care for a patient without an order stating, for example, “PDN 184 hrs per week”. If for any reason, we work past the ordered number of hours, in this case 84 hrs, we are required to get another order from the physician otherwise we have just cared for a patient without orders to do so and are subsequently working outside of our scope of practice. In addition, we can only bill insurance for 84 hrs, regardless of any orders received from the physician. For this reason, it is imperative that if your are required to work past your scheduled shift for ANY reason, we you must notify the office immediately so we can make schedule changes as needed and/or secure an order to remain in compliance with state regulations.
4) Last but not least, per Medicaid guidelines, a single nurse cannot work more than 16 hrs per shift. Since Medicaid is our primary reimbursement source we must adhere to this guideline. We understand that situations often arise which prevent a nurse from ending her shift at her previously scheduled end time, such as a prolonged MD or ER visit. We require that as soon as you know you are going to go over your previously scheduled shift, you notify the office or on-call person. Also, closing out one nurse’s note and starting a new one does not affect this requirement. 16 hours is 16 hours.
Thank you for taking the time to review this information. I welcome questions/concerns/feedback. We appreciate your cooperation in these matters, and thank you for all the hard work you do for our patients. Sincerely,
Britney Brazell, RN Director of Nursing Advocate Pediatric Home Care