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February 9, 2015
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Volume 4, Issue 6
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 CEO CORNER |
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I would like to take this opportunity to thank each and every one of you for all you are doing to continue to provide safe and effective care to our patients during the recent and ongoing storms. I am consistently impressed with the effort that everyone is demonstrating. We are getting more and more innovative with our approaches to provide patients with the care that they need, while at the same time, having a laser focus on keeping our staff out of harm's way.
You have done a yeoman's job and please do not think that it has gone unnoticed. Additionally, our referral sources and patients and families are appreciative of what it takes to do this job well in good weather, let alone the conditions that we have been experiencing this winter.
I encourage each and every one of you to stay in close touch with your manager so we know what you are dealing with at all times. We will be looking for your suggestions after this recent storm to ensure we are deploying the most effective procedures during tough weather conditions. Please stay tuned for that opportunity to provide feedback.
Once again, thank you for giving all that you can to the care and safety of our patients. The community is so much better off because they have all of you! Stay warm and safe.
Thank you,
Mary Ann
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SERVICE EXCELLENCE
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| With all of the snow and subsequent disruptions in normal operations over the last few weeks, we have decided to repeat last week's VNA Service Standard, Complaint Resolution Using LEAP. It is such an important topic that we want to make sure everyone has a chance to huddle around this Standard and explore the many strategies to achieve complaint resolution. |
 SERVICE STANDARD OF THE WEEK
Service Standard #5: Complaint Resolution
Using LEAP
We ensure that complaints are acknowledged, addressed, and proper action is taken by utilizing LEAP. |
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AGENCY ANNOUNCEMENTS AND UPDATES
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Please see the article below which appeared on page 2 of this past Sunday's Boston Globe highlighting our very own Nancy Egger. Thank you to Nancy for sharing her story and thank you to everyone out there who embodies the spirit of this article. It's not easy on a sunny day in June, never mind with the amount of snow we currently have!
**shared with permission from the Boston Globe and columnist Kevin Cullen**
Snowstorms no match for their spirit of service
By Kevin Cullen, Globe Columnist
When Lee Williams left his home base in Jamaica Plain last week, it was snowing. By the time he turned onto the Pike, it was really coming down. And when he turned onto Interstate 290, toward Worcester, he couldn't see the highway lanes or much of anything else.
He didn't close his eyes, but he might as well have.
"I couldn't see anything," he said. "I had the wipers going full blast, kept spraying the windshield fluid, and hoped for the best."
He could have turned back, but he wouldn't. Lee Williams is 23 years old and he feeds people. He is a driver for Community Servings, which delivers medically tailored meals to people with chronic illnesses like cancer, multiple sclerosis, HIV/AIDS, Lou Gehrig's.
There are 61 people in Worcester who depend on Lee Williams, a Dorchester kid who takes what he does seriously.
"When I was driving in the snow, I wasn't worried about getting in an accident as much as I was thinking about some of the older folks who wouldn't have anything to eat if I didn't get there," he said.
And so he drove on.
Fifty miles east of Worcester, in East Boston, Nancy Egger strapped a 25-pound pack on her back and started walking. Egger is a nurse with the Visiting Nurse Association of Boston, and, like Williams, it wasn't a question of whether she would get to the people who need her, it was a question of when.
If you ask Egger or any other home-care professional, they'll tell you the hardest thing about what they do in times like these is just finding a parking spot.
Egger had managed to find an indent in the snow along Marginal Street, down by the water, tucked her car into it, and began the half-mile trek to a patient's house. She walked facing the traffic, and when the snowplows approached she jumped into the roadside snowbanks.
She looked like Nanook of the North, if Nanook of the North was an RN.
She had called her patients in advance, to let them know she was coming. Some of them begged her not to. When Egger got to a lady's house on Webster Avenue, she began peeling off the layers of clothing and taking off her boots.
"Don't take off your boots!" her patient pleaded. "I don't want you to bother."
Nancy Egger waved her off and tended to her in stocking feet. She didn't want to get the woman's floor wet.
(it should be noted that Nancy had a second pair of shoes in her bag that she put on immediately after taking off her wet boots!)
She trudged back to Marginal Street and could barely see her car. It had been plowed in. So she grabbed the shovel from the car's trunk and, for the second time that day, began digging it out. It took her a half-hour.
At the storm's height, it was so bad that the VNA called the troops in, getting them off the streets.
Instead of heading home, Nancy Egger headed toward the Sumner Tunnel because she had to get back across town. She had blood samples. She had to get the blood to the lab.
Nancy Eggers is 51 years old and has been doing home care for almost 30 years. During the week, she listened to friends complain about how hard they've had it in the snow.
"Drive around with me for a week," she says.
Back in Worcester, Lee Williams felt a slight panic when the wheels of his van began spinning and slipping while going up a hill.
He pulled over, grabbed a bag of food, and began walking in the snow.
An old woman opened the door and was startled to see him.
"Where's your coat?" she asked.
In his haste, Williams had left it behind in the van.
"You really should have your coat on, dear," the old woman said.
Williams smiled because she reminded him of his grandmother, Virginia Wilson. Lee Williams probably wouldn't be delivering meals to sick people if it wasn't for his grandmother. She worked for Community Servings, and so does her daughter, Lee's mom.
Virginia Wilson died nine years ago, but her picture is hanging in one of the rooms back at the Community Servings home base in JP, and Lee Williams looks at it every time before he climbs into the van and heads out to Worcester.
When he shows up in the snow, people with very little try to give him whatever they can. A cup of coffee. Water. A hug. Some of them even dig into their pockets, and Lee Williams has to wave his hand and gently remind them he can't take tips. He doesn't do it for tips.
We are smack dab in the middle of this, our winter of discontent. The most recent forecast calls for a continuous snowfall over several days. It is crystalline water torture.
While so many of us complain, people like Lee Williams and Nancy Egger just get on with it, because neither they nor the people they help have the luxury of just riding out the storm.
Nancy Egger is a big fan of irony. Which probably explains why she spent the weekend snowshoeing in New Hampshire.
She'll need the snowshoes in Eastie this week.
Lee Williams tried to outfox the weather. He delivered a five-day supply of meals to his clients in Worcester on Saturday, before the snow started falling again.
But, like the flakes, the days fly by and he'll be back on the Pike, heading west, before you know it.
And however bad it gets, he doesn't have to close his eyes to see his grandmother, to remember why he does what he does.
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Scenes from the Street
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| | Roisin Keon, physical therapist out of the Danvers office borrowed her husband's "monster" plow truck to get to her patients. | Nancy Morrison, MCH nurse out of the Charlestown office trekked her way through Southie. |
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CLINICAL SERVICES
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Clinical Services Announcements and Updates
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REMINDER: Critical McKesson Update this Week
By Kathy Schuft, Clinical Applications Specialist
There will be another critical update to the McKesson system the night of Wednesday, February 11th for both certified home care and hospice. This update will repair a problem we are having with the HHRG score in home care. Also, on the home care side McKesson has added homebound status from the OASIS to Locator Box 22 (Goals) on the 485. Any hospice changes for clinicians will be sent as a separate email. All further communications will be via the Connecter.
Here is what you need to know about the night of the update:
- The system will be shutdown at 9pm sharp on Wednesday, February 11th.
- During the shutdown the following systems will be unavailable:
- Horizon Homecare for VNAB
- TeleHealth Interface
- WebChart
- Web Referrals
- iPad Users/Desktop Users/Laptop Users with Citrix Receiver:
- You must be signed out of the system by 8:45pm to avoid losing any documentation
- Please do not log on again before 6am the next morning
- Laptop Users that Require Transfer:
- Complete your final transfer no later than 8 p.m. to be sure that all information is transferred by the time the system is shutdown
- You may not document on your laptop again until you have performed the ESD transfer the next morning or after
- The best way to perform an ESD Transfer is via network cable in the office. However if coming to the office to perform the transfer is very inconvenient then you may attempt the transfer via VPN with the following warnings:
- VNAB users you MUST use the VNAB-MetroNorth when signing into VPN
- You MUST be prepared to come into the office if the ESD fails via VPN
- You DO NOT need to remove the patient charts from your laptop
- Instructions for performing an ESD Transfer will be sent separately.
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Wound V.A.C. Training in Braintree Rescheduled
By Joan Fall, Manager of Orientation and Education
Michael Deely, our KCI representative, will hold a wound V.A.C. training session for all interested clinicians in the Braintree office on Monday, Feb 23 from 3-4 p.m.
To sign up, please contact Joan Fall at 781-535-5426 or email jfall@vnab.org.
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Wound Care Update By Judy Sojack, Patient Services Manager Effective January 29, 2015, Medicare has stopped covering all honey-based dressings, i.e., MediHoney, Manukapli, and Therahoney. MediHoney and other honey based dressings have been used by some medical providers as a wound dressing. Effective immediately, patients will have full financial responsibility for the cost of honey based dressings. If a medical provider has a strong preference for these products, they can still recommend them to the patient, who can opt to pay privately. This may represent a significant out-of-pocket cost for the patient. If the patient does not want to do this, we can offer alternative products. Your office CWON can confer with the primary nurse to determine which product is best for the patient. Potential alternative product options include, but are not limited to: - Dry to Light Draining Wounds -
- Hydrogels (Restore Hydrogel or Woun'dres Hydrogel). A silver option is available (Elta Silver Gel)
- Light Draining Wounds
- Mesalt hypertonic saline dressing, available in pad and ribbon forms.
- Hydrocolloid
- Moderate to Heavy Draining Wounds -
- Collagen dressing (Puracol - Manager approval needed)
- Alginate dressings (Restore Calcium Alginate or Restore AG Calcium Alginate)
- Foam dressings (Restore or PolyMem) or Silver Foam dressing (Optifoam AG - Manager approval needed)
Please take Note: Medicare will usually not cover a combination of a hydrogel with a collagen, alginate or foam dressings when use on the same wound.
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FACILITIES
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Braintree Office Move
By Lorraine Potter, Director of Facilities
Even though the snow won't quit, we are still on target to move the Braintree office.
The move date is set for Friday, February 27th. The new Quincy and Weymouth locations are on track for construction.
A Move Committee was formed and has been meeting over the last few Tuesdays to ensure a smooth transition. We are now cleaning the office of items that will not be making the move. Packing crates from Tobin and Son's Movers arrived today and can be retrieved from David James.
The goal is to have the office packed up by Wednesday, February 25th. Clinicians are asked to have their assigned draws cleaned out by Thursday, February 19th. Please take all personal items home so they will not be mistakenly thrown away.
Thank you for your cooperation. Please contact Lorraine Potter at 508-751-6826 or lpotter@vnab.org with any questions.
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HUMAN RESOURCES
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Job Postings - VNA Care Network and VNA Hospice Care
To learn more about career opportunities, contact a human resources representative:
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Job Postings - VNA of Boston and VNA Hospice Care
To learn more about career opportunities listed in the links above, contact Debbie Brown, Human Resources Manager at dbrown@vnab.org. |
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QUALITY AND RISK MANAGEMENT
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QI Department Update QUESTION: What is a clinician to do at ROC, RECERT, DISCHARGE or TRANSFER when the OASIS: - ICD-9 diagnosis code(s) requires updating
- Review is requested
ANSWER: Send an email to either: Your request will be forwarded to the appropriate QI staff. Using the clinical documentation in the patient's chart, the OASIS will be reviewed and/or coded so that your patient's condition including diagnose(s) is accurately reflected in the OASIS document. Our QI Department reviewing and coding your SOC (start of care) OASIS. Most other OASIS are not being reviewed and/or coded currently. Please contact your office's Patient Care Manager, QI Nurse or QI Support Coordinator with any questions. |
Office
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Name
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Office
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Cell/Direct
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Position
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Braintree
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Carol Morris
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781-535-5380
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Patient Care Manager
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Charlestown
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Elaine Gardner
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617-886-6464
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Patient Care Manager
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Danvers
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Marilyn Bowden
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888-663-3688 X1271
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774-502-7478
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Patient Care Manager
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Gloucester
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Marilyn Bowden
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888-663-3688 X1271
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774-502-7478
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Patient Care Manager
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Leominster
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Terry Dancewicz
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888-663-3688 X1341
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774-502-7481
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Patient Care Manager
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Needham
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Maura Vitello
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888-663-3688 X4536
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774-502-7475
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Patient Care Manager
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Southborough
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Maria Dunn
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888-663-3688 X1317
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508-688-2449
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Patient Care Program Manager
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Worcester
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Susan McGeary
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6824
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774-232-1628
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Patient Care Manager
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n/a
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Shamala Rao
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6876
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n/a
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QI Nurse
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n/a
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Chris Schultz
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n/a
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617-886-6527
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QI Support Coordinator
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Resumption of Care after Inpatient Stay
Per CMS (OASIS Considerations, 2010), "a Resumption of Care (ROC) should be done if a patient experiences a "Qualifying Inpatient Stay" with a return to the agency during the current episode of care (certification period)". This includes when a patient is "inpatient" for more than 24 hours (not in observation, etc.). It is important to follow the process outlined below when you are the first "qualified" clinician (RN, PT, OT, SLP) that visits the patient upon the Resumption of Care.
NOTE: the process will be different per CMS "if the patient is discharged from the inpatient facility during the last 5 days of an episode (i.e. days 56-60)". In this case, contact your Patient Care Manager or a QI representative for direction.
Process:- Select the current active episode. A resumed patient should have an established SOC. Avoid entering a new episode.
- Select (Discipline) Daily Visit- Create. A RESUMPTION OASIS will pop-up...DO NOT BYPASS. YOU MUST ANSWER NO TO FIRST QUESTION (DO YOU WISH TO BYPASS) AND WHEN FINISHED COMPLETING FORM HIT F8.
- Write your Daily Visit Note. On the first page, under Reason for Billable Visit, use the F2 and select "Reassessment after Hospitalization" for your visit reason. Do a thorough assessment, utilizing all Clinfinds, and document any teachings or interventions in your POC. In the Statistical Information pop-up, use your discipline's resumption visit code.
- Review and Update: Med List, Care Plan (goals, teachings and interventions need to be addressed & updated,) Referral Clinical and update Projected Visit pattern. Answer YES to the question "Do you want to generate a verbal order?"
- If there are any discrepancies in the medications or treatments, the physician must be contacted by the visiting clinician during the resumption of care visit.
- Select Verbal Order from the menu. Press F3 to create a new Verbal Order. You must title the Verbal Order "Resumption of Care Verbal Orders (Add ROC Date)". Ensure the correct MD is listed on the first page. The second page must include "Please confirm attached Medication List. Underneath this statement, please list other resumption orders. The changes to your visit pattern and care plan, etc. will already be on the order but may need to be edited for clarity. Include a brief summary of patient's status following the hospitalization including the reason for hospitalization and any new diagnoses for the patient's POC. When complete, F8 the Verbal Order. To add new diagnoses to the POC, please e-mail Shamala Rao and ask for this patient to be added to the coding assignment.
- F8 Activity Control Screen
- Remember - if the patient has a HHA, you must call the x1234 line and notify the HHA Dept. that the patient has returned home. Then review and update the HHA Care Plan as appropriate noting the patient's ROC visit date within the care plan (per F2 lookup).
*When the procedure is completed, the Medical Records Department will coordinate the printing of the "Resumption of Care Verbal Orders" and current Medication List and will send it to the physician for signature. Troubleshooting: (Frequently Asked Questions)Q: I went into my daily visit note and no RESUMPTION OASIS popped-up.A: The most common reason for this scenario is that a TRANSFER OASIS was never completed. A transfer Oasis will need to be completed in order for the RESUMPTION OASIS to appear. This can be done in your laptop at the time of the visit if necessary, being careful to enter an accurate date for the transfer. Call the office to verify if necessary.Q: I went to do my resumption and there were two episodes. Which one do I use?A: If you are sure the patient is to be resumed and not re-admitted, enter the most recent episode with a start of care date. Occasionally, a new episode is inadvertently entered by central intake. Leave a voice mail for the CSA or CSM so that the incorrect new episode can be taken care of.Q: OASIS questions i.e. which dates go where OR should a ROC OASIS be done?A: Please contact a QI representative (QI Nurse Shamala Rao x6876, your office's Patient Care Manager or Clinical Documentation Analyst).
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