New Icon for the McKesson RPM Database

By Kathy Schuft, Clinical Application Specialist

The McKesson Remote Patient Monitoring (RPM) database will now have a new icon. This will help differentiate it from the certified McKesson database. Click on it to open as usual.

This is what the icon will look like on your desktop.

If you have any questions please contact Kathy Schuft at 617-886-6968 or kschuft@vnab.org. 

HHA News & Updates

By Elaine Buckley, Patient Services Manager

My name is Elaine Buckley and I am excited for my new role as the HHA Manager for the entire organization. I am planning on communicating frequently through the Connecter with information to help clinicians with HHA management.

This week, we would like to focus on the Home Health Aide assignment. Some feedback from the HHA's is the assignment is not in the patient's home at their first visit. It is best practice that the HHA assignment is present in the home and available for the HHA to reference for the patient's care. It is also a Condition of Participation.

Once the case is filled, the HHA Department mails out the HHA assignment (on colored paper) to the patient's home. The envelopes have the agency logo and the HHA Department will begin to write "HHA Dept" under the logo. During the welcome call, we will emphasize the assignment is coming in the mail, tell them what to look for and ask them to place the assignment in the VNA Care Network admission folder.

We need your help with this! Please tell your patients and families to expect this mailing. Ask the patient or family to look for the mailing and reiterate what we have told them in the Welcome Call. During your visits, see if an active patient has an assignment in the home. Please let Amanda Burke know if your patient needs a new assignment mailed or if they never received one. We will get one out right away!

We would love your feedback! If you have any suggestions or comments, please contact Amanda Burke at 978-777-6100 X1204 or myself at ebuckley2@vnab.org. (I am currently in the process of getting a phone line in Danvers)

Thanks for all your help with this. I look forward to working with all of you.

McKesson System Upgrade for VNAB Home Care and Hospice in June

By Kathy Schuft, Clinical Application Specialist

There will be a McKesson update for both home care and hospice the end of June. Changes for clinical and office staff will be communicated later in the month. These are the details regarding the update:

Here is what you need to know about the night of the update:

• The system will be shutdown at 9pm sharp on Wednesday, June 24th

• During the shutdown the following systems will be unavailable:
• Horizon Homecare for VNAB and Hospice
• TeleHealth Interface
• WebChart
• Web Referrals

• Laptop Users:
  • Full detail and instructions regarding the ESD transfer will be communicated in an email.
  • To help you plan we do know that the ESD transfer will need to be performed in the office and will take about 30-45 minutes. Further detail to follow. 

• iPad Users and Office Staff:
• 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

If you have any questions please contact Kathy Schuft at 617-886-6968 or kschuft@vnab.org.

Hemoglobin A1c - A Primer

By Joan Fall, RN, BSN, CDE, Manager of Clinical Orientation and Education

A new directive from our Medicare intermediary requires that in order to be reimbursed when a patient has a primary or secondary diagnosis of type 2 Diabetes that we must have a documented HbA1c (also known as Hemoglobin A1C or Glycosylated hemoglobin)from the physician. This applies to patients on admission and recertification. The HbA1c results must have been obtained within 120 days of the OASIS assessment.

The American Diabetes Association guidelines recommend that anyone with diabetes should have their HbA1c checked 2x a year (every 6 months) if their blood sugars are well controlled. For patients with poorly controlled blood sugars the recommendations is to check the HbA1c 4x a year (every 3 months).

So what is an HbA1c?

HbA1c is the "A" of the ABCs in diabetes - the Average Blood Glucose.

It is an average of the blood sugars over 2-3 months which is determined by the amount of sugar that adheres to the red blood cells as illustrated below:

Please note that patients with anemia and other hemoglobin variants will most likely not have an HbA1c that accurately reflects the actual blood glucose.

How does the HbA1c numbers correlate to the actual blood glucose readings? See the chart below:

What do the HbA1c readings mean with regard to the big picture for glycemic control?

• 4% - 5.7% is normal for someone without diabetes
• 5.7- 6.4% is considered Pre Diabetes
• Less than 7% decreases the risk of complications
• 8% or greater indicates need for changes in treatment unless the patient is at risk for complications due to hypoglycemia or has limited life expectancy
• In an effort to have this accessible to our clinical staff... Liaisons, Intake and Case managers across all disciplines will be asked to get this information from our MD providers and or hospital lab data. In many cases the information will be entered into the chart for you, under the lab section (McKesson) and in a Doc Comm (Encore) by the CDA staff. If we need the HbA1c then the primary clinician will be asked to call MD for an order or the result and document this in the chart. The HbA1c will be in the Lab Section for McKesson users and in a Doc Comm for Encore staff, titled HbA1c ......for PT primary cases, please call and get an order for Diabetic management for SN referral if the patient needs assistance, education and follow up with Diabetic status. Thank you for your continued support with this effort to insure Best Practice Guidance for our patients.

References:

• Standards of Medical Care in Diabetes, 2015, American Diabetes Association
• Glycemic Targets - Diabetes Care 2015;38(Suppl. 1):S33-S40 | DOI: 10.2337/dc15-S009
• The A1c Test and Diabetes retrieved June 3, 2015 from http://diabetes.niddk.nih.gov/dm/pubs/A1CTest/#1
• Diabetic Live retrieved June 3, 2015 from https://www.diabeticlive.com/diabetes-101/a1c-levels/
• https://www.google.com/search?q=cartoon+of+hemoglobin+a1c&rls=com.microsoft:en retrieved June 3, 2015

Back to Top

Behavioral Health Program

By Molly Lukason, Behavioral Health Manager

We know as clinicians how important it is to have a patient feel stronger both in mind and body. The Behavioral Health Program provides opportunity and options for our patients to work through challenges and struggles. Recent comments from patients who have completed the program describe feelings including "empowered," "calmer," and "seeing things differently."

Please take a second look...

We invite all managers and clinicians to take a second look at their current caseload. Who are those patients that have a current diagnosis of depression, anxiety, or early stage dementia? Who are those patients that may not have a documented diagnosis of depression or anxiety but who are showing signs of sadness, hopelessness, and/or restlessness that is interfering with their goal of getting well?

We are happy to participate in case conferences and collaborate regarding current patient concerns. We are happy to meet with patients to discuss the Behavioral Health Program in more detail. We are happy to confer with any clinician regarding a patient.

Please take a second look...

So please, take a second look at your caseload. We can be part of the team even if skilled nursing needs to remain in on the case. We can become the primary clinician when skilled nursing is ready to terminate services. We accept patients who have straight Medicare or Medicaid.

Please call Molly Lukason at 774-502-5545or email at mlukason@vnacarenetwork.org with any questions.

Med Reconciliation in SOC Macro

We are currently involved in an audit with Tufts Medical Center. In an effort to meet the audit requirements, we had to make a small change to the medication reconciliation statement in our SOC macro. Please see screen shot below and continue to assess medication reconciliation at each admission and document accordingly.

Thank you for your help to insure all our patients have medication reconciliation upon SOC.