Daily Skilled Nursing
If in an exceptional circumstance (e.g., when progress is noted in wound healing and daily visits need to continue for a specific amount of time), daily skilled nursing (SN) care is needed beyond 21 days, then a finite and predictable endpoint to the daily skilled nursing care is needed.
Helpful hints to document an endpoint:
- Use a finite date, e.g. "Daily SN ending May 1"
- Be reasonable and realistic, e.g. if diabetic wound will take up to three months to heal, use this date.
- Remember, the end-point is for the daily visits, not the care.
- If able to teach another caregiver who is available on weekends, that would be the end-point.
- Collaborate with physician for alternate wound treatment, if daily visits for wound care.
- Use your best clinical judgment, along with the physician and patient history to project the date when daily SN services can be reduced.
- Avoid using 21 days or end of certification periods repeatedly.
- Reassess need for daily SN by asking:
- How long has the patient been seen daily?
- Has his or her condition changed?
- Would a different treatment that requires less than daily care be as effective?
- Is there another caregiver that can do care at least one day/week?
- Is there a realistic end-point or should it be changed?
Posted: 09.28.11