Determining need

The Complex Care Guide > Family Support > Home nursing > Determining need
  • State Medicaid and individual insurance companies’ guidelines should be consulted
  • Helpful documents in determining PDN need
    • Nurses notes (2 weeks to 1 month prior to the request)
    • Home Health Plan of Care
    • Nursing Addendum (summary and 24 hour daily flow sheet)
    • Information from a peer to peer phone call (in some cases)
  • Tool for determining nursing need
DomainLevel ILevel IILevel III
Skin
  • No issues
  • Incontinence
  • High risk for/mild breakdown
  • Dressing changes 2-3x/day
  • Frequent turns
  • Major skin ulcerations/wounds
  • Dressing changes 3+/day
Airway
  • No issues
  • Suction/neb prn
  • Occasional or positional stridor
  • CPT, vest, cough assist, IPV BID
  • Intermittent O2, BIPAP/CPAP
  • Trach without vent dependence
  • Airway clearance >2x/day
  • Continuous O2 or mostly BIPAP/CPAP dependent
  • Need for bagging ( trach, apnea)
  • Vent dependence
Elimination
  • No issues
  • Daily cathing
  • Single ostomy
  • Daily venting
  • Indwelling cath
  • Multiple ostomies
Behavioral
  • No issues
  • Intermittent agitation
  • Impaired cognition, vision or hearing
  • Self injury from aggressive behavior
  • Severe agitation, requires 2 caregivers for procedures
  • Attempts to strike staff, pulls out tubes
  • Awake q2h
Feeding
  • No issues
  • Requires monitoring during PO feeds
  • Bolus GB <4x/day
  • Bolus GB>4x/day
  • Continuous GB feeds
  • Difficult or prolonged PO feeds
  • Central line with TPN, lipids, or both
Medications
  • No issues
  • Multiple medications (>6/day or frequent prns)
  • IM injections
  • PICC or portacath
  • CVAD with meds or infusion therapy
  • Blood draws; IV site dressing changes
Seizures
  • No issues
  • Seizure in past year
  • Frequent seizures without need for rescue
  • Seizure rescue with meds or VNS<1x/month
  • Seizure rescue with meds or VNS>1x/month
  • Complex seizure requiring airway monitoring/support
Complex vitals
  • No issues
  • BP monitoring
  • Strict ins/outs
  • Peritoneal dialysis
Activity
  • Ambulatory
  • Frequent PROM, turns
  • 2 person transfer, stander, Hoyer lift use
  • Attends school
Assessment
  • VS/resp/neuro q8h
  • Assessment q4-6h
  • Continuous or q2h
RN case management
  • Minimal
  • >4h/week phone intervention
  • >6h/week phone
  • Onsite 1x/month +
Suggested hours/week2040-8496-144

 

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