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Ankota: Ushering in the Next Generation of Homecare Blog

5 Ways To Help Nursing Staff Avoid Nursing Errors

Posted by Ken Accardi on Oct 16, 2017 11:00:00 AM

Today's guest post is from Tom Moverman. Tom established the Lipsig Bronx Firm with Harry Lipsig and his partners in 1989; The firm’s focus is in personal injury, construction accidents, car accidents, products liability, and medical malpractice. Tom's website is www.lipsigbronx.com.

Patients put an enormous amount of trust in the hands of healthcare workers. Efforts to avoid breaking this trust must be continuously implemented. Nurses are required, both ethically and legally, to treat patients according to the standards of their profession. Unfortunately medical mistakes are most likely the third leading cause of death in the United States. Furthermore, ten percent of all deaths in America are said to be medical error related. In order to avoid nursing errors, following these standards, as meticulously as possible, is necessary.

Double Check Every Procedure

In a study from the Journal of Nursing Care Quality, 68.3 percent of nurses remember making at least two to five errors over the course of their careers. The majority of these errors occurred when a doctor's order form was too difficult to read or illegible. The second major cause of nursing mishaps was distractions from patients, coworkers, or events.

Home Health Nurse

Statistically, the highest rate of nursing errors occurs with prescriptions. Dosage errors are committed at an alarmingly high rate. To prevent these types of errors, nurses need to check medications multiple times before they are administered to patients. If a nurse has any questions or notices something out of the ordinary, they must approach a doctor. There is no place for shyness in this profession.

Less than half of all nurses involved in the study indicated that they believe drug errors are only reported 45.6 percent of the time. This reveals that nurses are hesitant to report errors and may fear a medical malpractice lawsuit if they do. Unfortunately, not reporting errors can severely diminish patient care and prevent the improvement of future procedures. Miscommunication and lack of communication in a healthcare environment is highly detrimental to all involved.

Give Complete Reports

Hastily completed medical documents or documents that lack information are a huge cause of nursing mishaps. To avoid a medical malpractice lawsuit, nurses should be as prepared and concise as they can when talking with a doctor. A patient's chart, a list of questions, and any suggestions should be available and ready before meeting with a doctor over the care of a patient.

Nursing errors frequently result from treatment miscommunication. In this situation, a nurse must be fully aware of all treatment methods. If multiple tubes need to be drained, if blood needs to be drawn every few hours, etc., a nurse must learn to communicate effectively with doctors to derive all necessary information. This collaborative environment must be reflected in all documentation and during in-person procedures.

Avoid Time Mismanagement

Time mismanagement is common in chaotic healthcare environments. Nurses may become overwhelmed and neglect patients or haphazardly fill out patient charts. To avoid nursing errors nurses must learn how to set priorities. A nurse must also realize the importance of flexibility and patience. Patients are present because they suffer from some sort of ailment. Remaining calm, collected, and level-headed is necessary during dire healthcare situations.

The most important time management skill for nurses is learning when to take a break. Healthcare workers work long, physically demanding shifts. It's easy to often forget to take care of your own body as a healthcare worker. Fatigue, burnout, and other serious medical issues can all contribute to the productivity breakdown of a nurse. If a break is needed, it must be taken.

Limit Overtime

It is well-known that healthcare professionals work long shifts. Administrators may try to schedule workers for back to back or extended shifts and this is particularly common for nurses. To avoid nursing mishaps, it is important to give nursing staff an adequate amount of downtime.

According to a study in the Journal of Safety Research, all nursing errors were directly related to working more than 40 hours a week. Medication errors had the most consistent relationship to overtime. Ignoring nursing fatigue has been proven to cause nursing errors and, ultimately, a medical malpractice lawsuit. This information should be thoroughly considered when a nurse is scheduled to work overtime.

Do Not Understaff

In a study from the Journal of Clinical Nursing, 82 percent of nursing errors were caused by a hospital administration's forced understaffing. Understaffing a hospital, or other healthcare environments is destructive to patient access and care. It is also a legal liability that can easily result in a medical malpractice lawsuit. Healthcare entities must schedule the right amount of staff for possible patient intake. They must also avoid treating staff unfavorably. Healthcare professionals work frequent shifts and shouldn't be performing these shifts alone. To provide the best level of care possible to patients, professionals need to actively collaborate with each other.

In order to avoid nursing errors, nurses must actively take steps to adhere to medical standards ascribed to their professional behavior. Double checking every procedure, limiting overtime, alerting administration to understaffing, checking reports for completeness, and managing time correctly are all methods that will work to prevent nursing mishaps. In a profession where accuracy is key, nurses must be vigilant in maintaining efficient, effective, and error-free patient care.

One of Ankota's recent whitepapers, entitled "Blueprint for the Next Generation of Healthcare at Home"  is available for download.  Please click the link or the picture below to download.Blueprint Healthcare Cover.png

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact us.




Topics: Private Duty Agency Software, Home Care Best Practices, Care Transitions

7 Keys to Starting a Home Health / Hospice Agency

Posted by Ken Accardi on Oct 9, 2017 5:17:17 PM

One of the industry experts I learn from every time we speak is Ginny Kenyon, principal at Kenyon Home Care Consulting.  Ginny helps open home care agencies and has given Ankota great inputs on our software.  We at Ankota strongly believe that keeping elderly people healthy and comfortable in their homes (and out of the hospital) is an important step in the evolution of healthcare.  Ginny is one of the pioneers driving moves in home health delivery.  Enjoy her post (below).

There are well over 12,000 home health & hospice agencies in the US, and the industry grew some 4% annually between 2010 and 2015 due to a rapidly aging U.S.. population. For someone with an entrepreneurial spirit to meet the real healthcare needs of people, the homecare industry represents a real opportunity. But, how do you get started? What is involved in a successful homecare agency startup? Seven key areas of concern for every new homecare agency startup are as follows:

1. Vision and Business Plan

 The first step in starting up your new home health organization is formulating a clear vision of meeting community needs. A detailed community assessment gives you direction and your own background and focus will play into the decision.

There are many types of home health & hospice agencies, some focused only on non-medical daily living assistance for seniors and disabled persons, others equipped with nurses and therapists to take care of medical needs. To make your vision a reality, you need to think and put into writing a detailed business plan and find effective ways of marketing your vision to the community.Home Health

2. Licensing Issues

Step two in getting your homecare agency startup off the ground is obtaining all necessary licenses. A good consulting firm, will guides you through this complex legal process and uses experienced senior consultants to expedite the process to licensure.

Your agency will need to be incorporated with a Tax ID. You will also need to obtain a NPI (National Provider Identification) number with Medicare/Medicaid. There are differences in licensing from state to state. Expert guidance helps you properly prepare for successful practice.

3. Medicare Accreditation

 Next, as a large portion of your reimbursements will come through Medicare (Parts A and B), you must go through the certification process. This involves a three-day Medicare survey in which your policies/ procedures, record keeping, and clinical practice will be evaluated. Consulting trains and prepares you to pass the first time.

Often times, agencies will choose accreditation from CHAP, ACHC, or JCO instead of the Medicare certification every three years. Accrediting bodies hold agencies to all Medicare Conditions of Participation as well as standards of excellence above and beyond Medicare/ Medicaid.

4. Software Selection

Today’s healthcare industry requires advanced medical equipment and computerized record-keeping. An existing agency may update software systems as needed, however, a homecare startup agency should carefully select the most effective software program to meet their needs. Senior level consultants help with making sure agencies do not make the costly mistake of choosing the wrong software.

5. Preparation of Manuals

To run your agency smoothly from day one, you will need to develop customized administrative policy and procedure manuals, employee handbooks, forms manuals, and other important organizational tools. Optimizing your manuals can save you valuable time and money.

6. Staffing Your Agency

So far, we have defined goals, removed legal barriers, and provided an organizational structure. This is like a naked skeleton. To put flesh and bones on this plan, you next develop effective recruitment and retention strategies. Hiring the well-trained and reputable staff members dedicated to providing top-quality care is key to fulfilling your mission. If you fail to fill your ranks with conscientious staff members, you could retain staff but fail to retain clients. On the other hand, retaining good managers may be a function of your overall policies and standards.

You can hire some staff directly full-time, some part-time, and contract out other specialists as needed. But you must do a thorough background check on anyone who will be working under you agency’s name, to protect patients, to avoid a possible lawsuit, and to protect your agency’s reputation.

7. ICD-10 Readiness

Finally, you should realize cash flow and reimbursement rates depend on efficient, accurate, and complete ICD medical coding practices. You need to train in-house coders or use a 3rd-party ICD-10 coding partner. Your clinicians need extensive documentation training to back up coders and keep everyone on the same page.

Do your homework before starting hiring your consultant. Look at the background of your consulting agency. Do they have expertise in all the items you need to begin your agency? Find the agency that offers specialists in all areas of the process. Are you obtaining access to one individual or a team of individuals working for you?

To accomplish all of the above and more for a successful homecare agency startup, you should invest in homecare consulting services such as those offered by Kenyon HomeCare Consulting. To learn more about Kenyon’s start-up packages, which cover everything from A to Z and are run by senior administrators with 20-plus years of experience, contact Kenyon online or call 206-721-5091.
One of Ankota's recent eBooks, entitled "Selling Care Transition Services to Hospitals" is available for download and we think you'll find it useful.  Please click the link or the picture below to download.

Selling Care Transition Services to Hospitals CoverRead this post on Tim Rowan's Site

Click Here for a Free Demo

Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact us.




Topics: Private Duty Agency Software, Home Care Best Practices, Care Transitions

EVV Best Practice: The One Day Time Sheet

Posted by Ken Accardi on Oct 2, 2017 11:00:00 AM

circuit-158374_640.pngAs agencies move to Electronic Visit Verification (EVV) they will achieve numerous benefits including regulatory compliance and increased speed for processing billing and payroll. To learn more about EVV, please see our earlier articles explaining EVV and the 21st Century Cures Act.

Challenges to Overcome When Implementing EVV

There are several issues that will arise as you implement EVV, as follows:

  • Reported Times will no longer be "perfect:" When your not using EVV, your time sheets will generally be "perfect." Your caregiver will show up right when they're supposed to and leave right on time. A visit scheduled from 8:00 AM to 10:00 AM will be recorded as arrived at 8:00 AM and departed exactly at 10:00. When EVV is added, these times will no longer be perfect. For example they might arrive at 7:56 AM and leave at 9:53 AM.

  • You'll need to "round" or "truncate" visits in accordance with the rules of your funding source: Most Medicaid programs have you bill personal care visits in 15 minute units. Some programs only pay for completed 15 minute units, while others employ rounding rules. A typical rounding rule is called the "rule of seven eigths," which means that 7 minutes rounds down and 8 minutes round up.  Other rules apply too. For example labor laws often require you to pay for every minute worked even if you're not able to bill for those minutes.

  • Resistance to Change: In a typical organization, 20% of your workers will love and embrace EVV right away and 60% will be fine with it but the last 20% will be unhappy about it and come along "kicking and screaming." The best thing you can do to prevent this is to make sure that the EVV system is easy to use and that you provide training and hand-holding in the early days.

  • Caregivers will make mistakes: In the early days of your implementation, caregivers will forget to clock in or clock out or make other mistakes. When mistakes are made, it is likely that a time sheet, signed by the client will be required.

A Best Practice: The One Day Time Sheet

One best practice that we share is the idea of a one day time sheet. Most agencies who are "on paper" use a one week time sheet. Continuing with a one-week time sheet makes it "too easy" for your caregivers who are resistant to the new approach. They'll just keep doing it the "old way."

The idea of a one-day time sheet changes this. If the caregiver makes an error, you ask for them to fill out a time sheet for that one day and have the client sign it. Some agencies even mandate.that the time sheet be brought to the office that same day  This is a bit difficult, but that's by design. If the caregiver has to fill out a paper time sheet and get it signed each time that they forget to clock in our out, they will quickly learn.

More Best Practices

If you have additional questions or are seeking further best practices for implementing EVV in your organization, we'd be happy to help. The easiest way is to click here to contact Ankota or call us on 844-4-ANKOTA.

I Need Help with EVV



Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Readmission avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact us.   

Topics: Private Duty Agency Software, Home Care Best Practices, Care Transitions, September 2017 Newsletter

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Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Reeadmisison avoidance and on management of Private Duty non-medical home care. To learn more, please visit www.ankota.com or contact Ankota.

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