Guidelines for the provision of community nursing services - Case ...

Scenario 1DVA Community Nursing ProgramGuidelines for the provision of community nursing services– effective 1 March 2010Case Studies with answersA veteran client is living alone in the country town of Longwayaway, 32 kilometres fromthe DVA contracted community nursing provider’s location. The client is independent inpersonal care but requires a routine microlax enema second daily, as directed bycontinence specialist. The veteran client is also independent in all other aspects of care.1. Under which Schedule and which item number would the DVA-contractedprovider classify this veteran client?2. What level of personnel would be required to give these services?3. When would the care be reviewed and by whom (eg level of personnel)?Answer Scenario 11. Clinical Care Schedule - General – NY04 and Additional Travel - NB102. Personnel used to deliver clinical care services must be registered nurses or endorsedenrolled nurses*3. As clinical care is involved, the 28-day retrospective and 3 monthly reviews of carewould be conducted by a registered nurse* Based on their qualifications, experience and the legislative requirements of the State/Territoryin which they workScenario 2A veteran client requires assistance with personal care three times per week, they are alsocurrently having injections once a month. This veteran client is otherwise independentand self reporting.1. Under which Schedule and which item number would the DVA-contractedprovider classify this veteran client?2. What level of personnel would be required to give these services?The Department of Veterans’ Affairs – Community Nursing Guidelines DVA Community NursingClassification System - 'Case Studies' with answers.docPage 1 of 5

3. When would the care be reviewed and by whom (eg level of personnel)?Answer Scenario 21. Personal Care Schedule – Personal Care 12-17 visits - NZ03Under the Personal Care Schedule limited clinical interventions can be provided(The personal care takes the majority of the time as opposed to the injections)2. Registered nurse/enrolled nurse/nursing support staff for the personal care andregistered nurses or endorsed enrolled nurses for the clinical care*3. As clinical care is involved, the 28-day retrospective and 3 monthly reviews of carewould be conducted by a registered nurse* Based on their qualifications, experience and the legislative requirements of the State/Territoryin which they workScenario 3A younger disabled veteran was referred to community nursing following hospitalisationfor a fall in which he sustained a fracture to the right ankle.During his stay in hospital the veteran client developed a pressure ulcer on his left heelwhich will require wound dressings three times per weekly.While the veteran client usually manages all activities of daily living independently, thefracture has caused some limitations in his mobility and capacity to perform householdtasks.VHC domestic assistance was organised by the Discharge Planner.The veteran client is seen by RN/EN three days per week for wound management forthree weeks, then discharged from CN. The average length of visit was less than 20minutes.The Wound consumables cost the provider $52.00.1. Under which Schedule and which item number would the DVA-contractedprovider classify this veteran client?2. What level of personnel would be required to give these services?3. When would the care be reassessed, and by whom (eg level of personnel)?4. When would the care be reviewed and by whom (eg level of personnel)?5. How would your answer differ if the veteran client received the same services, butwas discharged in less than 14 days?The Department of Veterans’ Affairs – Community Nursing Guidelines DVA Community NursingClassification System - 'Case Studies' with answers.docPage 2 of 5

Answer Scenario 31. Clinical Care Schedule: Technical, visit length – 20 minutes or less per visits - NY02and Clinical Care Schedule Additional Components: Wound ManagementConsumables - NC142. Personnel used to deliver wound management services must be registered nurses orenrolled nurses*3. As clinical care is involved, the care needs would be reassessed at each visit by aregistered nurse4. As clinical care is involved, the 28-day retrospective review and 3 monthly reviews ofcare would be conducted by a registered nurse5. Clinical Care Variation Schedule: NY14* Based on their qualifications, experience and the legislative requirements of the State/Territoryin which they workScenario 4A new veteran client has been recently diagnosed with diabetes.The community nursing provider receives a referral asking that the veteran client’s bloodglucose be monitored second daily and once blood glucose level is stable, weekly. TheCN also provides reinforcement of the veteran client’s education on the management oftheir diabetes.1. Under which Schedule and which item number would the DVA-contractedprovider classify this veteran client?2. What level of personnel would be required to give these services?3. When would the care be reviewed and by whom (eg level of personnel)?4. How often would you feedback to GP?Answer Scenario 41. Clinical Care Schedule: Clinical Monitoring - NY012. Personnel used to deliver Clinical Monitoring services must be registered nurses orenrolled nurses*3. As clinical monitoring is involved, the 28-day retrospective and 3 monthly reviews ofcare would be conducted by a registered nurse4. Weekly feedback to the GP until BGL is stable and once stable on a regular basis,generally at every 3 monthly review or if any changes occur* Based on their qualifications, experience and the legislative requirements of the State/Territoryin which they workThe Department of Veterans’ Affairs – Community Nursing Guidelines DVA Community NursingClassification System - 'Case Studies' with answers.docPage 3 of 5

Scenario 5An on-going veteran client usually receives daily visits for administration of medicationthat has been prescribed by his GP and dispensed by a pharmacist.For this 28-day period, the veteran client is in hospital for seven days and receives dailyvisits for the remaining days.1. Under which Schedule and which item number would the DVA-contractedprovider classify this veteran client during this period?2. What level of personnel would be required to give these services?3. When would the care be reviewed and by whom (eg level of personnel)?Answer Scenario 51. Clinical Care Schedule: Medication Administration - the item number claimed for this28-day claim period would be NY08 (15 – 21 visits)2. Personnel used to deliver Medication Administration services must be registerednurses and endorsed enrolled nurses based on their qualifications, experience and thelegislative requirements of the State or Territory in which they work3. As clinical care is involved, the 28-day retrospective and 3 monthly reviews of carewould be conducted by a registered nurseScenario 6A veteran client receives medication prompting five days a week and showers three daysa week. The medication prompting is provided at the same time as the showers on thedays that the showers are undertaken. The veteran client has no other need forcommunity nursing services.1. Under which Schedule and which item number would the DVA-contractedprovider classify this veteran client?2. What level of personnel would be required to give these services?3. When would the care be reviewed and by whom (eg level of personnel)?Answer Scenario 61. As medication can be provided under the Personal Care Schedule, the client would beclassified as NZ042. Medication Prompting services can be delivered by enrolled nurses or nursing supportstaff under the supervision of a registered nurse. Personal care services can bedelivered by an enrolled nurse or nursing support staff3. As assistance with self administration is involved, the 28-day retrospective and 3monthly reviews of care would be conducted by a registered nurseThe Department of Veterans’ Affairs – Community Nursing Guidelines DVA Community NursingClassification System - 'Case Studies' with answers.docPage 4 of 5

Scenario 7A veteran client has complex multiple wounds that require a wound dressing to bechanged. The veteran client also requires personal care assistance to shower three times aweek at the same time.The visit length for the personal care assistance and wound dressing is 50 minutes pervisit, with the wound dressing taking 30 minutes and the personal care 20 minutes.1. Under which Schedule and which item number would the DVA-contractedprovider classify this veteran client?2. What is another likely item that the provider could claim and how would thisclaim be made?3. What level of personnel would be required to give these services?4. When would the care be reviewed and by whom (eg level of personnel)?Answer Scenario 71. As the majority of care is associated with the wound dressings, the client should beclassified under the Clinical Care Schedule – Technical. The item claimed is NY032. The provider could also claim an Additional Component – Wound ManagementConsumables item number either through the Schedule of Fees or directly to the DVAContract Management staff for consumables costing over $150 in the 28-day period3. Clinical care services must be delivered by a registered nurse or enrolled nurse*Personal care services can be delivered by an enrolled nurse or nursing support staff4. As clinical care is involved, the 28-day retrospective and 3 monthly reviews of carewould be conducted by a registered nurse* Based on their qualifications, experience and the legislative requirements of the State/Territoryin which they workScenario 8A veteran client is receiving daily personal care assistance (28 visits). The visit lengthoften varies for the visit type over the 28-day claim period (short, medium or long). Howdo I work out which item number to claim?Classification in the Personal Care Schedule is based on the number of visits provided inthe 28-day claim period (Visit Range). There is also provision for a further classificationlevel of Visit Type for the Visit Ranges that fall between 28 and 56 visits in a 28-dayclaim period (28 to 34 visits, 35 to 46 visits and 47 to 56 visits). These are Short,Medium and Long.If in a 28-day claim period the Visit Type varies for the Personal Care Visit Ranges over28 visits (or for Technical client type Visit Length - 20 mins or less / 21 minutes or more)the DVA-contracted community nursing provider would add all the minutes togetherthen divide by the number of visits provided (or number of days of service) todetermine the correct classification to claim based on the average minutes per visit (or perday). This method would also be used to determine the Visit Length for a Technical orTechnical Variation Client Type.The Department of Veterans’ Affairs – Community Nursing Guidelines DVA Community NursingClassification System - 'Case Studies' with answers.docPage 5 of 5