Home Health & Hospice

Do Not Mix PRN and Aide Assignments

Homecare Insider, August 3, 2009

Home health aide services receive considerable scrutiny during surveys.  Surveyors must ensure that aides are competent, provide appropriate care under supervision, and participate in in-service education.  Because providers want to avoid problems during the survey, they ask questions like this one.

Can we assign home health aides to perform PRN duties, such as a bath or shampoo?

Some surveyors are not too keen on the use of PRN duties on the aide assignment.  PRN means as needed.  Deciding when the patient needs a treatment or service takes a certain level of judgment and discretion.  Aides may not possess these abilities because of their level of training and education.  It is within the aide’s scope of responsibility to determine when a patient may need a shave.  However, because an agency is responsible for its patients, it must take action to ensure that they receive appropriate care.  

Aides must know when and how to care for the patient.  The nurse must assign specific duties and times whenever possible.  If the patient doesn’t want the shampoo at the assigned time, the aide can document the patient’s refusal.  If a patient starts refusing too much care, investigate what is happening.  For patients who are able to direct and participate in their care, “per patient request” may be an appropriate directive.  Example:  Sponge bath at sink or shower as patient requests.

The Home Health Aide A to Z Pocket Reference can teach your home health aides proper observation and documentation and also help your nurses develop appropriate assignments.  Check out this handbook.