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Criteria for Singles Charge for Patients Receiving 1 to 1 Care not in an ICU Setting (9.10)

Criteria for Singles Charge for Patients Receiving 1 to 1 Care not in an ICU Setting (9.10) - Policies, Administrative, UWHC, Department Specific, Nursing Administrative, Patient Charges

9.10

POLICY & PROCEDURE





Effective Date:
September 21, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.10

Original
Revision

Page 1
Of 4

Title: Criteria for Singles Charge for Patients
Receiving 1 to 1 Care Not in an ICU Setting



I. PURPOSE:
A. Patients will be charged a higher daily care rate when they are admitted to selected
inpatient units and meet certain criteria as specified in the Policy section below.
II. POLICY:
A. This Daily Care Non-ICU Singled charge (1 To 1 Staffing on General Care Unit) applies
only to the general care units: Pediatric Hem/Onc/BMT/Neuro/Plastics (93480) and Adult
Hem/Onc/BMT (93680).
B. Criteria for Daily Care Non-ICU Singled charge:
1. To receive this higher charge, the patient would need to have received 1 on 1 care
from an RN for greater than 4 consecutive hours within a 24 hour period. The
charge will be applied only when the 1 on 1 care of a patient is warranted based
upon the criteria as outlined below.
C. Criteria for "singling" patients in a non-ICU setting
1. For a patient to be considered 1:1, at least one of the following criteria must be
met. The Care Team Leader (CTL) and nurse caring for the patient determine if
the patient meets the criteria for the 1:1 nursing care.
a. Neurological:
i. New onset of neurologic changes requiring continuous monitoring
b. Cardiovascular:
i. Patients with unstable hemodynamics as evidenced by blood
pressure and pulse instability requiring interventions including
fluid resuscitation, volume expanders, etc.
c. Respiratory:
i. Patients with low or unstable pulse oximetry who may require
frequent interventions (suctioning, changing oxygen requirement)
d. Gastro Intestinal/Urinary (GI/GU)
i. Patients with an active GI/GU bleed who are unstable requiring
frequent (throughout the day/evening) and/or continuous blood
product transfusions or other infusions intended to control
bleeding.
e. Skin:
i. Patients with large dressing changes or skin care due to severe graft
versus host complications that require four consecutive hours of
nursing time.

POLICY & PROCEDURE





Effective Date:
September 21, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.10

Original
Revision

Page 2
Of 4

Title: Criteria for Singles Charge for Patients
Receiving 1 to 1 Care Not in an ICU Setting



f. Activity:
i. RN presence required in the patient's room during a
procedure/treatment for four or more consecutive hours.
ii. Patient traveling off unit for tests, four or more consecutive hours
and accompanied by a unit-based RN.
III. PROCESS:
A. Application of the Non-ICU Singled charge:
1. The Care Team Leader (CTL) or Nurse Manager (CNM) and the nurse caring for
the patient determine if the patient meets the criteria for 1:1 non-ICU nursing care
(“singling.”).
2. If the criteria for a Non-ICU Singled Care charge are met, then this charge must
be applied by updating the patient’s accommodation code from General Care to
Singled Care. The Singled Care accommodation code must remain in effect
through midnight, when the patient charges are posted for the previous 24 hour
period.
3. If the singles charge criteria has been met, the CTL is responsible for
communicating this to the Health Unit Coordinator (HUC). The HUC is
responsible for updating the accommodation code in HL to Singled Care.
4. It is the responsibility of each Nurse Manager to specify which staff member is
accountable for charge entry when a HUC is not working. Generally, the task of
assuring correct charges are reflected in the system will be assigned to either the
Care Team Leader or the nurse caring for the patient when a HUC is not available.
The assigned staff member is responsible for entering the Singled Care
accommodation code into Health Link.
5. The defining criteria for a Non-ICU Singled charge will be available 24/7 on
uConnect for use by staff.
B. Discontinuation of the Non-ICU Singled Care Charge:
1. The Non-ICU Singled Care charge will remain in effect until the criteria are no
longer met. This daily care charge must be evaluated for appropriateness prior to
midnight on each day of the patient stay.
2. The nurse assigned to the patient (or other staff as delegated by CNM) will
communicate with the Health Unit Coordinator when the Non-ICU Singled Care
charge should be discontinued. To discontinue this charge, the Singled Care
accommodation code is removed and replaced with the appropriate

POLICY & PROCEDURE





Effective Date:
September 21, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.10

Original
Revision

Page 3
Of 4

Title: Criteria for Singles Charge for Patients
Receiving 1 to 1 Care Not in an ICU Setting



accommodation code.
3. It is the responsibility of each Nurse Manager to specify which staff member is
accountable for charge entry when a HUC is not working. Generally, the task of
assuring correct charges are reflected in the system will be assigned to either the
Care Team Leader or the nurse caring for the patient when a HUC is not available.
The assigned staff member is responsible for removing the Singled Care
accommodation code in HL and replacing it with the appropriate accommodation
code.
C. Daily Patient Charge Review:
1. On a daily basis, the Manager or Manager’s delegate (e.g. Care Team
Leader/Senior Team Member (STM) or Health Unit Coordinator) is responsible
for reviewing all active charges before midnight and for assuring that all patient
charges are correct for the midnight charge capture. Data pertinent to the daily
care patient charges can be found in either the home page patient list or the unit
census snapshot report in Health Link. Because Singled Care is activated based on
Nursing Policy criteria, the CNM will determine the process to be used for
assuring the correct application.
2. On a daily basis, the Manager or Manager’s delegate (e.g. Care Team
Leader/STM or Health Unit Coordinator) must review the Daily Activity Journal
report (DAJ) which lists all charges posted for a patient the previous midnight. A
comparison of the DAJ with the unit census snapshot run for the previous 24
hours will be conducted. Any patient charge errors discovered as a result of this
review will be corrected immediately. If the patient is not yet discharged,
corrections can be made in Health Link by the unit staff. If the patient has been
discharged by the time the error is discovered, the unit staff will notify the
Admissions Department. Admissions will then correct the charge error when
feasible to do so.

IV. REVIEWED BY:
A. Nurse Manager, B66-Inpatient Adult Oncology , September 2015
B. Nurse Manager, P4-Pediatric Hem,Onc,BMT, Neuro & Plastic, September 2015
C. Financial Officer for Nursing & Patient Care Services, September 2015
D. Manager, Charge Capture, September 2015
E. Nursing Administrative Policy & Procedure Committee, September 2015

POLICY & PROCEDURE





Effective Date:
September 21, 2015

Administrative Manual
 Nursing Manual
 Other _______________

Policy #:
9.10

Original
Revision

Page 4
Of 4

Title: Criteria for Singles Charge for Patients
Receiving 1 to 1 Care Not in an ICU Setting




SIGNED BY:

Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services,
Chief Nursing Officer