Field Nurse Handbook

Part 5

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1. Overview. Catastrophic cases are defined as those in which the injured worker (IW) has sustained life-threatening injuries or the injury has resulted in extensive functional deficits where the medical recovery is expected to extend over a long or indefinite period of time (traumatic head or spinal cord injuries, severe burns, strokes, multiple fractures, amputations, etc.). Catastrophic cases are primarily those cases involving multiple and/or complex medical conditions and involve multiple and various medical specialists and other health care professionals.

The District Director (or designee) determines when a case should be classified as catastrophic in nature. Cases are then reviewed periodically to determine when/if the case should no longer be considered catastrophic.

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2. Assigning a Field Nurse. Management of catastrophic injuries often requires the Field Nurse (FN) to have specialized knowledge/skills as the immediate intervention is directed at the IW's needs during the acute phase of the injury (usually involving coordination of hospital care with the variety of medical specialists involved in the case) and continues until stabilization has been achieved (e.g. placement in a rehabilitation facility or at home with modifications). Due to the nature and complexity of the assignment, on-site, face-to-face case management services are expected, where possible.

Based on these factors, the SN will assign a FN case manager who is best qualified to provide these specialized services.

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3. Interventions and Contacts. The expectations related to FN interventions and contacts remain consistent with those set forth for Early Disability Management FN assignments. (See Part 3, paragraph 3 of this handbook). Due to the nature of the Catastrophic Case FN Assignment, it is expected that at the outset, the interventions and contacts involved with the nursing case management of these cases will be more complex and require the coordination of more diverse medical services.

FN intervention activities and contacts may include, but are not limited to:

a. Ascertaining whether there is adequate coordination of services through discussion of the case with the varying physicians and other health care professionals;

b. Acting as the liaison between the physicians, CE and IW;

c. Assessing the need for the approval of, or the continuation of, various services such as skilled nursing facilities, home health care, durable medical equipment, etc.; and

d. Assisting in identifying a proper placement for the IW on a long term basis, if necessary.

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4. Timeframes.

a. Once the case has been classified as catastrophic in nature, the SN has the authority to waive the timeframe and expenditure limits normally associated with Early Disability Management FN assignments, and instead establish extended timeframes and expenditure limits based on the needs of the particular case. This is accomplished without the formality associated with documentation of extensions as required with other FN assignment types, however, the CE and SN should document the case file with the initial and updated authorized limits for the Catastrophic Case FN assignment and communicate the authorizations to the assigned FN.

b. The SN and/or CE then monitors the medical status at regular intervals to assess the ongoing need for the case to continue in catastrophic status for nurse intervention activity. This includes review of the current medical documentation and the FN's case management plan, as well as conferencing with the FN (if needed).

c. Once the SN and/or CE determines that the acute medical issues have resolved or reached a stable plateau and that such intensive nursing intervention is no longer needed, the catastrophic case designation is no longer applicable from a nurse intervention perspective. At that time, the SN and CE assess the need for ongoing FN services and the anticipated length of time that FN services may be necessary.

Specific timeframes should then be documented in the case file and communicated to the FN, along with updated goal(s) and objective(s).

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5. Dual Tracking. A catastrophic case may be appropriate for dual tracking as discussed in Part 3, paragraph 8 of this handbook. The SN, CE and FN should monitor the case status closely to determine when the simultaneous assignment of a Vocational Rehabilitation Counselor would be beneficial (and initiate the recommendation and referral for dual tracking assignment).

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