There are sample procedures for use for those "what if" situations that may be encountered. Each agency must review these sample procedures and either use the procedures or modify them to meet the agency’s needs. An example of a procedure is "what if a patient is admitted to the hospital for more than 48 hours and comes back to home care with the same condition?"  The patient had completed 5 visits of the pathway before the hospitalization. It should not be assumed that the next visit would be visit 6. Therefore, a procedure may be to "complete the Multipurpose Visit Note for the Post-Hospital visit and then initiate a new pathway on the next visit, starting with visit 2." (Visit 1 of the pathways relates to the admission visit).

The variance codes should be available.  Encourage the clinicians to become familiar with the codes. Discourage the use of the variance code "7 – Other," unless a sub-code is used. This is an easy one to choose, however, the clinician must write the actual reason for not doing the intervention or why an outcome was not met. This is less efficient than writing what the actual code number is. Most of the time, the clinician’s note explaining this variance "7 – Other" is related to another variance code. If clinicians use the variance codes appropriately, then the agency is able to provide efficient and cost-effective care. For example, the agency is more efficient in case management, reviewing previous notes and completing the next visit, communicating with payers, explaining a particular patient or a population of patients, evaluating the pathways against an agency’s population of patients, and in performing quality improvement studies.