Do you have this problem too?

  1. So 8 months into working HH per diem, and I have noticed that some days I can't get ahold of the patients. They either don't answer the phone, asked to be rescheduled, or something. So I end up having 5 .people to see in the morning, to actually making 2 visits. As per diem I get paid per visit. So I get frustrated when I plan to see 5 and only get 2 in. What do you guys do or suggest I do to fix this?? Thoughts?
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    About nursynurseRN

    Joined: Nov '06; Posts: 300; Likes: 131
    RN; from US
    Specialty: 12 year(s) of experience in TELEMETRY


  3. by   suanniam4
    I agree, very frustrating part of HH. Yesterday, had 6, 1 hospitalized, 1 chf clinic, 1 no answer.
    Ended up with 3 only. With big gaps between the visits, d/t pt not wanting visits till after 11am etc..
    I was thinking why am I doing this. Also, see how hard it is to take a week unpaid vacation, have to give
    report, write up nurse to nurse and wrap up issues before you leave. All unpaid of course.
  4. by   nursynurseRN
    So this is what you called the bad part of HH I bet....
  5. by   livelaughlove09
    I have this problem sometimes. I'll tell you what I do. First let me say I am NOT the most organized person, but it can bite me sometimes, so i just keep it simple. I make my schedule for the next week late in the week (Thursday or Friday.) I always ask my patients about next Dr. Appt. and make a note of it so I know to not even bother with that day. Usually I'll even plug them in on the following day on the schedule and tell them I'd like to see them to follow up on their MD visit, get new orders, med changes, etc. Then I look at patients who have regular orders (wound care mon/wed/fri, infusions that have labs every Monday) and I fill those patients in first. Then I take into consideration acuity level, visit pattern, last visit, and of course location (lol) and fill those patients in.

    I always call patients the night before to schedule the appointment, unless I'm swamped and I don't get home from work until after 8, but sometimes when that happens I just stop and take a few minutes to call and schedule. Some agencies I know call same day, and it's great to have the flexibility to do that last minute but I find on rare occasions I don't schedule the night before I'm almost begging my visits in. If I don't get in touch with someone (and it's not an ordered visit for labs or what have you) then I fill them in with someone else who is conveniently located near my route who actually answers their phone and move that person to another day. It doesn't take too long to figure out who never answers their phone and then I just leave a message "Mrs. Smith, it's the nurse, I'm planning on seeing you tomorrow between 10-11." Sometimes I get there and they've gone out to the hospital, but if they're one of those that never answers there's no way to know that and oh well it happens.

    There's always those new admits that take longer than expected, but I mostly manage to avoid those visits you think are going to be in and out and you get there and find out the patient fell two days ago so you need an incident report and yesterday they went to the PCP and he decided to change all their meds around and they're holding a Spiriva playing with it saying "how do you use this thing?" because they're going to spill all that when you call to make the appointment so I know ahead of time to schedule a little bit of extra time to deal with all that. I can normally manage to stay within the arranged times though, and the patients are there expecting me.

    Oh and did I mention I REALLY dislike having a bunch of "oh no you can't come until after 11" at the same time.
  6. by   nursynurseRN
    Wow that sounds Luke a great idea. The only problem for me would br that since I work st the hospital some says too, it would be difficult to call in advance. The prep. Work would probably help getting my visits in though.the other problem is that the manager sometimes decides to change my patients day of..... But love your plan if I was fill time
  7. by   paradiseboundRN
    Call patients the night before and write your visit on a calendar in the home. Also use the same calender to write down their doctors visits. If there not home a lot and not at doctors appts; Are they homebound?
  8. by   livelaughlove09
    "if you have a better social life than I do, you're not homebound."
  9. by   paradiseboundRN
    Love it!
  10. by   KelRN215
    For my regular patients, I like to schedule their next visit when I'm with them and keep it consistent. For example, I have one patient I see every Tuesday at 4pm, another Wednesday at 9am and another Friday at 8am. It works for some and not for others. One of my regular patients, I have to call them every week and they're still not always there when I get there! The turn around on my patients can be pretty quick and things also change frequently with them... and I do pediatrics so the homebound rules that apply to adults don't always apply. I get a lot of "well, he's going to school and then he has to get on a boat for his high school dance at 4pm, so you can only come between 2:30-3:30 pm".

    Today, I was supposed to do a PRN visit at 10am (because the family called yesterday saying they needed help) and then the father called me and said they were just going to the ER. I've had that happen many times where the child gets admitted and the family forgets that they had a visiting nurse appointment so I get there and no one's home. When kids are admitted on the weekend, especially, there are no Case Managers at the hospital to call to notify the agency and the Case Managers often don't get around to making these calls until the middle of the day on Monday, so Monday morning appointments are the frequent "not found" patients, at least that's what I'm finding. We are also paid per visit but we do get a small amount for show up pay if the patient is not home.
  11. by   livelaughlove09
    I like to schedule with mine for their next visit as well, I just can't lock down a time with them unless day they're the closest ones to my house. I have a very large area and we get SOC's the day before so I never know until the night before after 5 where all I have to be. We also get that no show or refusal pay, which is okay, I just hate having the rest of my schedule off because of a missed appointment. I'm sure we all do lol.