Laptop use in Home Health

In Sept 2002, my homecare agency started McKesson's HBOC Homecare Pathways computer program. Laptop training started in 2003 and completed in one office by 2004. We've added few other offices since then; fifth office started laptop training last week.

In first office we started with, RN's had NO computer familiarity or expertise. One supervisor didn't get a home computer till 2006. We lost 3 nurses who refused to become computer literate. Took 18 months for first office staff 75 nurses to become comfortable and all get up to speed; 25 PT's/OT's then trained.

Today, if computer program down 24hrs to upgrade database and laptop being re-imaged, staff are banging at IT's door to get their laptop back as they HATE the paper.

One branch has Weekend admit nurses that do FIVE admissions each day Fri/Sat/Sun on laptop. Our patients paper charts area are about a quarters thickness. For our frequent flyer patients, I can go back to 2002 to review meds or wound care records with just a few clicks of my computer keyboard.

Two of my staff were age 68 when they learned computer system, so with the right mindset anything is possible! I can put anyone in touch with our IT database administrator ---just PM me if interested.

It is SO worth the few months of grunts and groans to go laptop.

We are a non-profit ifree standing homecare agency along with sister agency in Pittsburgh, part of 5 hospital health system. I manage Central intake Dept for both agency's processing 75 new patient referrals/ day---Fridays have 125-135..... So advantage is enourmous for visit scheduling and follow-up

Documentation is expected to be initiated in the home: Visit reason, Vital signs, medication review and reconciliation current pill bottles/unfilled scripts, pertinent info. Completion of visit note expected same day---then info must be sent from laptop (process called laptop transfer) to main database so others can view instantaneously. Takes 5-10 min on DSL line or 15 -20 min on dial-up conncection --to transfer data automatically.

Our OASIS, agency assessment, nursing care plan along with plan of treatment (485) are combined into one 17 page document; medication profile is another form and most cumbersome part of entering electonic medical record.

Part of our issue was nurses did not do plans of treatment at time of computer laptop training. Prior OASIS and meds reviewed by CI staff then we generated checklist form that desks data entered into old computer system to print plan of treamtne. This system antiquated for agency our size with 3 clerks behind by average 6 wks from SOC to get 485 typed and sent to doctors. Process was started as too many 485's missing pertanent details when RN's did themselves. (process in place prior to my arrival in March 1999; took over as manager in Sept 2002).
BOXES of forms siting in the office awaiting typing.

As part of pretraining, nurses were educated on combined form described above. Since nurses are often resistent to change and perceived "more work", initial resistanece needed to be overcome. Since I was trained RN's rresponsible for our 485 care plans in colaboration with doctors, I'd been writing my own since mid-1985.
Once that hurdle overcome, things got easier.

It takes about 45 to 70 min to enter OASIS, admision assement, plan of treament and med sheet---more DX and meds, longer it takes. Expeclatio it will be completed and transfered within 48hrs admit start of care. We have our RN coders review next day then lock form if no corrections recommended to RN, Clerks print that day, RN signs off next day and mailed to docs. So 75% of plan of treatments + med orders out the door and returned signed within 10-15 days. 90% nurses have admit completed by next AM.

RE training: staff start out doing revisits in computer 2 per day first week training, 2nd week do 1 admit/1 revisit and progress upward. most see 3-4pts/day 3rd-4th weeks till comfortable with system. 4-5 staff attend each 2 wk class.
RN IT eductor reviews each entry till satisfied "got it"!

Hope this helps.

We are a non-profit ifree standing homecare agency along with sister agency in Pittsburgh, part of 5 hospital health system. I manage Central intake Dept for both agency's processing 75 new patient referrals/ day---Fridays have 125-135..... So advantage is enourmous for visit scheduling and follow-up

Documentation is expected to be initiated in the home: Visit reason, Vital signs, medication review and reconciliation current pill bottles/unfilled scripts, pertinent info. Completion of visit note expected same day---then info must be sent from laptop (process called laptop transfer) to main database so others can view instantaneously. Takes 5-10 min on DSL line or 15 -20 min on dial-up conncection --to transfer data automatically.

Our OASIS, agency assessment, nursing care plan along with plan of treatment (485) are combined into one 17 page document; medication profile is another form and most cumbersome part of entering electonic medical record.

Part of our issue was nurses did not do plans of treatment at time of computer laptop training. Prior OASIS and meds reviewed by CI staff then we generated checklist form that desks data entered into old computer system to print plan of treamtne. This system antiquated for agency our size with 3 clerks behind by average 6 wks from SOC to get 485 typed and sent to doctors. Process was started as too many 485's missing pertanent details when RN's did themselves. (process in place prior to my arrival in March 1999; took over as manager in Sept 2002).
BOXES of forms siting in the office awaiting typing.

As part of pretraining, nurses were educated on combined form described above. Since nurses are often resistent to change and perceived "more work", initial resistanece needed to be overcome. Since I was trained RN's rresponsible for our 485 care plans in colaboration with doctors, I'd been writing my own since mid-1985.
Once that hurdle overcome, things got easier.

It takes about 45 to 70 min to enter OASIS, admision assement, plan of treament and med sheet---more DX and meds, longer it takes. Expeclatio it will be completed and transfered within 48hrs admit start of care. We have our RN coders review next day then lock form if no corrections recommended to RN, Clerks print that day, RN signs off next day and mailed to docs. So 75% of plan of treatments + med orders out the door and returned signed within 10-15 days. 90% nurses have admit completed by next AM.

RE training: staff start out doing revisits in computer 2 per day first week training, 2nd week do 1 admit/1 revisit and progress upward. most see 3-4pts/day 3rd-4th weeks till comfortable with system.
RN IT eductor reviews each entry till satisfied "got it"! We

Hope this helps.

I haven't worked for an agency that uses laptops yet. Even though most people using laptops have expressed that they are very happy with the process, I don't look forward to it. One of the reasons is that I do not care to be carrying around a valuable piece of equipment that further makes me vulnerable to criminal activity. It's bad enough that I have to take myself and my car and a little bit of money and my nursing bag with me when I go out into the wilds. I also have my own viewpoint concerning computer patient documentation. I do not agree with the entire concept, even though it is expedient. JMHO.

I used a laptop last year when I worked for a HHA and I didn't like it. To me, it was just another piece of equipment to have to keep up with. I never took mine into my patients' homes not only because I feared that it would be stolen, but also because it took up too much time during the visit to set up. Instead, I printed off hard copies of visit notes and OASIS forms beforehand and used them to record my assessments before doing the actual data entry.

I like your idea CseMgr1 and will use it if I ever have to use a laptop. Thanks for sharing.

No problem. Anything to make life easier!