Please share your home care nursing tips/tricks with others

RuthRo · Oct 2, 2012

I thought it would be helpful if we shared our tips/tricks for staying sane in home care with others. For example, How do you keep your paperwork organized? How do you keep your lunch cold?, How do you prepare for the weather? How do you organize your supplies, etc. Any tips for dealing with non-compliant patients? I'll start..
1. If you are taking supplies from the office use the "Noahs Ark" technique and always take two. That way if there are problems with the first one your covered. (I know this may not be allowed anymore).
2. My agency is on computers and I keep a word document with phrases/skills that I can copy and paste into documents. Saves time!
3. I bought a car desk online and this helps keeping the paperwork organized and not having items falling all over the car.
4 We use computers and have installed BMI calculator, 60 day episode calendar, 3M coder, and other reference material on each desktop for easy access.
5. One of the best, most liked by my clients, med teaching tools can be found at Mymedschedule.com. It is simple to understand, quick to make and has pictures of non-generic meds. It's built with only your cl's meds. My clients LOVE it.
6. Do as much of the doc as you can while in the home, even if you have to sched. the visits further apart. Jamming the visits in then trying to do the doc after you're done is a lose/lose habit.
7. We use ranges for our orders (not using scheduler yet). This makes it's easier to juggle your visits around. You can also make a phone visit if you just run out of time and are still within your range. These are non-billable though.
8. As far as non compliant clients. We are going by the philosophy of," if you're not willing to do the work to stay healthy then why are we here?" give them the info then dc.
We also contract with known non-compliant people, even before they leave the hospital. Break the agreement and you're done.

Sterlink · Oct 25, 2012

How about how much time it takes to know what's really going on? I had a daughter call me back and say she could NOT get her mom to a doctor's appt. Seemed to be saying "it's her problem." I was surprised. But the next day, the daughter called me back....she has issues with her mom, but after sleeping on it, she wanted to call me back...and I learned a lot more about these particular family dynamics.

paradiseboundRN · Oct 26, 2012

Happens all the time and it is a time suck! Don't know of any shortcuts for that. The parent-adult child relationship is very complex. Sometimes I feel more like a social worker than a nurse.

I<3H2O, BSN, RN · Oct 26, 2012

You all have some really great tips! I really love the mymedschedule.com site, I've never used that but you can bet I will now!!

I don't really have any amazing tips to share but I look forward to reading more.

RuthRo · Nov 24, 2012

You stated the answer to your problem. Get an order for a MSW and let them duke it out with the family and client. Just make sure from the get go that everyone understands the role of the nurse. We have had a lot of families that thought we could just run over to clean their family member up after being incontinent. Make sure they understand what skilled care is and that insurance and MCA will not pay for non-skilled care.

eaduarte · Nov 24, 2012

I have gotten really good at redirecting patients/families when they start to yak on and on about irrelevant information. Of course as we all know people are lonely and we are sometimes the only people they see and talk to. I basically multitask. If they are a chatter then I will let them talk on and on while I chart on my computer. I make eye contact intermittently while they talk and have found that they actually add little bits that can add to my assessment while they are talking. Also I will interrupt them and just point blank ask them a question that I need for my assessment. I haven't found that anybody gets offended by this. For the most part they know I have a job to do, that I am there for a purpose and me letting them talk about the weather or the holiday food prep is just bonus. Again, it is an acquired skill and I have realized that while they are talking I can get things I need to get done, killing two birds with one stone. If you sit there and not chart while they drone on and on about their grandchild, then you are wasting your precious time and will have a ton of charting to do later.

I agree with charting at bedside or out in your car immediately after the visit. I find that if I force myself to do it then I am much better off in the long run because I am not annoyed, stressed, and anxious about having to do all my charting at the end of the day when I am already tired and ready to be off work.

I keep a notebook and use the front of the right side and back of the left side to do my day's schedule and notes. That way I can look at it quickly if needed, such as addresses and phone numbers. I also number the order that I am seeing people and the time ranges I have given them, that way I don't have to open my computer and log on to see their number and address.

One thing that we do with supplies is place them in separate paper bags, and put the patient name on it. That way all you do is grab your regular kit and the patient's paper bag with supplies and you are on your way. No more sorting and digging.

I also like to fill out lab forms at the office before I get in my car. I hate having to write stuff in the car.

Paperwork, I organize in a plastic bin (one that is file folder sized) and keep things in labeled folders in alphabetical order.

I will have to check out your patient education website.

Sterlink · Nov 24, 2012

"front of the right side, back of the left side..." please explain that again...not sure what you mean...

lovingtheunloved, ASN, RN · Nov 25, 2012

I guess I'm the only one who finds it easier to see all my pts and then chart in the office? I seem to get done faster that way.

eaduarte · Nov 25, 2012

I have a small hard cover notebook that is about the size of a grocery list pad (like maybe 3 inches across and 6 inches in height). When I open the notebook it lays flat and so I use the opened and exposed pages for one day. Therefore the left side is the back of the previous page, the right side is the front (or the usual place you would be writing in a notebook). I use both for the same day so that I don't have to flip pages (as inevitably I don't have enough room to write everything on just the right side (regular page). I am sure I said it where it is confusing and too complex, but hopefully I have illustrated what I mean now.

Anyway, I usually space out the patient's names and have their addresses and phone numbers and small reminders about the visit written under (or around them). Then I also number the order I will see them and also the time frames that I am going to see them (so that I have a reminder in case I am running behind and also have handy info so that I can manage things easier without having to open and log on to my computer). Then as the day goes by and I complete (finish charting on them) I strike a line through the patient's notes on my notebook page and that way I know that I did everything that I needed to (charting, phone calls to MD, etc) and I don't have to click and look back on the computer to make sure all my areas were charted and covered. If I don't have a line through the name then I know there are some loose ends that I need to get completed. I also use the notebook to jot down notes (around the appropriate patient's name) to help me remember things (such as need to call MD Smith about PT/INR, or make a note about supply needs next visit, etc.) that way I can do those things later when the time is more appropriate. I just find this easy for me to stay organized, make notes, yet not have anything tied to the computer (which mine constantly loses charge, so depending entirely upon it for all patient info---like phone numbers and addresses--would be harder for me to use and I feel like constantly rebooting my computer really sucks and takes too long when I just need to know something quick). My little notebook also helps me remind myself about a patient from a previous visit, like if a name is familiar but I can't think of the patient offhand, then I can look back on previous entries and maybe trigger something about the patient or their location--like how to get to their house).

Again, it is just something that helps me and may not be for everybody.

I have also utilized the "post it notes" feature or program on my computer which allows me to add little sticky (or post it) notes on the desktop screen of my computer. Of course I still like a physical piece of paper, but this helps keep phrases or details that I need for my note handy where I can just cut and paste.

Sterlink · Nov 26, 2012

Got it. Yeah, good to have something to look at quickly. I know what you mean about having to go back to the computer for something simple...

Mandy LVN · Nov 26, 2012

I am an LVN, did HH for about 8 months before taking a "sebatical" However, while I was working, I had a patient that would call me and the CM because she had an episode of bowel incontinence. My CM sent me over to her house to clean her up....I was over 50 miles away and had 5 more visits that day!