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Kittypower123, ADN, BSN, RN 4,302 Views

Joined Feb 13, '09. Posts: 143 (66% Liked) Likes: 283

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  • Sep 29

    There are a few things that help your patients and their families to have positive experience. First, don't promise anything that you can't personally deliver on. If it's not up to you, don't promise. Be honest about what you and hospice can and cannot do. Second, check meds at every visit and order any refills needed. If you wait for them to tell you, they will be calling after hours and on the weekend. Third, educate. The patient and family need to know what's coming. They need to know what changes will occur. When they don't know what's coming, they panic needlessly. That doesn't do anyone any good. They need to know which things they can and should do something about (and what to do) and which are natural and do not cause discomfort. Don't make the mistake of educating once and figuring they'll remember. They won't. Educate again, and again, and again. Finally, don't rush. Things will come more naturally and will take less time as you gain experience. That being said, don't rush a visit. Even when you feel rushed and are trying to get out as quickly as possible, take a breath and focus on what's in front of you. The patient and their family deserve your best.

  • Sep 25

    There are a few things that help your patients and their families to have positive experience. First, don't promise anything that you can't personally deliver on. If it's not up to you, don't promise. Be honest about what you and hospice can and cannot do. Second, check meds at every visit and order any refills needed. If you wait for them to tell you, they will be calling after hours and on the weekend. Third, educate. The patient and family need to know what's coming. They need to know what changes will occur. When they don't know what's coming, they panic needlessly. That doesn't do anyone any good. They need to know which things they can and should do something about (and what to do) and which are natural and do not cause discomfort. Don't make the mistake of educating once and figuring they'll remember. They won't. Educate again, and again, and again. Finally, don't rush. Things will come more naturally and will take less time as you gain experience. That being said, don't rush a visit. Even when you feel rushed and are trying to get out as quickly as possible, take a breath and focus on what's in front of you. The patient and their family deserve your best.

  • Feb 10

    Time management can be difficult. You can plan your week, but it won't turn out that way! One thing I do is front-load my week. I plan to get almost all of my visits done in the first three days of the week. I know it won't happen, but if I plan for 4 visits on Friday, I know I might end up with 8. As I plan my week, I try to cluster visits geographically. I also think about which visits should be pretty straightforward (patient is stable, not much in the way of education needs, etc) and which will likely take more time. I think about which visits can be moved to later in week if something comes up and which can't. Having this information in my mind helps me change plans as I go and still be sure patient needs are being met. I'm constantly reviewing my schedule to check my progress and any changes I've had to make. If I have a CC or GIP patient, I see them first. I know they can take more time and I want get them taken care of. Most of time, if something else comes up with them after the visit, I can handle it by phone. It's tough to get time managed well in hospice, it takes time and practice. Use the frustrations with time management to learn. It will get easier.

    As for documentation, that takes practice too. Remember to document decline. For example, on admission patient ambulated with rolling walker, now confined to wheelchair. Also, you don't need to write a narrative for every system. Focus on what is an issue for that particular patient. For example, if you have a CHF patient, what is their b/p, hr, heart rhythm, do they have edema, is it better/worse/the same, are they on oxygen, are they compliant with meds, what education did they need, etc. For us, the assessment is mostly checking boxes and imputing certain stats like vital signs, last BM, Diet and % eaten, pain rating, that sort of thing. The narrative itself doesn't need to be long, just focus on the reason for the visit or the particular issues for that patient.

  • Nov 25 '16

    I was watching The Walking Dead and the town they were in was attacked. Not by zombies, by other people. Anyway, a woman is carried into the clinic with a large slash wound to her abdomen. The lady who was the "doctor" (she was actually a psychiatrist, but at least she'd been to med school, right?) says "She's severed her femoral artery."



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