Chasing doen pt's

caliotter3 · May 20, 2010

I would not just show up without an appointment. There can be other matters involved than you just showing up unannounced. Make the call, make several calls, and of course, document your attempts. But I would never just "show up" unless that was a prearranged practice acceptable for a particular patient.

annaedRN, RN · May 20, 2010

Are these patients homebound? Sounds like the situation needs to be reassessed...

KateRN1 · May 20, 2010

Our policy is to call the patient the night before to give them a window of time when you expect you will be there the next day, say between 2 and 4. Then call them when you're on the way to make sure they're there and as soon as possible if you're running late or early so that they can plan accordingly.

Patients can be homebound and yet still leave the house on occasion. And sometimes they don't hear the phone or know how to use the voice mail/answering machine. If I've tried to call several times, left messages with no call back, I do a drive-by and leave a door-hanger if they're not home.

annaedRN, RN · May 21, 2010

We make sure the patient know what day we are coming again when we are leaving a visit..then a phone call that morning to let them know approx time of visit that day. of course we work around md/other appts, family functions, etc. If it is an occasional thing, then that is fine, but if it starts being "chasing them down" often kinda thing -that is what should be reassessed.

ilovenursing2009 · May 21, 2010

Are these patients homebound? Sounds like the situation needs to be reassessed...

Yeah, they are homebound. The chasing is not literal!! I am getting so tired of making phone call after phone call. I left a message telling them I will be there between a certain time. I never get a call back. I am going to show up unannounced....if they are ticked it is not my problem.

ilovenursing2009 · May 21, 2010

We make sure the patient know what day we are coming again when we are leaving a visit..then a phone call that morning to let them know approx time of visit that day. of course we work around md/other appts, family functions, etc. If it is an occasional thing, then that is fine, but if it starts being "chasing them down" often kinda thing -that is what should be reassessed.

Do you fax or call the Dr. to report the situation....? I just wish I could d/c the pt for non-compliance. I feel bad though because it is not the pt's fault. It is the families for not communicating.

KateRN1 · May 21, 2010

Not returning phone calls is possibly rude, but certainly doesn't count as non-compliance. Perhaps the patient doesn't know that you expect a call back? Maybe they think you are just calling to let them know you're on the way. Or maybe they don't understand how to use answering machine/voice mail. I had a patient once who swore up and down he didn't have voice mail on his phone after I had lefthim several messages. His daughter had to show him how to use it, he honestly had no clue. In any case, if you have called and left messages, you are not showing up unannounced, you've announced yourself quite well. Just remember that home health care revolves around the patient, not the nurse.

caliotter3 · May 21, 2010

If I don't get an acknowledgement from the person I am trying to reach, I don't assume they are going to comply with my plans to visit them. They can go on about their business and I still drive all the way to an out of the way address to find no one at home. Since I didn't speak to someone at the home, there is no one to blame but myself. I don't rely on phone messages because voicemail is unreliable. If the agency pays for your gas and your hours to drive there, no bother. But my agency does not pay me when I don't get a signature for a visit. And 9 times out of 10, the client doesn't care whether I know what is going on or don't. They are involved in their own concerns.

Lacie, BSN, RN · May 21, 2010

We call the night before, then when on our way. If no response after multiple calls then we do a driveby and leave a door hanger. Recently a pt was in the home and found dead in the floor after a weekend, you never know. Also document, document, and should I say it again document. Use a communication note documenting your attempts for the the chart. If you can confirm they are out for anything else then the allowable reasons and it's repeatedly occuring then reassess that homebound status. You also call the doc every missed visit.

anticoagulationurse · May 22, 2010

I will just add that I do sometimes just stop by for patients who are particularly elusive and never return calls and frequently decline visits... I just show up and say, "Oh gee whiz, you weren't expecting me? Well, is now a good time for you anyway?" It has worked out in my favor 100% of the time and sure beats wasting time chasing the patient you know is home bound anyway!

TAANDOHRN · May 25, 2010

I hate to admit but you know some patients you just have to chase down! No matter how hard you arrange a time to visit and they agree they somewho are not home!! These particular patients tend to do well with the drive by method. Most of the time you can catch them at home especially if you stop by in the morning before they get going! If they are not there then you can simply leave them a doorhanger and notify everyone that needs to be notified. I have done drive by only to find that patient in some weird problem that I was glad that I did do a drive by or the situtition could have been a lot worst. I think making an attempt to at least see that patient is better than not going by because you couldn't reach them! Good Luck!