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Documentation, Time Management, Help!!!


I have been working as an RN case manager in home health for almost two years now. I'll preface this by saying I love almost everything about this job. Except for......the hours I spend on charting!! I know this is the unfortunate part of home health care, but I feel like there has to be a better way to do things than I have been doing them. Are there any of you out there who are able to do this job well, get your charting work done during the day, and not spend hours and hours each night and weekend away from family time because you are catching up on the never ending charting? This has been my life. It's starting to drag me down badly. So much so that I've considered going back to the hospital and that's something I never thought I would ever consider again.

Please, if any of you home health nurses have mastered the skill of documentation and time management so that you still have a life, please, please, please let me know your secret! How do you usually organize your day, etc? I've heard some people say chart everything in the home, but honestly that doesn't seem realistic to me, especially for OASIS visits.

Thanks in advance! I hope this post gets some answers!:)

I don't typically have that problem.

Can you describe how your day goes to see where it might be tweaked?

Also, how about your coworkers? Are they spending hours after work as well?

Edited by Libby1987

In my view, the answer is to complete the vast majority of your documentation at point of service. I sit in my patient's home, drive, or in a nearby safe location in my truck to complete the required forms and checklists.

I make MD phone calls during the visit so that the patient hears what I am saying to/requesting from the MD. I direct the MD office to contact my employer office with their response as I will be driving and unavailable.

The best suggestion that I can make is to become extremely efficient with your hands on nursing care, practice the skill of interacting with the patient verbally WHILE documenting your visit, and get as much of the charting done in the patient home as is humanly possible.

We use electronic documentation.

I have worked with people who have perfected "canned" documentation for situations that occur frequently. The more you work in the field, the more you will see opportunities to use phrases that you don't have to mull over for time-consuming minutes when charting.

How many patients do you see in a day? Does the number go down when you do an admission? Do you paper or computer chart?

I have both home care and hospice experience, at different agencies. I am relatively new to home care visits (paper charting) and am also trying to figure out time mgmt. I am ok most days, but I rarely (yet) have a full visit load. When I look at other nurses that have full loads, it seems like they are days to weeks behind on their charting. Eeek. No way am I comfortable with that!! On the other hand, I have some prior experience with hospice (computer charting) and was pretty good at time mgmt until we switched to new software program.

I average 6 *visits*. That can be 4 revisits and 1 admit or some other rough mix that averages out at 6/day.

I chart both POS and offsite, it depends on how I've scheduled the patients and what else I've got going. Sometimes I want to complete my visit/s as quickly as possible to do something else (personal appt or something) and will combine my charting off site.

I don't chart my admits in the home whether paper or EMR unless I'm otherwise tied there and delayed in leaving. Patients don't like it, I've had comments consistently to that end about the other nurses who completed their open in the home. I've got the essential questions down and can whip thru the admit charting at one sitting.

However that means the visit will have to be less time. Completing the admit and charting at POS may be more time efficient overall but it just isn't my preference for what and how I want to accomplish things at SOC. I don't want to be tied up working on my computer when I'm just getting acquainted and establishing a relationship, but that's a personal style thing.

I do my own f/u visits and once I set up things on the front end, most revisits are quicker and streamlined.

Edited by Libby1987

I prepare patients at first visit to expect that they will see me using a variety of "tools" so complete my work and one of them is a laptop. I tell them to expect to see me and other disciplines opening the laptop to verify information and to create notes for the current visit.

I engage in conversation with the patient while I am documenting. I can type and make eye contact at the same time, often enough to keep the patient/family engaged.