How to decide visit frequency?

doodlemom · Nov 23, 2006

I've never seen any flow chart or algorhythms regarding visits. It is so hard to predict. I usually make a plan for the week on Monday and try to stick to it - but so many things change. Someone that may have seemed pretty stable on Monday may now be having symptoms that require me to make 2-3 visits this week. My usual weekly plan has the intention of seeing each person at least once and the ones who are more symptomatic, I'll schedule for 2-3 times. Then there are the imminent ones that I plan to see QD.

EmptytheBoat · Nov 23, 2006

Ditto doodlemom! I have seen a flow chart/algorhythm for CNA/HHA

visits, but not for nurses, and I'm not smart enough to even envision

this being done. I make a weekly schedule and try to follow but triage

daily and adjust accordingly, and then you have the new admits to

factor in. Best wishes!

aimeee, BSN, RN · Nov 24, 2006

Our patients can change so rapidly that it would be hard to do this. We plan for 2 visits a week and the second visit might turn into a phone visit if they are pretty stable and additional visits are needed for others that are rapidly changing. I think you just have to assess this day by day.

AtlantaRN, RN · Dec 16, 2006

I was wondering that myself. I had a nursing home patient admission the other day, and the daughter (who was power of attorney said), well "we want as much as we can get). I explained a home health aide can come 5 days a week, but as he is stable, it is normal once a week, but of course the nursing home can call me at anytime to see him. She kept saying "we want as much as we can get."

Linda

CapeCodMermaid, RN · Dec 17, 2006

The two hospices we have contracts with base their visits on the skills needed. If someone is on 'routine' hospice, the HHA comes 5 times a week and a nurse once a week. If they are on an 'inpatient' level of hospice, the nurse comes once a day.

a21chdchic · Jun 29, 2007

I base my # of visits/week on how stable my patients are. All of my patients are in facilities, so the facility is the primary caregiver, and they are skilled caregivers (nurses), I visit daily for imminent patients, once a week for stable patients, and 2-3 times per week for patients who are actively declining - this is usually required for med management - as you need to evaluate the response to the meds ordered, to evaluate for further changes that may be needed.

Ana

chris_at_lucas_RN, RN · Jul 14, 2007

I was wondering that myself. I had a nursing home patient admission the other day, and the daughter (who was power of attorney said), well "we want as much as we can get). I explained a home health aide can come 5 days a week, but as he is stable, it is normal once a week, but of course the nursing home can call me at anytime to see him. She kept saying "we want as much as we can get."
Linda

Hi, Linda--

I see this occasionally too. Usually with people either not able to accept the hospice concept and the idea the patient is dying, or, as in my most recent case, the person had been sick all their lives, married a person who had recent extended hospital and rehab experience due to trauma, and the latter was used to drawing lots of attn to himself and the patient.

I could be there for two hours, leave, and five minutes after the evening crew came on, there would be the call. The RN would go out, and the patient would be peaceful, comfy with no signs described by the CG.

The best spin I can put on this is, anxious about the course of the patient's care.

The more realistic is, related to that unfortunate attitude we see sometimes where people are used to getting lots and lots for free, whether they need it or not, and by damn they are going to get lots and lots from you too.

In the latter situation, explain clearly and gently that more is not always better, that we cannot and should not be in the home more than is necessary to support the family and friends and the patient, that the kind of nursing they envision might be more "hospital" and "hospice," and that the constant intrusion of staff undermines the peaceful process in the home.

Good luck. When it is personality, you are pretty much jammed. Be sure to be gentle and caring, and document in as much detail as you can. These are the ones that will fire you as soon as look at you, and you have to cover yourself, liability wise.