How do you do it? Pt satisfaction and ease of scheduling visits?

[rnkwissie]

Our agency has a chronic problem of trying to get the ease of scheduling at a point where it is "doable" for the clinician, and makes the pt happy. We are a growing agency with our RN CM having 20-23 pts to CM. In addition to RN, we have LVNs, PT, OT, MSW, HHA, RD. We use HCHB for our scheduling/charting, and the field clinicians use Tablets to chart in the homes. With HCHB we cannot see each other's calendars.

We expect the nurses to either average 4 pts a day,or average 6.4 pts/in 8 hr day during a pay period.

The expectation is for all RN CM to see their pts at least once a week (LVNs help fill in the ordered frequency)and each day to leave room for a SOC (2.5pts)

The issues we are having:

1. Some RNs not seeing their pts weekly

2. Lack of continuity (often times the RN will let the LVN CM, which is not acceptable)

3. Pts are promised visits by staff seeing pt, due to the projected schedule in HCHB, and are upset when the visits are not occurring, despite the fact no one called to confirm the visit.

We cover a very large demographic area. It is not uncommon for daily milage to be between 70-90+ miles a day.

I guess there are really 2 issues I need help with

1. How do you increase the communication between all the disciplines seeing the pt (including projected visits)

2. How do you handle scheduling of pts visits, when they all want a visit after 11, but before 2?

We have tried many things, but I'd be curious to see what has worked for others.

I feel like we are banging our heads against the wall to make the pts and the clinicians happy.

[KelRN215, BSN, RN]

Re: the scheduling of visits. Don't give them that much of a choice. We (RN visit staff) schedule all our own visits, we know our schedules and patients have limited choices. These are the times I have available, take your pick. Someone has to have the 8am visit. For most of my patients, that's the coveted visit though. We don't have LPNs do visits in my program because they can't push chemo or do a lot of the other things our visits entail. Many of our patients are not seen once/week because they don't need to be seen that frequently so we don't have these issues.

[redfoxglove]

Agree with Kel above. Don't give the patients so much of a range. Give the patient a choice, morning or afternoon? 8 am to 10 am or 10 am to noon?

In our agency RN sees the patient every 2 weeks if they have wound, a bath aide, or something complicated. Otherwise LPNs do the weekly care.

We increase communication via email, a bimonthly meeting with the DON, and a weekly all staff meeting. It's still not a perfect world, but we work at it.

[LaRN]

make your schedule and map your pts out in the order you will travel. then call and be direct... tell them an approx time you will be in their area (with a 1-2 hr window) and that they are scheduled for a visit. most will grumble about any time you give them, but don't budge (unless they have md appt). Occasionally I will have a pt give me a hard time, and I tell them very kindly, sorry thats the only time i will be in that area. worse case scenario, they don't get a visit that week.

text worke best for most. had a supervisor who used to fill out slips on anything the nurse failed to communicate and gave them to us. at one point, communication sucked so bad, we were required to call the office after every visit and give a report to the cm or supervisor. that got old really fast.