New to Home Health any pointers?

Alex Egan, LPN, EMT-B · Feb 6, 2012

Hi. My question to you is what kind of home health are you doing? Visits, shift work, well baby? They are all home health but the approch varies quite a bit.

RachelRN2011 · Feb 6, 2012

I am doing visits, wounds, PICCS, etc... Does that help?

tlancio · Feb 6, 2012

Hi, I've been in Home Care for about 14 years now, doing Oncology Home Care. I'm assuming your doing med-surg patient care visits right? My advice is to be organized at the start of your day so that if you need to change your schedule you'll be able to without feeling overwhelmed. What I mean by that is 1. Map out the best route to get to your patients homes. Don't count on your GPS, it's not always right. I ask for directions when I'm talking with the patient. This saves time and gas. 2. Have all the supplies needed. When calling a patient make sure you ask if supplies are in the home, otherwise you might have to make another trip to the home, big time waster. 3. Speaking of supplies make sure you have supplies in your car box for those times you can't get to the office like when working evening, weekends or on call. 4. Have someone or a company you can call if you have car problems such as AAA, or a friend who could pick you up and have a flashlight, flares, jumper cables, blanket, snack foods in your car for times when you are strained. These are my 4 top things that have ruined my day over the years of working in home care. Hope this helps.

84RN · Feb 7, 2012

A fellow RN gave me a book that's been a huge help, since my background was not Med/Surg: "Pocket Guide to Home Care Standards: Complete Guidelines for Clinical Practice, Documentation, and Reimbursement." For each diagnosis, it has sections explaining basic info about dx, then Previsit Checklist, Safety Requirements, Major Diagnostic Codes, Defense of homebound status, Selected nursing diagnoses and patient outcomes, skilled nursing services including care measures and patient/family teaching, Interdisciplinary actions, Discharge plan, Documentation requirements, and Reimbursement reminders.

Organization is key, and I'm just now figuring out a system that works best for me. I have a binder where I keep each of my patients information in a section. It starts with a clear protector sheet that has their calendar and 485 and also my notes from the SOC and referral. Then I have a pocket sheet that I keep any pertinent info for patient visits, like a sheet with daily weights or bg's, wound care info, notes I make about a visit and copies of communication with the physician. I copy everything and usually have the last few visit notes in there too, so that way I can know at a glance what I've already done with a patient and makes it easier to plan my next visit. The night before my visits, I get the visit note ready with patient info and make any notes to myself about what teaching I need to do or any wound care or procedures. To make it easier to remember, I've made it a habit of doing any weekly needs at whatever day my first visit for that week may be. For example, at my office we measure wounds weekly, so each week I'll measure the wound on first visit of the week, and keep a paper with all measurements in the patients pocket of info.

Then I have a clipboard I also carry that opens and has space inside for paperwork and pens. I keep extra visit notes, few other papers from the office inside and clipped to the front is a legal pad where I write each days "to do" list. I also have a running list of calls I need to make, things to get or do at the office, and any notes I jot to myself that day. I keep these in a folder so I have all of my notes and reminders. I also keep my weekly patient visit schedule on the clipboard and when I visit a patient, I can make the next visit appt and note the time on the schedule for the day it's needed.

When doing wound care, I like to get the supplies ready and have everything in a ziplock bag for easier access in my backpack. That way I'm not digging for things when in the home. I buy ziplocks at the dollar store and use them a lot, and after doing the wound care, can dispose of paper and dirty items (nothing biohazardous) in the sealed ziplock in the patient's home.

One of the nurses in my agency showed me a good way to keep track of all of your patient's on one sheet. Write the names on the left, underneath I put the MR number and the episode dates, SOC and EOC. Then horizontally it's divided into each day of the week, making little boxes across the paper, and on the paper I use (8.5 x 11 inch graph paper), I can fit 5 weeks at a time. I write in pencil on the boxes and write in the tenative visit dates with a V in that box, and each week (I draw a dark line delineating the weeks) I jot down how many visits scheduled that week. I can put in the recert or d/c dates down to remind myself when those are upcoming. On this sheet I have room for small notations like "change catheter" that sort of things This way, it's easy to see all of my patients at a glance, and going vertically I can see how many visits I have each week for each patient.

84RN · Feb 7, 2012

Forgot to say to make sure you keep enough paperwork with you. Nothing worse than needing to do a resume of care or SOC and not having what you need. I have a bin for paperwork in my trunk and keep at least 3 SOC packets, and some discharge, resume of care and recert packets as well.

In my supply bin I have extra gloves, 4x4s, wound care supplies, spare batteries for the bp cuff and thermometer.

tlancio · Feb 7, 2012

To 84RN you still use paper. We do everything on a laptop and all patient information including signing the SOC and ROC is done on the computer, I have no need to carry all that paper but that is something to consider for those Home Healthcare Nurses out there who are still using paper. Good advice.

84RN · Feb 7, 2012

Our DON told me at hire that we'd be computerized within two years, so it should be interesting. All of your charting and notations are made on computer? Does this make it easier to fill in for other nurses? I'm thinking of when I've done a visit for someone on a weekend, and it would have been really nice to be able to pull up their whole chart on the computer, so I'd have more information.

I love the idea of electronic medical records/charting, but have heard that sometimes it makes things more complicated. How do you think it's working ?

Do you have the capability at the click of a button to send info online to physicians, or other clinicians like if you need to tell a PT some info about a patient? Does your agency supply you with the laptop?

I've been in home health for almost 6 mos now, so everything is still pretty new for me, and each time I get a new patient I'm looking up diagnoses and learning about the disease processes and all of the meds. Sometimes it feels like information overload, lol.

nannymcpheeRN · Feb 8, 2012

Hi Rachel, I too just started HH in Jan 2012. Our agency is computerized and we have the Visiting Nurses Association of America's website loaded on our home page. We use their guidelines for treatments/procedures. It includes tons of reliable and evidenced based info. Check with your agencies Policy and Procedure manual to cross-reference if you can. Good Luck!

tiggerifficRN · Feb 12, 2012

I am also new to home health and this has been a big change for me..I would appreciate all the advice and suggestions i can obtain..My top concern at this point is writing orders..in our agency when we write a verbal order we have to have goals for the order that we wrote..i am having a very difficult time with this and my orders are being returned to me to redo all the time..and my DON is not very helpful as to helping me learn how to write the goals. For instance i wrote an order to obtain a UA/CNS for a client who was having dysuria. for my goals i put that the SN will monitor urinary symptoms every visit. And that the client will be free of UTI symptoms by end of cert period. I thought that these goals were appropriate, but i guess not..any help or suggestions from anyone would be greatly appreciated..thank you

MaheaRN · Feb 17, 2012

I have been a hh nurse for 3yrs. I agree that organization is the key. It will give your clients confidence in you because you will look like you have the situation under control. Take these 2 senarios:#1. Hh nurse comes over, washes up, gets set up by pulling out a ziploc bag and lays out all supplies on a chux she has on the kitchen table.#2. Hh nurse comes over, washes up but then realizes she left something she needs in the car. She goes out and comes back as you watch her nervously looking thru her nursing bag digging around pulling things out for about 5 minutes. Then she finally puts her things on the table and says "ok then, are we ready to get started?"

RachelRN2011 · Feb 18, 2012

Thank you all so much! We are currently in the middle of transferring companies and our computer system is changing. We are also all electronic charts. It is a big adjustment, but I feel like when I get in a groove I will really feel at home with the job. MaheaRN I agree completely with the organization aspect!! I want my pt's to feel confident in my ability to care for them! I know when I find my own rhythm things will get easier. I have purchased a pocket book for home health procedures and an acute and chronic wound care book. They both look like they will be very valuable resources for me. I have not had the opportunity to really get into either one of them due to the change in the charting system as it has consumed me!! Thanks again!!

RachelRN2011