BeExcellent

I have a question about documentation in the HomeWorks program that "disappeared". I worked for a Home Health agency that is telling a past nurse employee that he must reconstruct on paper visits where visit documentation can not be found in HomeWorks. The time in /out and mileage is retrievable. The explanation is that the visit documentation did not attach to the visit. Is this documentation retrievable?

The hardware is more than adequate. Hardware and software were purchased specifically to replace paper and to implement Misys organization wide. We have just upgraded server to so more problems with multiple users synching. Tablet laptops were purchased to enhance "bedside" documentation. We have used program approximately a year. Initial implementation was a nightmare. Over 90% of nurse users do less than 20% of documentation at bedside. No one uses tablets. Integration of care plan problems with documentations is understandably fragmented. I am identifying "superusers", working on my learning curve from Misys naive to future "superuser", trying to mend fences between the nurse IT and staff. Does anyone know of, or have any Misys competency checklists? I am considering proposing a skill lab for Misys use to simulate bedside. Any suggestions to refresh this group or info specific to Misys appreciated.

Yes, it is helpful. I am glad to hear that my initial intuition was correct re:super-users. I landed in the middle of this when I took a mid-level nurse manager position a few months ago. Chart audits showed inconsistent use of the EMR with overtime and inefficiency up. I have openly addressed the issue with the clear emphasis that no one is to be blamed. Techie's say management didn't enforce performance standards related to EMR and clinical staff say they can not remember complicated executions. Currently, less than 5% of the clinical staff is doing more than 10% of their EMR in the field. They are relying on notebooks and "cheatsheets" to enter data later. Just to complicate things all players, techie's, business staff, and clinical staff all report to a different cost centers, so no line authority. It is like herding cats toward water!!

Well, Sue..., your reply made me feel like Einstein that is EXACTLY what I am attempting to do. Okay, I am of reasonable intelligence, why can't I find much info about the Misys software on my own. Is there a "Misys for Dummies" equivalent? Really, how hard can this be if it is a EMR software package used throughout the industry?

Let's just imagine like Alice falling down the rabbit hole, you found yourself in the center of a hospice using the Misys EMR system. Let's also imagine you are not a techie yourself and you find after one year of use the system is inefficiently and inconsistently used. Okay, let's add one last thing, the techie's and the nurses are now feuding. The techie's are saying,"I taught them that in class." Nurses are saying, "I didn't know about THAT!" We have great hardware, Misys is the software, limited budget and quite the impasse. If you were down this rabbit hole where to start?

Well, thanks for being there for your patients. You don't always know when but you WILL get blessings. LTC's are a business and ALWAYS interested in money. Two calm approaches may work. First, hospices started going into LTC facilities not because they are so wonderful and giving but because it was good business. Both the hospice and the LTC facility benefit by the Medicare Hospice provision. Also, I understand some LTC facilities are doing palliative care under the skilled nursing provision. In my area LTC's are HIRING palliative care nurses to coordinate this care. I am not saying this is ideal hospice care but a start. This is sometimes marketed by the LTC as "aging in place". Do your homework on who is paying for what type of end of life in like LTCF's and propose a "money for you...end of life care for them". Established hospices going into a facility will also often be generous to support the LTC with CEU supported inservices and even support many activites within the LTC remembering "kickbacks" are illegal! Be cool to your school. BEACH BOYS

As far as my frame of reference is concerned, all of us reach a point in life..and die. My years in nursing gave me understanding that the death was inevitable but HOW the person died and the impact on loved ones could be influenced for the better. I knew that I could be part of that better way and so I do hospice nursing. Probably more important than the question, "Is hospice for me?, is the question, "Which hospice is for me?".

Yes, Leslie and all, appalling. I have decided to follow ...'change what I can, when I can" and try to at least, motivate my immediate staff to the wonders of good hospice nursing.

Recently finished "Final Gifts". As said before, this is a great read. The book uses the term" Nearing Death Awareness" for the mental process often experienced as a person declines toward death. I also just finished the first of three books by Michael Holmes, "Crossing the Creek". I certainly appreciated the thoughtfulness and insight that is shared based on his experiences with the dying. The tone of the book is soft and appealing. These books help give me a vocabulary to discuss this unique process with staff new to hospice. There is value to be able to reflect on the dignity and importance of recognizing the complexity and opportunities often missed in the dying process.

I am now working in our inpatient hospice unit. I may be fretting over nothing but we don't move much less bathe patients very much. Room are assigned by shift for a bath and certainly not every pt needs a complete bed bath every day but if a pt looks "comfortable" they may not be turned or bathed for days. This freaks me out. I am very sensitive to the dying process and pain issues and all but I think gentle repositioning and bathing is a comfort and dignity issue. Any thoughts?

Okay Dokey.... Actually the term "palliative care" always makes me mad. I think IT is disgusting. "Palliative care" (to me) is care that the insurance company will reimburse and the acute care hospital will pass off to the pt and family as "quality of life" while they hook 'em up to PCA pumps to infuse chemotherapy (or terminaltherapy, as one pt once called it.) The term "palliative care" makes me want to puke. I'll go sit down now....

If your Mom does seem to need serial taps, you may consider a Denver catheter placement. This allows easy home (sterile) para or thorcentesis. I have had a few pts d/c'd from acute care with one and was amazed at the ease of use and the improved quality of life. You can find info online with a simple "how to" video. Google " Denver catheters."

I am not sure that homeopathic hospice exists. But, it isn't uncommon to have a few pts on the hospice caseload that prefers less conventional care and treatment. I think I would contact the homeopathic MD's in area and ask if they see a need. I don't think any hospice you choose would object to you coordinating the 'homeopathic pts" with agreement from the hospice med director and the referring homeopathic doctor. Just because most of the case managers may be managing pts in one way, we are all artists painting the tree in different ways. We have legal, moral and ethical codes, of course, but we have the wiggle room within our own practice to address those pts with cultural/values not in the majority. Let us know how it works out.

Most 'good" hospice nurses I know are on the mature side of life. I don't think you have to have been a nurse a long time but having life experience helps. Admittedly, hospice is about symptom control to allow calmness and comfort but it is also about helping those who are left behind to go on with life. Having an experienced hospice nurse to mentor you will help. Interestingly, many hospice nurses go into this having had an experience with a family member or friend. Treat your pts and families just like you would want to be treated and you will be fine. O and have fun!

Yes, to all. I think we need a separate thread on the spiritual aspect of a good death. Maybe this thread has just become too long and muddy for people to want to jump right in. I agree that every "midmorte" I have ever known has developed over time a strong personal spiritual beliefs. Many of us have found comfort and spiritual strength in our spiritual communities. But me having a strong spiritual conviction does not mean that I use THAT conviction to strength the pt and family. They can be helped to use their own spiritual strengths. One of the things I try to facilitate, if appropriate, is to have the family and friends start bringing in photographs of the pt. I start by noticing the photos in the home and then ask if there are photos of the pt as a teenage or a baby. What i am trying to do is show them that this dying part of the pt's life is such a small part of a rich life on earth. I love it when we have photos all over the pt room and laugh and cry at events. I know at some level tht dying pt is laughing and crying with us. What also happens is that inevitably some in the photos have since died themselves and folks can SEE that flow of life and start to part wht is happening in as part of that flow. Sad but not damaging.