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Discussion

question about client info for new case....

If the agency does not provide you with good information before sending you out to a case, how do you get the information you need? For example, I went to my first client ever and my first shift was a 6 hour shift. The agency provided me VERY little background on client. I oriented with the regular nurse and got more information, but was not told anything about allergies, code status, doctors names, hospital preference should client need to be hospitalized, etc. I was shown his routine and where his meds were kept and told about his ways. I was trying to keep notes and take it all in and forgot to ask this info, orientation was two hours. When I showed up for my scheduled shift, I asked the wife about allergies and she gave me more information, but I still do not know that clients code status or what hospital preference. I did see where he had been admitted to a local hospital in the log book the wife keeps, but there was absolutely NO nursing notes on the client from the other nurse - she keeps them all with her. Is there typically a chart on file I could reference to find this information out at the agency office? Is this how many agencies operate, just throw someone to the field with little knowledge about the client. I walked in the pts door knowing how to get to his house and his current diagnosis, that was it.

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    Our agency requires every patient to have a chart in the home with that information and a chart at the office! I'm surprised there's nothing in the home for you to look at regarding the Pt, especially code status and allergies!! Id talk to the wife again about his code staus, im sure she knows! When I'm unsure I go right to the family since they usually know just about anything! Though really if it's an emergency and the Pt needs to get to a hospital, the closest will do! (call 911!) We also have 2 hour orientations and I learned to ask any stupid question I can think of during that time! I make the nurse show me anything I could possibly need and get any bit of detail I can! Then on my first shift I have mom/wife/family member help with anything if needed! But if all else fails I'd call my agency and have the don or someone go over concerns! Best of luck xoxo

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    • Experts

    Your agency should have given you a copy of the 485 prior to you going to the house. Minimum. If you are going to see this client on a regular basis, go back to the agency and get a copy. From now on, always get a copy of the 485 prior to meeting the client for the first time.

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    • Experts

    And speak to the agency about the missing field chart. The other nurse has no business keeping the field chart copies of her charting with her. They belong in the home. I suppose there are also no MAR sheets or TAR sheets? Your nursing supervisor who opened this case needs to get on the ball.

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    Amazingly the current months Mar is there, but its not filled out thoroughly as the wife doesn't mark when she gives what, but maybe that's common in home health. My first shift, the wife had to work so it was me and the pt. I found a descrepancy between the Med bottle and Mar and called the on call nurse to question what I do and how to document it, since obviously a written Med error if I just documented I gave the lower dose as written on the Mar compared to directions on bottle. She gave me the instructions on what to do and I went about my business, but the lpn on the case had been documenting this for who knows how long since I have no idea when the Med was changed since there are no notes or chart in the home!

    I am not real thrilled with this agency as it seems like they will throw anyone out in the field without proper training. When they hired me they told me I would be consistently with a client who had a trach and a vent. I told them I didn't have vent experience and they said "oh not a problem we provide training." Was a total scam to get me to accept the job because they were short staffed. They wanted me to drive 70 miles round trip twice a day for a client that need 3 hours in the morning and 3 hours at night... I don't think so, I would be paying to work for them in the gas I would be using!

    I start orientation for my main job the 13th and I think I am going to have to tell this agency it isn't going to work out. There's another home care agency who has my app and given me a first interview who will work around my schedule when I know it that has a much better reputation. If they give me a second interview and offer I will accept with their company for some extra cash, but they have already given me more solid information than this other company and I got a much better feeling about them in general.

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    • Experts

    The MAR is for the use of the licensed nurses ONLY. The wife may look at it, but does not write on it. If the wife gives a med in your presence, you write "PCG" in the block to indicate she gave the med. Otherwise, all meds she gives during times the nurses are not present are left blank on the MAR. As for the discrepancy, do not be concerned with showing up the other nurse in a med error. Call the doctor immediately and get a telephonic "claification of order". Write this up on the form you should have for physician orders. Send the original to the office and keep the copy in the book as a suspense copy. Follow the doctor's order as given to you over the phone. Write that out on the MAR after dc'ing the line that the previous nurse started. In lieu of all of this, you should have followed the info on the prescription label, making necessary changes on the MAR. An alternate course of action would be to follow the instructions on the prescription label. Write this out on a physician order sheet and write underneath the prescription order "transcribed from prescription label/your name". Send that forward for the doctor to sign as written or to make changes to. Do not trust that LPN to know what she is doing, because she is not following through on things as it is. Good move to go to the other agency. Good luck.

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    • Author

    That's another thing that concerns me about this agency - there is absolutely NO patient book/chart/doctor's orders/phone numbers for doctors/hospital preference (closest one obviously but still)/nursing notes/nothing about patient condition in the home except what I can get from the wife, or this "log book" that the LPN set up to communicate with the wife back and forth on about his condition when the wife isn't there, which has very little information aside from "good night/bad night" and vital signs. Without even a doctor's name or phone number, I couldn't clarify the prescription order and the obvious solution was to give the pill according to prescription bottle instructions, but I still wasn't sure how to document that and which is why I called the on call nurse, seeing as this was my first shift ever alone as a nurse, and I sure felt blind on many things, especially without having the patient chart/nursing notes to refer back to. He had a pulse of 54 while lying down and I asked the wife if that was normal since I had no recent reference to compare to, luckily she did know that he sometimes has a lower pulse while lying down and told me to not be concerned (which I was still a little concerned and kept a close eye on his pulse as he has had pulse issues before I was told by the wife, so how I could not be concerned, I don't know) he is on an insulin scale and on the scale, the isntructions are "under 80 call physician after giving juice or a snack" yeah, thats a great protocol... but without a doctor's number, I would be calling 911 or at the VERY LEAST the agency to find out the doctor on file, probably get quicker results with 911 though...

    I am just waiting for the other agency to call (they said they would, in a couple weeks since the main nurse who gives the nursing interviews was out of town for Memorial day and when she got back, might take her a few more days to return calls and make second interviews).

    I am scheduled for one more shift with this client this weekend and I am DEFINITELY going to go into the agency and tell them I need to see patient information and get some questions answered.

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    • Experts

    As I said, ask them for a copy of the 485. For that matter two copies, one for you and one for the home. They will probably look at you as if you just dropped in from the far reaches of the galaxy. If you were going to stick around, you could set up the field chart. But I see your best move to get out of there. The way this agency is run, (actually not run), is not good for a new nurse, or an experienced nurse, for that matter. No wonder the LPN isn't concerned with anything.

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    • Author

    Thanks for the advice, and yeah... I would like to actually practice with my hard earned license... not lose it over an agency that is unprofessional and careless....

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    • Experts

    Sounds to me as if they are an agency that started out as a nonmedical caregiver agency and they have "eased" into offering skilled nursing care. If the honchos are not even nurses, they probably do not have a clue.

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    • Author

    Just the littqle bit I have heard while in the office from the schedulers makes me wonder about their ultimate priorities.I realize not everyone has a great work ethic, but these two were complaining and talking about how they hire people and then they don't want to work.. well hello, ever think it was a company issue and not the individual nurses? I was excited to start work as a nurse and after just one shift they have turned me off and actually, I hadn't been calling into them and saying I was available because i was not happy how orientation and their attempt to get me to drive at least 140 miles per day went that I didn't want to work for them anyway. Yet called me on this case and since it wasn't far away I decided to give it a shot... glad I haven't committed to anything permanent with them. I wont desert my client for this weekend since I already said I would work this shift, but I am not taking anymore from this agency. Just not worth it to me... I want and need my license and really want to be a good nurse and don't need this job that badly to be thrown out there because they change employees almost has much as people change their underwear...

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    • Experts

    You have good critical thinking skills already. Just from working one day for these people. Hopefully the other agency has got at least part of their act together, enough for you to survive and learn.

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