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  1. Not a bad day today... started back per diem today. 6 cases, all in the same township. Not my usual zip codes though, so I did waste some time and scheduled visits akimbo, instead of in a line like I usually try to do. 8:00 am:6 pt's, one needed labs/medicare/had to drop off at nearby hospital, one needed a urine c+s/aetna/had to use quest lab...not local, but one in my neighborhood, so I'll take this on my way home. One prefill/and recert oasis, a discharge, a HHA sup, and one regular CP check. Did quick review, got all lab supplies, mapped a route, made my calls, route goes to hell b/c of this and that. First lady, very sweet elderly woman, just d/c w pleural effusions sec to CHF. Also has bad COPD. I got her labs on first stick (w butterfly d/t horrendously fragile skin and bruising sec steroids), reviewed her meds, VS stable, edema but no change. Off I go. Can't drop labs yet b/c I have to first get to next home by 10:30 or no one can let me in. This guy is mildly retarded and we prefill his mediplanner weekly. Get there, he hasn't taken several evening doses of meds. I prefill meds, call in refills...snag..RPh tells me the insulin pen is back ordered by manufacturer. We will have to prefill syringes, of course pt has no vials or syringes in home. Call endo and lv mssg re pls give pt Rx for vials and syringes d/t shortage. Check sugar (132) and VS, and off I go. Stop and hospital drop labs, grab a sprite and pop tarts from the vending machine (thought I'd be in my own neck of the woods and could stop at my house for a bowl of cereal, starving now) Next pt, had to get there before 1 or no one will let me in. This poor woman w MS is STILL on the commode since when I called at about 9:15! She is upset b/c her aide will leave at 1:00 and she hasn't had her BM. She doesn't want MOM or enema, since she will be alone and is afraid to risk having to lay in stool until eve aide comes, if they come. Usual bowel routine is q M-W-F, didn't go on Monday, but belly is nice and soft, + flatus, + BS. I advise her to try more fruit, and if no success repeat her suppos tomorrow. She does admit she didn't eat as much as usual on the weekend. Her aide said when she gave the sup this am, there was no stool felt in the rectum as far as she could reach. (Wow, this aide is a good one!!) Then I check her S-P tube site, looks clean, she was worried, Instructed her on S+S infection, got the UA/C+S from the S-P Tube, VS WNL, and off I go Next, LOL who has CA, family doesn't want her to know. I get there, she looks good, hubby is cute, says "Boy, it's cold out there." We have a mini chat about yes how cold it is, only to have him do it again 3 more times!! (A tad forgetful I am picking up!) Dtr arrives midway into vs, says doc wants labs repeated later this week. Apparently, she was on spironolactone bid, another doc inc it to qid, her K went off the scale, they dec the spiro back to bid, and K is high norm so he just wants one more set to be sure. Call the doc, confirm the order (Uh doc, we can't take orders from family members!) VS WNL, review all meds, advise we will be back Thursday for labs. off I go Next, funniest LOL, she answers the door in a robe and damp hair, her HHA just left and she feels clean and great. But she is all upset b/c she can't get the calculator to figure right. She asks me to double check her, which I did, and we figured out what happened, and she felt better. She was quite euphoric and agreeable, saying "Oh yeah, yeah, yeah, yeah, yeah!" I was starting to wonder if she was flaky, but she knew to call her dtr, how to balance her checkbook and was taking her meds correctly. Then she pulls out five Rx dated 1-21-03, two are new meds, but prn types. I asked her why she didn't fill them yet, she says, My dtr has been sick. Having been just sick as a dog myself, I asked her what pharm she used, and for some reason, she uses one in my neighborhood so I offered to drop it off, b/c I know they deliver. She is so relieved, she gives me a big hug. Off I go Last vs, still no real food and I am famished. The discharge. Cute LOL, very ambulatory, very sharp. Review s+s she needs to report for emergencies, meds actions, s/e, and VS stable, she will still have PT, so the discharge paperwork won't be so bad. 2:15 pm. Back to my township, drop wee wee at quest labs, drop off Rx at the pharm, get to my house. Reheat leftover Chinese and get a huge glass of water. My bones are aching from being in and out of the cold so much. Worked on paperwork until 4:45, finished time sheet. End of story. I'll take charts back in tomorrow since I am working. Tomorrow it is supposed to snow, which means a lot of people will call out sick. I was supposed to do 3 new admits, but will probably get stuck w seven revisits b/c we will have to triage for call-outs and snow. Pretty routine kind of day today. Anyone else want to share?? A Day in the Life of a Public Health Nurse... Typical-day-for-a-home-health-nurse.pdf
  2. homehealth20

    10 Tips for Home Health Nursing

    The following are some tips I have learned from experience and my peers: 1. Have a good sense of humor. You have to learn to laugh at yourself. This is a good practice for most aspects of your life. But if you take yourself too seriously, no career will be enjoyable. 2. Be open minded. Toto, we are not in the hospital anymore. In the patient's home, you are no longer in a controlled environment like a hospital or doctor office. You still have to follow your agency's policies, safety rules and perform procedures correctly, but if the patient requests you enter their home and take your shoes off because of religious reasons, you do. The beautiful woman that presents as your patient, turns out to be a man. (You learn this without warning when they drop their drawers for the dressing change you came to perform. The scheduler thought it would be funny if you were surprised.) Diversity is one of the wonderful aspects of home care, you learn how other people really live. Learn to appreciate different cultures. 3. Learn to modify. You have to hang an IV. It's after hours and the pharmacy forgot to send the IV pole. The hanger over the door may work, or the broom handle strapped on the upright vacuum suddenly creates a wheeled IV pole. But always make sure that your modifications are safe and appropriate, otherwise, it will come back to bite you in the .... 4. Be flexible. The day you planned will change, guaranteed. There is an accident on the freeway, now you are late. The patient has a doctor's appointment they forgot to tell you about and now they aren't home. Someone called in sick so now you have 5 extra visits. If you can't be flexible, home care may not be your bag. 5. Be prepared. Sure enough, the dog ate the patient's box of dressings, or the patient has a bed sore that did not show up on the hospital discharge information. Your car trunk should look like a supply closet. 6. Be organized. For those home health nurses that drive a car between patient visits, your car is your office. It should contain supplies, paperwork, computer and cell phone battery chargers, pens, marketing flyers, etc., etc., etc. Learn to plot your visit route. With the cost of gas nowadays, you don't want to have to drive needless miles. 7. Have basic computer skills. If you don't have them, learn them. Many home health agencies have already gone to field staff carrying laptop computers into the patient's homes. It is the way of the future. 8. Be alert and be safe. You may be presented with many new dangers that you won't see in the hospital. Take a self-defense class. Learn what areas are the "unsafe neighborhoods" in your territory. Visit those places early in the morning. Always be alert to your surroundings. Don't talk on your cell phone while driving. Follow safety rules. 9. Don't be afraid of paperwork. If you work for a home health agency that performs Medicare visits, YIKES, what paperwork (thanks in part to the Medicare Paperwork Reduction Act?)!! An OASIS is not a desert paradise. Those agencies that have laptops for their field staff have part of this licked. However, the questions still need to be asked and documented. Practice does help speed up the documentation process. 10. Keep your skills up. Take continuing education classes online. Attend seminars. Read articles. Knowledge is power. You are very autonomous in the patient's home and good skills and quick thinking are mandatory to survive. In closing, home health is a wonderful way to care for patients. You are able to interact with the family and really do one-to-one education. Whether it be with a Medicare agency, Hospice, private duty or other home care venue, it is an enjoyable and full-filling division of nursing. Remember, many home health nurses believe: A bad day in home health is better than a good day in the hospital.
  3. Melissa Mills

    30 Safety Tips for the Home Care Nurse

    Home care nurses have a unique and rewarding job. You provide skilled care where the patient lives. You get to experience their everyday life and impact their overall health and well-being. But, there are dangers when traveling all day in and out of homes and in new neighborhoods. This isn't just anecdotal, consider stories like the New Orleans home health nurse who was abducted at gunpoint in 2012. Safety concerns for home health nurses are real. As a former field nurse in home care and hospice, I have had my fair share of stories of family members that gave me the creeps, "tomato plants" that looked very much like marijuana plants, and patients with guns hidden under mattresses. Even though there were times I felt unsafe, I loved my patients and the unique perspective I was given into their lives. But, you do need to implement simple ways to stay safe. Safety Tips and Tricks for the Home Care Nurse Keeping yourself safe doesn't take a lot of work, but it does require intention. Here are a few easy ways to increase your safety knowledge. 1. Know your workplace policies for safety and violence prevention. Don't wait until you are in the middle of a crisis to understand how to activate your company's safety program. 2. Report any unsafe situations as soon as possible. Even if it is just a feeling, be sure to report it to your supervisor. You may not be the next staff member in that home. It is your responsibility to keep others safe too. 3. Be active in your agencies safety committee. 4. Map out your visits so that you know where you are going. Wandering around new neighborhoods looking lost is not safe. 5. Be sure your car is full of fuel and in good working condition. 6. Create a car emergency kit that includes: Candle to keep you warm Band-aids, hand sanitizer, antibiotic ointment Road flares Rain poncho Rags Duct Tape Baby wipes Whistle to signal for help Non-perishable foods or snacks Water Ice scraper Kitty litter for slick roads Blanket and warm clothing Flashlight and extra batteries 7. Park on the street if possible. You don't want to be blocked in if you need to leave quickly. 8. Trust your gut. If a situation feels unsafe, it probably is, and you need to get out quickly. Make sure the patient is safe, leave the home, and call your supervisor. 9. Set boundaries. If a patient or family member starts saying things or acting in a way you do not like, tell them. Be polite and direct. Avoid being argumentative. 10. Keep your cell phone on you at all times. Make sure it's fully charged before you leave in the morning and charge it throughout the day. 11. Know your company's policy on joint visits and behavioral contracts. Contact your supervisor if you need to implement either of these interventions. 12. Start your visits early. Avoid nighttime visits if possible. 13. Take a self-defense course. 14. Don't carry large amounts of cash on you. 15. Always wear your agency badge and carry your driver's license or other ID. 16. Watch your step. Be sure to pay attention to the ground and floors in homes so that you don't fall, trip, or become injured in other ways. 17. Be alert, but not nosey. You're there for the patient. If you are unsure what others in the home are doing, don't go snooping around. Do your job and leave the home. Remember, if the patient is in their right mind, they have the right to live however they desire. 18. Ask your patient to contain any aggressive pets before you enter the home. 19. Keep your sharps container in your nursing bag for easy access when you are in the patient's home. 20. Carry spray or 91% alcohol to fight against bed bugs and other critters you may come in contact with in patient homes. Wipe down the bottom of your nursing bag, soles of your shoes, and any equipment that may have come into contact with surfaces in the patient's home. 21. Always have hand sanitizer in case the patients home doesn't have running water. 22. Document in the patient's home when possible. Don't sit in their driveway or on the street for long periods of time finishing up your charting. 23. Know your service area. Learn the unsafe neighborhoods and find out where the closest police stations are in the areas that you serve the most. 24. Be prepared. Set up your visits and supplies the night before. If you must take supplies into a home, put them in bags and label them with the patient's name the night before. This allows you to gather your supplies and get into the home quickly. Don't make multiple trips back and forth to your car and don't rummage through your car getting ready for the visit. You must be alert at all times. 25. If you are confronted by someone who asks for your money, nursing bag, or other belongings, hand it over! 26. Make sure someone in your company has your schedule, just on the off chance that someone can't find you. 27. Keep trash bags in your trunk. If you go into a home that you suspect may have an insect infestation, don't take your nursing bag into the house. Place the necessary equipment into a trash bag and only carry in what you need. 28. Buy a plastic stool that you can keep in your car. During your visit, set your bag on the stool use it to take a seat. This prevents you from sitting on plush furniture that may be soiled or infested. 29. If there are safety concerns in a patient's home or building, call ahead and let them know you are coming. Most patients will be more than happy to open the door or keep an eye out for you if possible. 30. Don't talk or text while you are driving. If you are a home care nurse, do you need other resources for safety? Check out this great list of OSHA resources specifically for home healthcare workers. Do you have other safety tips that you use when making home visits? Put your suggestions in the comments below. You could save someone else just by sharing the things you do every day to keep yourself safe.
  4. Melissa Mills

    Bag Technique 101 for Home Care Nurses

    You enter Mrs. Jones' home to do your Start of Care assessment. She opens the door to reveal a maze of newspapers and other memorabilia that she's been keeping since at least 1929. You begin surveying the scene for a place to put your nursing bag. Just as you think you've found a spot on a table at the end of the couch, 4 cats pop out of nowhere and begin to inspect you and your bag. What do you do? Here are a few things you should know about bag technique in the home care setting. Is Bag Technique Important? There are no confirmed reports of patients becoming ill due to pathogens brought into their home on a nursing bag. However, there is some research about what grows on the outside and inside of your bag. One study reports that 83.6% of the exteriors of nursing bags cultured were positive for human pathogens and 15.9% of these pathogens were multidrug-resistant organisms. The inside of nursing bags was not clean either. The study found that 48.4% of the inside of nursing bags were positive for human pathogens, with 6.3% being multi-drug resistant. How do you limit the number of organisms you carry from one home to the next? It's simple - Bag Technique. What is Bag Technique? Bag technique is used to prevent the transmission of pathogens while making home visits. There are a few basic principles involved in bag technique: Hand hygiene Bag placement while in patient homes Bag placement during storage Cleaning interior and exterior surfaces of the bag Handling equipment and supplies in the bag Handling equipment and supplies after they are removed from bag Your home care agency will have a policy and procedure on the exact steps to take when performing bag technique. Here, we will explore the basic ideas behind the principles of getting in and out of your nursing bag. Hand Hygiene Your hands become a vector that can transmit pathogens from your bag to the patient. The reverse is true too. Similar to other clinical areas, hand hygiene is of the utmost importance. The CDC reports that healthcare providers clean their hands less than half of the times they should. They also recommend washing your hands before any contact with the patient. Your agency may also recommend that you wash your hands -with soap and water or hand sanitizer- before entering the inside of your nursing bag too. The more you wash your hands before contact with the patient and your bag the more you decrease the risk of transmitting bacteria to your patients. When working inside the bag, be sure to never place "dirty" items inside the bag. If you have a sharps container, place into an exterior compartment of the nursing bag, but never stored inside the bag. Bag Placement Place your bag on a clean, dry surface, if available. If not available, place a clean barrier down first before putting your bag on a table or other surface. Another option is to hang the bag from a doorknob or over a door. Keep the bag closed when you are not working inside of the bag, especially if there are pets near. If you have a bag with wheels, you can leave it on the floor with a barrier underneath. Pay close attention that items don't fall out onto the patient's floor and that exterior pockets never come in contact with the floor when they're unzipped. Vehicle Storage Your bag should be stored in your vehicle on a clean, dry surface. If you have supplies in your bag that may be temperature-sensitive, you will need to keep the bag inside your car versus the trunk. Be sure that the bag is always kept on the "clean" side of your vehicle. If you are concerned about bed bugs or other insects, place your bag inside a large plastic container inside your car. Cleaning the Bag The outside of your bag is important. Chose a bag that's made of smooth, non-canvas nylon or polyester or other materials that can be wiped down to decrease the number of pathogens you carry from one home to the next. When to Leave Your Bag in Your Vehicle There will be times when your nursing bag is best left in your vehicle. These times include: Known infestations with bedbugs or other insects Homes that are contaminated with excrement Patients known to have a multi-drug resistant organism Patients on transmission-based precautions You always have the right to leave your nursing bag in your vehicle. In these situations, double-bag all items so that you can throw one away in the patient's home and use the other to carry items back to your car. Be sure to disinfect all equipment in the bag before placing it back into your nursing bag. Do you have any tips and tricks you can share to help others use bag technique in their nursing practice?