What would you have done with this hard to track down client?

[nursegeorge]

I am new to HH, been in it since March '04.

Was calling on Saturday evening to set appointments for Sunday. Could not talk to one of the patients but left a message with the person who answered the phone, who would not identify themselves when I asked. I was told the message would be passed on. I also said I'd call Sunday morning and reconfirm the appointment.

Sunday morning, nobody answered the phone, so I left a message. I called back around noon on Sunday and got a different person and was told that my patient was not at that number and she gave me a different number, but did confirm that the patient was at the address that I had. So I called the phone number and got an answering machine. I left a message on the answering machine/service that I would be there between 2 and 3. I left the phone number to the office and my cell phone # (which I usually don't leave my cell #) My call was never returned and the patient never called the office. I went to the house at 2:25pm and knocked on the door...no answer to the door, but there was a large dog barking and snarling and jumping on the door. I knocked again, and waited a total of about 5 minutes until the dog quieted down and then I left. I called the doctor and notified him of not admitting the client to our agency and why as outlined above. I documented everything including phone numbers, dates, times, calls and non-responses. Informed my OCC (I had kept her abreast of this all day anyway.) and called it a day.

Today, I was again assigned this man, and when I called his home....NO RESPONSE again!!! I called twice and I called the first number that I had with no response either. I called the care coordinator for the area and asked what she wanted me to do. She told me not to go to the house, if he was that hard to get ahold of, we would NTUC him.

Then I get a call from the main office that this patient had called the night OCC last night (Monday) and was livid that nobody had made an effort to change his dressing or come to his home. She assured him that someone would be there today! I guess all of this was not passed on to her from previous OCC. She also double checked his phone number, and I did in fact have the right phone number......ARGH........I feel really bad about this, but I did all that I felt that I could to get this guy started up with care.

Oh, also, this house is located where there was a quadruple drive by shooting on the Saturday evening before my Sunday visit.

What would you have done? Did I do enough? I documented to protect myself and my agency.

Now understand, I love HH and I have 20 years hospital Med/Surg experience so I am not a new grad or anything. I am very dedicated to my job and have the highest respect for patients and their needs. I'm not a slacker and have made production since my first day out of orientation! (production of 7 per day)

So why am I feeling so bad about this one? I also told my supervisor that if he is put back on the opening schedule for tomorrow.......don't give him to me....I've had enough of this one. (Oh, and I usually only work weekends and am helping out today and tomorrow because they are really short of help!)

The other nurses have told me that I went beyond the call of duty and they wouldn't have made this big of an effort.

nursegeorge (I'm a female. *g*)

[caroladybelle, BSN, RN]

The patient has some responsibility in his own care. Why did he not call after the first appt was missed?

You did plenty to contact the patient, some of the work must be done on their side.

[renerian, BSN, RN]

You did your best. Don't give it a second thought.

renerian

[AngiRN]

I feel you have yourself covered... it is very frustrating when these clients only care about getting admitted to homecare when it's late at night and they start freaking about their wounds, meds, IV's, etc.

If the client was not physically in the home when you called for him all those times, I would have questioned if he actually qualified for homecare, depending on the payor source.

I personally feel that after you make those multiple phone calls without success, that homecare nurses should attempt to go to the home. This ensures the client has not fallen and lying there with a broken hip & can not reach to answer the phone. Once you have been to the home and they are not there, you called the doctor and reported it. It's exactly what I would have done! Good Job!!

[Hellllllo Nurse, BSN, RN]

I would make sure that your supervisor, and the OCCs get a copy of your documentation showing all the efforts you made to get in touch w/ this man.

That's all you can do.

I work in an outpt clinic. I am calling people all day to try and get them to come in for their tx and blood work. I keep a running nurses' note on a few of them that I can never get a hold of.

Example:

8/26/04

1030

Called pt's house to inform him of results of labs drawn 8-20-04. Pt's iron sat level is 6, and to inform pt of Dr. XXXX's orders received on 8-22-04 For IV iron admin (see order 8-22-04), and schedule appts for IV iron admin.

Left msg on ans machine informing pt of harmful effects of his low iron level, informing him of info above, w/ instructions to call me to schedule appts, asap.

8-24-04

1600

Again called pt to relay info as stated above. No answer.

1700

Again called pt's house to relay info as stated above. No answer.

8-26-04

1300

Called pt's house to relay info as stated above. Spoke to cousin "Joe" who said he would pass on message for pt to return my call. Stressed w/ Joe the importance of me getting in touch w/ pt.

8-28-04

1645

Called pt's house to relay info as stated above. No answer. Have not received any returned calls from pt.

etc., etc., etc.

At the end of the week, I make copies of these notes and put them on my boss' desk, then file the originals in the chart.

Maybe something like this could work for you.

As we like to say where I work-

"You can lead a horse to water, but you can't bang him on the head w/ a hammer."

(which is what we feel like doing, sometimes!)