How to make home care a smooth transition for patients

Patients are discharged as quickly as possible, whether from intensive care or rehabilitation, and nurses are ultimately liable for ensuring that patients return home easily. As a specialty, home care has developed best practices that might help with this process.

Karen Marshall Thompson, MS, RN, CNS, spoke with Nurse.com about these best practices, in addition to strategies which have worked for her organization. She also shared advice for nurses who’re recent to the specialty, in addition to those that need to turn into more involved in skilled organizations and political advocacy. Karen Thompson, RN Thompson is the director of Southern Ohio Medical Center’s Home Services Center in Portsmouth, Ohio. She has been a nurse for 41 years and has been practicing home care nursing for 38 years. Thompson also serves as co-chair of SOMC’s ANCC Magnet and provides administrative leadership for SOMC’s Wound Healing Center. He is energetic in state and national home care and hospice associations. At the 2018 National Association for Home Care and Hospice Annual Conference, Thompson and 27 other board members were inducted into the 2018 Caring Hall of Fame. There are two best practices that promote the protected transition of a patient from the hospital or expert nursing facility to home. The first is the nurse’s ability to quickly adjust the patient’s treatment regimen. The second is the patient’s ability to attend and complete a follow-up visit with a physician inside two weeks of discharge from the hospital or expert nursing facility. These two strategies are evidence-based as best practices developed by Improving the standard of health at home. The major explanation for re-hospitalization is the patient’s failure to comply with the prescribed treatment regimen. Using quality assessment improvement processes, we now have implemented the next best practice strategies to enhance patient medication management.

• Nurses provide patients with pill boxes and help pre-fill them with medications.
• Nurses received printers that they may use of their homes and print patients’ current drug profiles. They hand-deliver profiles to patients during home visits. Medication profiles are updated and printed at each patient’s initiation of care, during recertification, or every time a drugs is modified.
• Patients are instructed to bring their treatment profile with them to review with their physician during office visits.
• After discharge from home care, all patients receive an updated treatment profile by mail.
• Patient teaching processes have been improved. Plastic document folders resembling an accordion were purchased for the nurses, enabling them to store and transport lesson sheets.
• Easy-to-use reference sheets have been created that nurses can carry with them. The reference sheets list the needs and unwanted side effects of the most well-liked drugs. Nurses document the aim and unwanted side effects of the patient’s home medication profile by reviewing it with the patient. This information shall be present in the subsequent printed copy.
• Once discharged from home care, all the patient’s medications have their purpose and unwanted side effects noted within the medication profile. Nurses provide and document this data about two to 3 medications during each visit.

Patient satisfaction with medication management processes improved, and clinical outcomes related to medication management improved. Another example is our implementation HHQI zone tools for individuals with congestive heart failure and chronic obstructive pulmonary disease. The tools help patients higher manage these chronic conditions at home and reduce hospital readmissions. Zone tools are color coded: green (all clear), yellow (attention), and red (emergency). The tools list specific symptoms in each category and specific actions the patient should take. The zone tools also function a guide for nurses on how best to intervene with the patient based on the symptom zone. Nurses and other healthcare professionals are required to make use of evidence-based best practices to assist standardize care, reduce variability within the care patients receive, improve patient outcomes and improve cost control. HHQI is an excellent resource for evidence-based home health best practices. We have implemented lots of them best practice tools provided by HHQI. One example is LACE indexing tool, which determines the danger of re-hospitalization of the patient. Depending on the patient’s risk level, the house care nurse may implement specific strategies. Patients who rating 10 or more on the LACE index tool are considered to be at high risk for readmission. They receive initial visits from a registered nurse twice per week for 2 weeks, a further telephone call at the top of every of the primary two weeks of services to evaluate the patient’s condition and possible need for a further nursing visit, and a social work referral to discover social barriers to care. They may additionally complete physical therapy and occupational therapy assessment visits. Our 30-day readmission rate decreased by 5% in 4 months because of the LACE tool.

I even have been a nurse for 41 years and have worked in home look after most of my profession. I believe that home care is an area to which nurses are usually not indifferent; you either find it irresistible otherwise you hate it.

Home care presents unique challenges in an uncontrolled environment and requires the nurse to give you the option to serve patients inside their premises. The wonderful thing about home care is that nurses can see patients improve every single day and help them higher manage their illnesses. On the opposite hand, a house health nurse might help a patient navigate the wellness-illness continuum by making referrals to palliative care and hospice. I even have had tremendous opportunities to influence the practice of home care at each the state and national level by serving on the Ohio Home Care and Hospice Council and the National Home Care and Hospice Association. I served as a board member of each associations. To become involved in your state or national association, all you would like is a desire to serve. I began working on committees, akin to the Compliance and Reimbursement Committee and the Advocacy Committee at OCHCH. At NAHC, I started working on the Institutional-Based Home Care Advisory Group. If you aspire to leadership as an activist, share your interest in joining or chairing a committee or running as a board candidate.

I even have had the wonderful opportunity to take part in policy advocacy by meeting with legislators and testifying at hearings at each the state and national levels. Political support is required to tell policymakers about legal practice issues and reimbursement concerns.

To take part in political activities, concentrate on the problems that impact your practice, whether or not they come from knowledgeable organization, state association or state board of nursing. Find out who your lawmakers are. Lawmakers wish to hear the opinions of their constituents. Organizations and practitioner associations often provide legislative and advocacy toolkits that discover issues and supply template letters and ways to make use of social media to contact legislators. In most cases, the legislator will confirm your communication by letter or email. An example of a recent legal practice issue that has been voted on in laws is the power of hospice nurses to waste narcotics and other medications in a patient’s home to forestall these drugs and substances from being diverted to relations or caregivers. Another practice I’m working on nationally is to enable nurses to sign a Home Health Plan. Home care is the one setting for patient care that doesn’t allow nurses to initiate care or sign ongoing care orders. I even have developed wealthy and lasting relationships with my home care colleagues on the state and national levels. My participation in shaping the regulations that govern my practice and the relationships I even have developed with like-minded colleagues are a way for me to proceed to grow professionally and proceed to derive deep satisfaction from my work.

Take home care courses:

In the United States, the number of individuals using hospice and palliative care services is always growing. However, there continues to be confusion about what these programs offer. This educational activity compares the services and reimbursement of hospice and palliative care programs. The goal is to coach nurses in order that they can discuss available options with patients and make appropriate referrals based on the patient’s and family’s goals of care. According to statistics and forecasts of the National Labor Office and the Health Resources and Services Administration, there’s a growing demand for nurses qualified to look after patients of their homes. Now is time to think about a profession as a house health nurse. This course provides an summary of the form of care provided by community nurses, their roles and responsibilities, and the challenges of home health care. The demand for home health care services continues to extend because the population ages and more health care services are provided outside of acute care hospital settings. In 2010 alone, 3.4 million Medicare and Medicaid beneficiaries received some form of home health care. The demand for home health providers, especially RNs, also continues to grow. The 2013 National Workforce Survey of Registered Nurses found that 6% of nurses within the United States work in home care. Although certain legal risks for nurses apply to all settings, home care has some unique situations that nurses ought to be prepared for and manage.