Address specifics of patient care up front
Checklist ensures no details missed
Four years of a program focused on partnerships with long-term care facilities and contracts with 88 different facilities has taught the staff at Hospice Care in Madison, WI, a few tricks on how best to manage multiple relationships in different areas.
"It has been a challenge to manage the relationships as the program has grown, but we've focused on improved communications, and we've developed a template to make sure we address all of the issues we need to address as we admit each patient," says Kelly Fischer, RN, SHPN, director of long-term partners at Hospice Care in Madison, WI. "The contracts are renewed annually and we have one person in charge of tracking them."
While the overall contracts are the same, the form that describes specific responsibilities for each patient differs from facility to facility, she adds.
Before a patient is admitted to hospice and the care plan is developed, a checklist is used to assign responsibilities and collect information. The list includes:
- Who is responsible for obtaining the "do not resuscitate" order?
- Who makes sure the power of attorney for health care forms are in the chart?
- What is the patient's name, diagnosis, and ICD-9 code?
- Who will obtain the physician order for hospice medications?
- What nonpharmaceutical treatments are available for the patient, and who will provide them? (Examples include whirlpool, massage, volunteers to visit, and pet or music therapy.)
"We also discuss items such as how to handle falls, laboratory tests, and X-rays, and document our agreement," says Fischer. "In many nursing homes, the policy for a patient that has fallen may require a trip to the emergency room."
Her agency prefers that a hospice nurse evaluate the patient first to avoid an unnecessary trip to the hospital, Fischer says. "Not only is it stressful for the patient and family, but our patients have usually said that they never want to return to the hospital," she says. Asking the nursing home to wait until the hospice nurse has evaluated the patient is respecting the patient's wishes even if they conflict with nursing home policy, Fischer adds.
X-rays and lab tests also may be ordered routinely following a fall in some nursing homes, but Fischer's agency asks that they not be performed until after the hospice nurse's evaluation.
Weighing patients is another item that Fischer's agency asks for a departure from policy in some facilities. "A hospice patient is going to lose weight as a natural progression of the condition," she points out. "We've had many of our facilities agree that we can weigh our patients on different schedules than their other patients, even though they may still require some regular timeframe."
The goal in our relationships with long-term care facilities is to put comfort care at the forefront of the care plan, says Fischer. "Our patients' needs are different from the needs of a long-term care patient, and constant communication and education between the staffs of the two facilities is ensuring the best care for them," she says.
Four years of a program focused on partnerships with long-term care facilities and contracts with 88 different facilities has taught the staff at Hospice Care in Madison, WI, a few tricks on how best to manage multiple relationships in different areas.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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