One agency shortens the paper trail
If this is truly the Information Age, as social critics aver, then part of the reason for it must be documentation. Or as practitioners of home health know, if accountability is a fact of life, then there’s probably a form for it.
The paper trail winds long and wearisome. There are forms for verification, assessments, treatment plans, Medicare, Joint Commission on Accreditation of Healthcare Organizations, safety, and patients’ rights. Although the look and function of their forms may vary, all agencies are afflicted with the task of writing things down.
Is there a better way, or at least a shorter trail to follow?
Desert Home Health, the home health care agency of Kingman Regional Medical Center in Kingman, AZ, thinks so. Realizing that patients’ charts were bulging with excess paper and that more time was being spent by staff filling out the forms, director Carol Cayton, RN, and her nurses decided something must be done. So they met to review all their forms, discarding what they no longer used, then distilled two or three forms into one. The result has been a reduction from 18 forms to 12 that a nurse takes to a patient on the initial visit.
"You never seem to have the form you need," says Cayton. "We revised as many as a dozen forms and made combinations thereof."
Desert Home Health is not automated, Cayton says. "Our nurses still do their own script. A lot of places are on laptops, but that’s fairly expensive."
Start with a review
While Cayton’s forms requirements may be peculiar to her agency, others could benefit from a review of their own forms and a good housecleaning, says Dan Lerman, MHSA, president of the Center for Hospital Homecare Management in Memphis, TN. Lerman recommends that agencies "take a look at every piece of paper and ask, Is it appropriate?’
"Where do your forms duplicate each other, overlap? Is there redundancy? Look at your organization, and see how you can improve your paperwork," he advises.
Consolidate forms
Karen Van Dusen, RN, MA, director of Home Health Services at Riverside (CA) Community Hospital, has made some progress with forms reduction. "We have combined our care plan with our nursing evaluation. That has been very helpful to our nurses," Van Dusen says.
"In our basic admissions packet," she notes, there are still about 24 pieces of paper, though not all have to be filled out."
Yet new forms seem to appear almost as fast as old ones are consolidated, she adds.
Cayton’s agency’s efforts have included redesigning the initial consent form. "We made it inclusive," she says. "It combines infusion, patients’ rights, the advance medical directive. We went from three or four separate forms to one."
Nursing progress notes also have been streamlined. Whereas before nurses needed separate forms to document wound care and cardiovascular status, the General Daily Flow Sheet does it all on one page. (See flow sheet, inserted in this issue.)
Described by Cayton as the form used for a nurse’s daily visit to the home, it contains a checklist for such things as a patient’s skin condition; vital signs; appetite; and pulmonary, neurological, psychosocial, and homebound status.
Under the psychosocial/environmental section, such topics as safety and caregiver competence are covered.
The homebound status section includes an ambulatory assessment. On the back of the form is a space for comments.
A month-long project
The project took about a month to complete, and Cayton credits her nurses with coming up with the idea and with making the process work. "We got a bunch of different sheets, we assessed them, and we combined where we could," Cayton explains. "We sat down and reviewed. Then we went to Materials Management [the hospital’s printing department] and had them print them exactly the way we designed them."
Cayton acknowledges that her agency’s forms may not fit situations at other agencies, but she is convinced the project has saved her staff time. "Some agencies still have quite a bit of forms, and I’m not saying it’s good, bad, or indifferent. It’s always a time-savings when you can grab one sheet rather than several. The charts get thick. This eliminates a lot of paperwork."
And one other thing that’s important to Cayton: "We’re saving trees."
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