Searing heat impacts Texas agencies
Education helps keep home care patients safe
There were 29 straight days in July when the temperature in Texas didn't dip below 100. This was a potential disaster for home care patients. But the home care community in Texas is proud: Not one of the 100 deaths attributed to the heat came from the ranks of their patients. The agencies cite increased patient education and contact with clients, and a dedication to ensuring that visiting staff didn't succumb to the heat, either.
Maritta Loo, RN, CNA, director of Dallas/Ft. Worth Medical Center Home Health, is one of those proud home care executives. "We didn't even have a patient admitted to the hospital," she says. "The field staff have been aware and innovative. We have been ready to intervene as soon as we see something awry."
Visiting staff spent more time educating patients and their family on the need to drink more and keep fans going, says Rachel Ibarra, RN, CQI manager for Dallas/Ft. Worth Medical Center Home Health. She also brought in social workers to help educate patients on electricity issues, reminding them that electricity would not be turned off during a heat wave, and that help was available for large bills. "A lot of people have air conditioning or fans, but they won't use it because they are afraid of the bills," Ibarra explains.
Although generally happy for the advice, Loo says there were some patients who adamantly refused to use air conditioners. For them, getting a fan was paramount. "If you look at the people who died, almost exclusively, they didn't have a fan. It is the most economical thing you can tell them to do."
Despite the increased education, Loo says staff didn't make more visits. Instead, they used the telephone to keep in touch and spread the gospel of fluid intake and circulating air. "Although if we had a situation with a patient with minimal resources or minimal people contact, then we would visit more," she says.
To keep patients out of the heat, the agency also used the phones for consultations between patients and social workers, physicians, pharmacists, and even psychiatrists for certain patients, Loo adds.
Acute Home Care in Arlington, TX, also spent time trying to keep patients indoors, says Lori Denam, RN, BSN, director of professional service. Denam and her team asked patients to let them know if they needed errands done. She would then arrange to do them. "Sure it was extra work, but we had no hospitalizations or deaths from the heat," says Denam.
Visits, while no more frequent, averaged about 15 minutes longer for Acute staff. Like Dallas/Ft. Worth Medical Center Home Health, Denam says Acute spent more time doing patient education and evaluating the home environment.
Both agencies were aided in their education efforts with a heat checklist from the Texas Department of Health that each adapted for its own use. (The checklist appears on p. 142.)
Staff battle heat, too
Although the staff constantly drilled their clients on how to deal with the heat, Terri Cardona, MSW, director of therapy at Dallas/ Ft. Worth, says staff members also had to be reminded to take care of themselves. "We told them to drink water before they go, and some would take frozen bottles of water with them."
Staff members were advised to put their hair up to keep it off their neck, and told that keeping their car too cool might be a mistake. "It might be too much of a shock to go from a really cool car to the outside," says Cardona. The agency put flyers up in prominent places to remind staff of these issues.
One way Acute staff coped was to try to see patients in the morning or evening, spending the afternoons in the office. They also relaxed the dress code. But with the change in schedules, Denam says there were more people in the office at once, and that made for shorter tempers. Dallas/Ft. Worth also rearranged staff schedules, trying to get their visits done before 2 p.m. when the peak heat hits. "If you have wound care, you can't really do that. But we do try to make sure that staff isn't doing something like physical therapy in the middle of the day."
In spite of the obvious success for home care agencies, there have been lessons. Denam says in the future, Acute staff will probably be quicker to link problems to heat. "We didn't anticipate this heat wave would last 30 days," she says. "I think if this happened again, we would relate some health problems to heat faster than we did this time." In particular, many of their patients experienced respiratory problems when they went out into the heat. At first, the staff didn't make the connection between the heat and the increased need for inhalers.
The agency learned more practical things, too. "We have to take supplies in the house, not leave them in the car," says Denam. "We had some aerosols explode and we had seals on lab vials melt." Denam even found herself playing mechanic, and reminding staff to check fluid levels in cars and use their window shades.
Denam also anticipates some higher-than-normal energy bills for the summer. She says she hopes it won't affect the budget too greatly, but it will inspire the budget makers to plan for more air conditioning use in the summer than they have in the past.
One reason there were few problems for Texas home care patients is that most agencies already plan for heat. For Dallas/Ft. Worth patients, says Ibarra, a thorough assessment always takes high temperatures into account. "We identify right at the beginning if there is an environmental problem. We have heat every summer, so we are used to dealing with this. The difference this time is that the heat is so high, and it's been high for so long. But really, this isn't anything new for us."
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