Have aides play matching game with work sheets
What’s on nursing care plan must be followed
Metro Healthcare Services Inc. of Edison, NJ, found it had some documentation problems with its home health aides’ work sheets or task sheets.
These sheets occasionally did not match the tasks and information listed on the nursing plans of care. These discrepancies, however minor, could result in safety problems with the clients or staff, and they could result in an unfavorable survey by the Joint Commission on Accreditation of Healthcare Organizations, says Denise Connors, RN, Metro vice president of nursing.
The aides’ sheets must exactly match what is written on the nurse’s plan of care according to Joint Commission standards, Connors explains.
"You think, Oh, that’s not hard.’ But when you really think about it, it is," Connors says.
Metro’s home health aides use one task sheet that serves a dual purpose. It includes information on both the amount of time the aide worked, and on different tasks the aide may have performed. For example, the sheets have spaces for the aide to check off whether a patient was given a bath or whether the aide made the bed.
But this is a different format from the nursing plan of care forms. "When we open a case, the nurse goes out and develops a plan of care, and she writes for a particular patient that the aide should give the patient a bath once a day and check his meals and do other basic tasks," Connors explains.
So whatever the nurse has written on the care plan must be written on the aides’ task sheet, showing that it was taken care of. This meant aides had to follow the care plans and the agency’s policies in minute detail.
One of the most minor issues that tripped up aides was if they used a blue pen in filling out their task sheets. While not a major problem, it would have raised a red flag with the Joint Commission because the agency’s standard called for black ink.
Metro Healthcare gave aides mock surveys and inservices to bring home the importance of accurate documentation.
The agency developed two tools, called Quality Improvement Calendar: Review CHHA Work Sheet Documentation, and Client Care Review CCHA. These helped supervisors evaluate each aide’s performance.
These also clearly listed exactly what was expected of each aide during patient visits, and they documented how well the aides complied with these requirements on a monthly basis.
The aide work sheet documentation tool contains 42 check points, including these:
clean/defrost refrigerator once/week
clean/tidy bathroom each day
empty trash each day
weigh and record when applicable
offer fluids when applicable
nail care when applicable
mouth care/teeth every day
walking when applicable
range of motion when applicable
supervisor signed sheet
peri-care when applicable
record bowel movements when applicable
medication remind when applicable
The Client Care Review tool contains the following categories:
1. Prompt
2. Late
3. Communication
4. Respects Rights
5. Quality of Care
6. Dress Code
7. ID Available
8. Personal Hygiene
9. Initiative
10. Attitude
11. Professional Report
12. Client Diagnosis/needs
13. Follows plan of care
14. Prioritizes duties
15. Completes work sheet
16. Occurrence reporting
17. Safe
Transfer
Ambulation
Home Environment
Body Mechanics
18. Client nutrition/diet
19. Universal Precautions/hand washing
20. Range of Motion
Connors emphasized to the aides what type of repercussions could occur if they did not follow the nurse’s care plans to the absolute letter.
She gave these examples of potential problems:
• An aide is scheduled on the nurse’s care plan to see a client between 12 noon and 2 p.m. But the client calls the aide and says she’d prefer the aide arrive in the morning. The aide might acquiesce, thinking it isn’t a major problem.
But the aide didn’t bother to first gain approval for this change from the nurse. So perhaps the next day the agency learns that the patient has fallen and broken her hip. Managers look at the schedule and see that the aide was supposed to be at the home during that time. "If a nurse says to go to the home during a certain time, then you should go," Connors explains. "If you have concerns, call and discuss them with the nurse."
• An aide has a client who uses a walker. The nurse’s care plan states that the aide helps the client walk, using the walker. However, the aide decides the client has improved enough and doesn’t need to use the walker during a particular visit.
Then the client happens to fall. "Aides really need to go by the nurses’ plan of care, for the client’s safety as well as their own safety, and to make no changes without first discussing it with the nurse," Connors says.
As part of the QI process, the aides’ work sheets are continually audited to make sure they comply. If an aide’s documentation is inconsistent, then the field nurse would report this and the aide would be given another inservice.
"Our standard of care has always been wonderful, but there was room for improvement and we did that," Connors says.
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