Early on we were able to fill all of our hours with one nurse. However, as we added more shifts (day and night) we also had to add more nurses. Building a team and everyone working together is crucial. We encourage our nurses to not only chart what is required by the agency, but we also encourage them to talk to each other. We keep all of their phone numbers listed with the current schedule and we encourage them to talk to each other about schedule changes, changes in the plan of care, or anything.
We have a few communication stations through out the house. We have a PRN whiteboard on the fridge. Yes, they also mark the medications given on the MAR, but the whiteboard is a quick and easy way for them, us, and anyone to see which PRN medications Casey has had and/or may have at a given time. We have another whiteboard also on the fridge for notes and needs. The top section is used to make sure everyone sees any changes in doses, new medications, new concerns, therapy schedule changes, upcoming appointments, etc. Then the needs section makes it easy for me to know to pick up next time I am out (Benadryl, hand soap, toilet paper, lotion). In our supply closet we keep a chart that shows all of the monthly and PRN supplies, when they were last filled, and how to get more. On the other side of the supply closet we keep a task chart. There are some tasks that are done as time allows (soaking syringes, cleaning the concentrator filters, restocking the mini-supply stations, and a few others). We know some days Casey requires 100% of the nurses attention, but on other days there is some down time. During this down time our nurses are great about helping out with these tasks. In order to make sure it’s not the same tasks every time, but that all get rotated and done, they write down the date most recently completed.
In addition to our home health team, we also have a large team of doctors, their staffs, therapists, teachers, social workers, case managers and I am sure I missing someone. We work hard to make sure that our home team and our external care team talk to each other as well. Our external care team meets our home team at appointments. When we have to call things in, I make sure to cc the nurses on emails or pass the phone to them for the official orders. There are times when our home nurses help out and call the clinics for us about a concern, they may call the DME to get supplies, they may have to call and reschedule an appointment if something comes up and I can not take care of it. We encourage our team to all work together.
At least once a year, sometimes more, we have a care conference. Most of our external care team will all come together in a room (or on the phone) to take a collaborative approach to any concerns we have. With Casey having so many medical complications, it is easy for something to fix one thing but break something else. Having everyone work together to make sure the plan put in place is best for Casey makes a huge difference. Our home team is usually in these meetings as well. We like to have them there to be sure they can address concerns they may have since they will be carrying out the plan of care.
It can seem like a lot of extra work to coordinate all of the different members of our care team (especially since it continues to grow). I have found this extra effort is totally worth it. If your team is not talking to each other and on the same page, the quality of care will quickly decline. Whether your team is only a few individuals or enough to start a football team, teamwork is very important. If we have a nurse that does not work well with the team we don’t keep them. Casey is the is team captain, and we all have to play together.
This article was originally created for and published by Pediatric Home Service