Is your professional visiting staff as productive as they can be?
As home health agencies strive to cut costs by operating more efficiently, helping visiting professionals maximize their time should be a high priority. Numerous strategies are used to reach this goal, including providing technology such as point-of-care electronic documentation systems and smart phones, delegating roles and responsibilities to other personnel and providing up-to-date policies and procedures. An important skill that is often overlooked is teaching an organized way to conduct a home visit.
The home visit is the most important tool agency has and currently is the basis of our reimbursement. Conducting a home visit is an art that requires clinical expertise combined with organization skills and common sense.
I’ve taught clinicians and students the 3-Step Home Visit Process for years. I’ve found that after committing the steps to memory and consistently practicing it on visits, it becomes difficult for them to conduct a visit any other way — even for those clinicians who have lots of experience. I invite you to share this with your managers, educators and clinicians and provide me feedback at chumphrey@axxess.com.
NOTE: The 3-Step Home Visit Process described below does not include the additional steps required for a visit to admit a client to home care. However, the additional steps can be added to the structure.
The 3-Step Home Visit Process:
Pre-Visit Stage — Before entering the client’s home, you, as the clinician, should have a mental picture of how the visit will unfold, knowing that your flexibility is essential because client situations and conditions can change since the last visit.
- Review the client’s medical record: Diagnosis and conditions, medical history, current problems, medication regime, most recent OASIS assessment, care plan, specific interventions and any new information since the last visit.
- Identify the visit’s purpose(s): This assures you are taking the necessary items with you such as educational materials, unique supplies not found in your bag, etc. and helps estimate the visit’s length.
- Develop a tentative schedule for the day: Consider the time for each visit based on the purpose, routine time a procedure is done (insulin injection, changing a dressing), need to meet a caregiver to evaluate teaching, driving time and other factors.
- Briefly call the client to assure anticipated time is convenient, even if the date was previously scheduled. Ask how he/she is feeling and if there has been any changes in their condition since the last visit.
- Organize your Nursing Bag to restock and ensure you have any needed unique items.
- Double check the route to the client’s home before leaving for the day. Many electronic medical record (EMR) point-of-care systems (POC) have GPS built in and you should have a GPS in your car, phone or tablet. If any of your visits are in an area the agency has identified as needing special precautions, be sure to follow those procedures.
Visit Stage – On every visit, the initial face-to-face meeting between the nurse and the client is important. You should set a professional tone that focuses on the purpose and priorities of this visit.
- Use the first minutes to introduce yourself to everyone present and have a light conversation so that everyone is put at ease. From this point forward, be professional to keep the focus on the purpose and objectives of the visit. Always going back to this can guide the time so the patient won’t feel cut off or not listened to.
- Remember, you are a visitor in the client’s home.
- In my many years of practice, I have found nurses to disagree with this point. They feel everyone should be happy to see us and grateful for our help. Consider how you would feel if someone came into your home, started telling you what to do, and moved things around; then you may better understand how to proceed. The client’s home environment may not meet your standards, but most families are willing to accommodate what you need, if they are treated with respect.
- Identify an efficient work area and a place for your bag. The kitchen table is often used. Ask the client and/or family to clear any areas or ask if they mind if you organize the space. For example, if you need an area to change a dressing, ask if a table can be cleared so you can set up a clean or sterile site. If the clearing of space is performed on a regular basis by the family and you, encourage them to save this convenient space for the procedure.
- When the procedure is completed or when ending the visit, always offer to replace any rearranged items, first giving the family the opportunity.
- Begin implementing bag technique by washing your hands before starting the skilled part of the visit. Always follow your agency’s bag technique and infection control procedures.
- Perform required assessments and interventions while observing the client and family, environment, and behaviors and values that provide insights into the client’s culture, family roles, relationships and tasks, relationships with pets and the value placed on privacy. From these observations, changes in the plan of care can be made.
- Involve the client and caregiver in every step of the care. Research shows that engaging and empowering clients to take responsibility for their care will help them reach positive outcomes.
- To end the visit, summarize how the visit purpose and objectives were accomplished, ask the client to repeat teaching, clarify anything confusing, and set time for the next visit.
- Document…Document…Document! Whether you are using a paper system or an EMR, document as much as possible during the visit. You’ll report more accurate data, won’t need to work later, and will have more time to spend with your family.
Post-Visit Stage – If you’ve implemented the previous two steps, there should be less work to do after leaving the client’s home. However, based on data collected at this visit, you may need to:
- Revise the POC by adding a new problem, resolution of a current problem or updating the client’s information and status.
- Communicate with the client’s primary care provider regarding the client’s current condition.
- Initiate intra-agency communication such as updating the client’s primary nurse, scheduling a case conference with other disciplines involved or reporting updates to your supervisor.
- Initiate a referral to community agencies that could address the client’s specific need.
Look for my next blog on home visit safety tips.
Carolyn Humphrey, MS, RN, FAAN is President of CJ Humphrey Associates and a national leader in nursing, home care clinical practice, operational efficiency and regulatory compliance.
