Work with a hospice to improve palliative care
Work with a hospice to improve palliative care
Home care and hospice can learn from each other
Home care nurses might not often think in terms of palliative care since they traditionally have been focused on cures, not on easing pain without a cure.
Increasing numbers of patients are entering home care at the end of their lives as hospitals send even some of the sickest and high-tech care patients home. Plus many patients would rather live out their last weeks or months at home with their families than in a nursing home or hospital. While hospice is available, these patients might still desire some treatment that only home care may provide, or perhaps they have not yet accepted their deaths and will not agree to hospice.
Some home care agencies have decided that the best way to treat these patients is by linking up with a local hospice agency.
The VNA of Middlesex-East in Stoneham, MA, decided to take a close look at pain management last year, and the home care agency teamed up with its hospice counterpart to do so.
"We evaluated records and looked at charts and felt that although patients had some pain management, it wasn't being addressed on every home care visit," says Linda Miller, RN, hospice manager for the VNA of Middlesex-East Hospice, which serves an area north of Boston.
So the hospice helped the home care agency hold inservices on pain assessment, pharmacological management, and the different side effects of narcotic usage.
"We also did some alternative therapies, such as cold and heat massage, relaxation tapes, music, and things like that," Miller says.
Inservice raised test scores
Nurses were given pre-tests and post-tests, and their scores improved from a few wrong to 100% after the inservice.
For another part of the program, the home care agency now can request a pain management consultation with a hospice nurse. For example, a home care patient with arthritis may be having difficulty with pain management. So the home care nurse may request a hospice nurse to visit the patient and make some recommendations, Miller explains.
Home care-hospice partnerships can be useful for other reasons, as well. And they do not have to be restricted to agencies that are affiliated with a hospice.
Decatur General Home Health Care of Decatur, AL, for example, formed a partnership with the Hospice of the Valley of Decatur last year.
The way it works is that the home care agency trains hospice nurses how to do the documentation for home care, and then the agency hires the hospice nurses on a contract basis for dying patients, who are not ready for hospice care, says Lisa Hood, RN, BSN, patient care coordinator of Hospice of the Valley, which serves two rural counties in northern Alabama.
When the patients are switched over to hospice, they can keep the same nurses to whom they had become attached while in home care, Hood says.
The hospice and home care agencies decided to form the partnership after repeated cases in which patients had been in home care and were supposed to be transferred to hospice, but they refused because they didn't want new nurses and aides.
"So the home care agency would hang on to them as long as they could and then transfer them over to hospice," Hood explains. "We saw that as a great barrier to what we do because there was no time for a relationship and trust."
Under the new system, the hospice nurses are called dual-trained palliative care nurses, who may work in both the home care and hospice settings.
No complaints from either party
So far, both the hospice and home care agencies are happy with the arrangement.
"I think it's worked out very well," says Allyson Baker, RN, manager of clinical practice for Decatur General Home Health Care, a hospital-based, full-service agency that serves four rural counties in northern Alabama.
"Some of the doctors have even requested that certain patients be placed in the palliative program because they are terminal but not quite ready for hospice," Baker adds.
Hospice nurses train by making home visits with home care nurses for about a week. Then the education manager spends half of a day teaching them about documentation, Baker says.
Decatur General Home Health Care also provides inservices for home care nurses about the palliative care program and its purpose. "Hospice nurses have come and talked with them about what hospice can do once the patient gets into the hospice program itself," Baker says.
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