When it comes to good patient care there is no substitute for case conferencing. In my years of experience, I have seen agencies who chose not to conduct a structured case conference, agencies who held a meeting where patients were discussed just long enough to meet minimum standards and I have seen agencies that make the absolute most out of a weekly or bi-monthly case conference. Guess which agencies do better overall?
With OASIS-C now a reality, there are even more reasons to conduct a thorough case conference that includes process measures. In doing so, discharge reviews will be much easier to perform.
These are some of the processes I’ve seen at various agencies over the years that make case conferencing more effective. Pick and choose those ones that you like and send us any other ideas we might not have heard.
- Prepare a list of patients up for recert in advance so that charts can be reviewed by the RN who will do the recertification visit.
- Invite all disciplines involved in care. I have seen some agencies where aides are not included. This is a critical mistake.
Ensure that all the questions you want answered in case conference are addressed. You may want to make a short form or post the questions in the agency. That way the nurse who is reviewing the clinical record prior to case conference is aware of the information that she will be asked. Consider the following questions:
- Has the patient seen the doctor this episode and if so, why?
- Was any lab drawn? What are the abnormal results?
- Were there any medication changes?
- Was the patient taught on all medications?
- Did the patient go to the hospital at all? Why?
- Does the patient have heart failure? If so, what are the weight ranges?
- Does the patient have diabetes? What are the blood sugar ranges?
- Did any falls, injuries or other adverse events occur during the episode?
- Did the patient have a wound? Describe at beginning and end of episode. State wound care and any changes that occurred in the last episode.
- How was the patient’s pain managed? Were any interventions implemented with or without success?
- If a staff member is not able to attend, try to include them on the telephone.
Get signatures of all attendees.
Or you could just pull the staff in from the field, feed them donuts and do the bare minimum to demonstrate compliance to the care coordination condition of participation. Either way, it costs whenever you bring field staff in for mandatory meetings. Why not get the most for your dollar?