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Posts from the ‘hospice’ Category

Novus Hospice

Novus Hospice in Frisco accused of aggressively managed length of stay numbers by overdosing patients on continuous care.

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Suicide Contagion

Every time a celebrity commits suicide, we pay attention to Depression and the tragic end outcome if Depression is not treated or does not respond to treatment; at least for a little while.

I have never owned a Kate Spade purse but I liked her. Together with her husband, they created a brand that took whimsy seriously and added color to our world.

Anthony Bourdain lived the life of my dreams; travel, adventure and food. Could there be more?

Neither Kate Spade or Anthony Bourdain allowed their public personas to reflect the extent of their illness. This is understandable in terms of privacy but leaves many people shaking their heads because they can’t understand how celebrities who appear to have everything would choose to die.

Home healthcare patients are confined to their homes. Some have lost one or more spouses and may be separated from family who have moved to pursue careers. They are sick and many are in pain. Their outward presentation is that of a patient population at high risk for depression.

As it turns out, 20 percent of people over 65 are depressed and men in their 80’s have highest rate of suicide of all age groups.  Across the board, the rate of suicide is rising as funding for mental health is declining.

Suicide prevalence image

As of last week, patients are at an even greater risk for suicide due to the phenomenon of Suicide Contagion which is exactly what it sounds like.  Suicides occur in clusters almost appearing to be contagious like a virus.  In the four months after the loss of Robin Williams, the overall suicide rate increased by 10 percent. Google searches for suicide related topics increased after Netflix aired ‘13 Reasons Why’. There was a 25 percent increase in the number of calls to the National Suicide Prevention hotline in the two days following Anthony Bourdain’s death.

One reason has been attributed to journalism standards. There are journalistic guidelines for reporting suicides that nobody seems to follow. Near the top of the list is not reporting on the details of suicide.   When reporting on a suicide, the WHO also recommends including information on how to get help. Most initial reports of last week’s high profile deaths included this information – usually at the end of an article that might be missed – but as the days progressed, more attention was given to the ‘gossip’ and a few interesting conspiracy theories surrounding these stories.

But we’re not journalists so how does this pertain to nursing.  How many of your patients spend most of their waking hours tuned to the television news?  Depending on the reporter or news station, some news stories are almost like a tutorial or at best a psychological autopsy that is really none of our business.  Most nurses also have social media accounts.  Think twice before sharing or reposting a story that has sensational or dramatic headlines.

What should you do for your patients?

  • Regardless of prior diagnoses or risk factors, encourage your patient to do something other than consume the details of tragic suicides. You might investigate alternative viewing options, suggest some time outdoors, a book or a crossword.
  • Pay attention to your PHQ2 assessments. I am incredulous when reading about patients who start their day with a round of golf and end it with their chest opened with power tools due to a cardiac event. Three days later they are admitted to home healthcare and report zero days with little interest or pleasure of doing things or feeling down. A positive PHQ2 does not confirm a diagnosis of depression but it gives you a baseline and together with the physician, you can look at medication side effects, ensure the patient is able to sleep and address pain. If the patient doesn’t show improvement in two weeks, there is a strong possibility that he or she won’t participate in their plan of care to the extent that they can which will prolong healing and further treatment may be indicated.
  • If your patient is pre-loaded with a diagnosis of Depression and is on medication, take it from there. Don’t just assume it has been handled.  Teach side effects of meds, encourage socialization, educate the family, etc. Never assume that a med is going to work completely and consistently. After all, diabetic patients aren’t started on metformin and never checked again.
  • Talk about depression in the same tone that you talk about other diagnoses. Depression is seen by many from former generations as a weakness. Assure your patient that depression is an illness and is not a reflection on their character or inner strength.
  • Leave written information adjusted for the reading level and visual acuity of your patient about resources they can access if symptoms worsen. Put the information in a place that is obvious to the patient and near the phone.

Depression is not a normal part of aging. You can implement measures to improve your patient’s depression and dramatically improve the quality of their life. With mental health funding dwindling across the nation, we need to up our game.

Other Resources

Men and Depression – low literacy

Depression in the Elderly – low literacy

CDC Suicide Prevention Fact Sheet

A 36 Billion Cottage Industry

How home health and hospice visiting nurses can recognize financial exploitation of the elderly and who to call when they do.

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Giving Thanks

We have much to be thankful for this year, believe it or not.

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Making Time

It’s lonely being a Director of Nursing – doubly so when the agency Administrator is not a nurse.

There are subtle differences between states on the responsibilities of the Director of Nursing but together with the Clinical Supervisor’s role outlined in the Conditions of Participation, it is clear that a DON is responsible for almost everything that happens in a 200-mile radius.  These responsibilities include but are NOT limited to:

  • Oversight of all clinical personnel and all clinical services
  • Making sure that all patients have care plans
  • Patient Assignments
  • Developing and overseeing clinical policies and procedures
  • Infection Control
  • Quality Assurance
  • Staff education
  • Compliance
  • Hiring staff
  • Ensuring that all admission procedures are followed

That’s a pretty daunting list so I hesitate to say it is incomplete but… it is.  Although the tasks can be delegated the responsibility belongs to the DON alone.  Going to a non-clinical administrator about infection control or required education for staff may be a fun way to spend an afternoon but the surveyors will look to the DON for answers.

Before you quit your job and punch yourself in the face for accepting the responsibilities of the DON position, relax.  It can be handled and is handled every day by nurses who are no more skilled than you.

Like most overwhelming jobs, the position of DON is easier when broken down into smaller pieces.  It is also easier if you identify all the impediments to doing your job well before you try to do it better.

Time Management

  • Open Door Policy – this sounds really good in company sound bites and recruiting campaigns but an open door policy can wreak havoc on your day. Instead, hold office hours like college professors do.  This doesn’t mean that nurses cannot interrupt your day for urgent matters but all non-urgent matters should be conducted during office hours.  During office hours, your visitors should have your full undivided attention.  If you want to make notes, wait until after they leave and write down your thoughts while still fresh in your head.
  • Meetings – Meetings are important but after a point, they become time-wasters. Eliminate all meetings that are not necessary and be prepared for necessary meetings.  Meetings should start on time.  Invite participants to arrive a few minutes early if they want to visit with coworkers.  Clinicians who are unprepared at case conference will be obvious.  Don’t rescue them.  After they flounder in front of their peers once or twice, they will be able to fully participate.  Or not.  If an adult cannot be responsible and prepared for meetings, maybe you should rethink their position in your company.
  • Delegation – most tasks of the DON can be delegated. Delegation consists of two parts – one is assigning the task and the other is the oft forgotten follow up.  Survey is a very bad time to find out that a nurse performing utilization review did not understand the process.   Send yourself an email to follow-up on an assignment you delegated.  Was a nurse tasked with collecting data for infection control?  Write it on your calendar to check in with the nurse in a month.  Look at the work done.  This takes a lot less time than trying to recreate data during a survey.   Taking the time to schedule QA, OASIS transmission, annual advisory board meetings and other infrequent but mandated events will reap an enormous return on investment.
  • Set aside some time each day when the phone does not ring in your office. Have the receptionist screen the calls and take messages.  Only take calls from patients who cannot be helped by their nurse, and referral sources.  When this policy was implemented at one agency, about half of all phone calls were handled before they got to the DON.

Hiring Process

 Learn how to interview potential candidates for a job. Listen to what they have to say.  Monster. com has a list of the 100 Most Asked Job Interview Questions. Consider asking candidates to teach you about falls precautions or injecting insulin as if you were a patient.  (Note:  do not ask about what kind of care they drive as suggested on Monster.  Ask what kind of car they dream about owning.  Avoid candidates who name a grey sedan.)

  • Schedule all interviews on the same day and set a mental timer to reduce the amount of time you spend on each interview.
  • In larger agencies, consider deferring the initial interview to a case manager who will be the direct supervisor of the new employee.
  • In all agencies, schedule a second interview that includes various people the candidate will work with on a daily basis. Your current staff is more likely to support a new employee if they endorsed the initial hire.

Staff Education

  • Get someone else to provide education to your staff. Call on drug reps to teach your staff about new and trendy drugs.    Get the wound care folks to teach about wounds.
  • Involve staff by assigning a five to ten-minute presentation on compliant documentation, a new drug or a condition not seen very often in your area to begin each case conference. (Note:  You can start to identify the next case managers or even your replacement by observing how well prepared they are and how comfortable they are talking to their peers.)

Perks of Managers

Setting up your work environment to allow for focus and completion of the tasks and follow-up on coworker’s projects will leave you feeling accomplished. Your stress level will automatically decrease as deadlines are no longer looming over you.  Your ability to trust your staff will improve when you follow-up up on their projects allowing you to appreciate the support you have.   Most importantly, you’ll get home in time for dinner with the fam.

Got any other ideas?  Post in comments!

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