Thursday, February 13, 2014

My first admission

Yesterday I finally did it! I did my first start of care (SOC). My day started with our required care conferences where we discuss all of our patients, and then we had a staff meeting. I was annoyed because the meeting was almost 2 hrs ! I wanted to see my patient as early as possible because I knew it would take me a couple hours to do the full admission. After the meeting I scheduled my patient who said I could come at 12, this gave me over an hour to make sure I had all the paperwork and enough back ground info on her to do a good job.

I arrive at her house and she and her family were lovely and inviting. Unfortunately, this patient was pretty young and had a recent craniotomy (procedure involving the brain) to remove a mass. She was left with some physical limitations after the procedure which made her home bound. 

I started the admission with making sure she understood what our company offers. Sometimes patients think they are receiving around the clock nursing care, maid services and all kind of crazy stuff. Lucky for me she was well informed and knew exactly what we were offering, so we went ahead and signed consents. After the "business" part was complete I went ahead with collecting her medical history. This conversation tool a good 30-40 minutes and discussing her medications took just as long. Lucky for me, she wasn't on a ton of meds, because I have to document every single med she takes. Once I gathered all my information, I started my assessment which didn't take more than 5 minutes. I Tried my best to  chart as much as I could while I was in her home, but I'm not familiar with the paperwork so it would have taken way too long to do it in the home. The total visit ended up being 1hr 40minutes. We are paid a flat rate and admissions are supposed to only take 1 hr.... Lol

Now the hard part was waiting for me. I had to get all the paperwork completed and be out of the office by 3:30 to meet my daughter at the bus stop. I get back to the office and no one was available to help me because one of the nurses went home sick and my preceptor had to take her patients. My DON (manager or director of nursing) couldn't help because she was in a meeting. I was left to figure it out on my own. Most of the OASIS wasn't bad at all, I just had to simply fill in my assessment. I notice questions were asked over and over, and that was annoying. But I know it's made that way to make sure we are being consistent and honest... I guess that's why.  Finally at 3pm my manager was available to help, so she was able to help me with some of the documenting. But it was now 320 and I had to get ready to leave. Before I left the offic I called the patients DR and made sure she would sign our home care orders. I spoke with the secretary and was told they would call me back with an answer.

I make in home by 340 and just sat in my car until my daughter arrived. I was just about done the chart! After my daughter arrived we went to pick up my son. Once we were all home it was 4pm and I had to take the chart back by 5 for payroll!!!! I was really stressed now, because I knew I had to finish and my kids were being normal kids harassing me lol. I had to keep telling myself to get it done and if something is wrong I can always fix it later ( that's what my manager told me) this eased my anxiety and stress levels . By 440 we were leaving the house to drop off the chart. I made it back In perfect timing and handed the chart in and again my manager assured me that it was my first admission and I shouldn't worry. She said we would go over it together next week :)

Now that I think about it, I had a pretty stressful day but in the end I was able to pick my kids up and take them to the office with me. I still got my work done. I'm pretty sure it gets a little easier too. I spent the whole day working on this admission,but I'm glad I finally got to do one. I'm sure the next time I do one I will be much more comfortable.

I'm so excited to learn to be a proficient home care nurse. Right now I'm in the phase where I don't trust my assessment or anything I do. I think I'm doing an awful job and question whether I am really helping my patients.  I haven't received and negative feedback so I guess I'm doing ok,but I know I have so much to learn. For the first time in my nursing career,I really want to take my own time to invest in educating myself on my new role. I'm thinking of ordering a home care reference book to help with documenting. I may had said it before that this home health company teaches just by doing and doesn't t really rely on polices or written guidelines.  It worries me a little bit,  but I also look at it like there's room for improvement and I would like to help with that :)

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