How Hospice RN Case Managers Can Reduce After-Hour Calls
I understand the challenges that patients and families face when receiving hospice services. One common issue that arises is the need for after-hour calls, which can add stress to an already demanding situation. However, with proactive care and effective communication, dayshift hospice RN case managers can play a crucial role in reducing after-hour calls and providing better support to patients and their families. Here’s how:
1. Thorough Education and Preparation
Take the time to educate patients and families: One of the main reasons for after-hour calls is a lack of understanding about the patient’s condition or the appropriate actions to take. As a dayshift hospice RN case manager, you can dedicate time during your visits to thoroughly educate patients and families about the patient’s specific needs, symptoms to watch for, and steps to take when certain situations arise. This proactive approach can empower them to handle situations independently, reducing the need for after-hour calls.
Provide comprehensive care instructions: Ensure that patients and families have clear and concise care instructions that cover various aspects of their loved one’s condition. This may include information on medication administration, managing pain or discomfort, handling emergencies, and contacting the appropriate resources. Written materials or handouts can serve as a helpful reference, reinforcing what you discuss during your visits.
Empowering patients and families is crucial in reducing after-hour calls. When individuals feel confident in managing certain situations themselves, they are less likely to reach out for immediate assistance. RN case managers can empower patients and families by equipping them with the necessary knowledge, resources, and support.
To empower patients and families effectively:
- Patient Education: Provide comprehensive education on managing common symptoms, medication administration, and when to seek immediate medical attention. Offer educational materials and resources to reinforce learning.
- Caregiver Training: Train caregivers in essential skills, such as safe patient handling, medication administration, and emotional support. This training gives them the confidence to handle situations independently.
- Regular Supportive Conversations: Schedule regular supportive conversations with patients and families to address concerns, answer questions, and provide emotional support. These conversations create a sense of reassurance and empowerment.
2. Establishing Trust and Open Communication
Build a strong rapport with patients and families: Establishing trust and a good relationship with patients and families is key to reducing after-hour calls. Take the time to listen to their concerns, address their questions, and provide empathetic support. By building trust and being approachable, they will feel more comfortable reaching out to you during regular hours instead of resorting to after-hour calls.
Encourage open communication: Make it clear to patients and families that you are there to support them and that their concerns are valid. Encourage them to reach out to you during regular hours if they have any questions or if their loved one’s condition changes. Let them know that their calls will be prioritized, and you will provide timely responses. By fostering open communication, you can address their needs promptly, reducing the likelihood of after-hour calls.
To build trust and establish relationships effectively, RN case managers can:
- Initiate Regular Check-Ins: Proactively reach out to patients and families on a regular basis to assess their needs, provide updates on care plans, and address any concerns.
- Listen Actively: Practice active listening to understand the emotional and practical challenges patients and families are facing, validating their concerns, and offering empathy.
- Educate: Provide comprehensive education to patients and families about symptom management, medication schedules, and resources available to them. Empower them with knowledge so they can handle situations confidently.
3. Collaborative Care Planning
Involve the entire hospice interdisciplinary team: Collaborate closely with the interdisciplinary team involved in the patient’s care, including physicians, social workers, and counselors. Regularly communicate and share updates to ensure everyone is on the same page regarding the patient’s condition, goals of care, and any changes in the care plan. By working together, you can proactively address issues during the day and prevent emergencies or crises that might lead to after-hour calls.
Anticipate and address potential issues: Use your experience as a hospice nurse to anticipate potential issues that might arise and proactively address them. For example, if a patient is experiencing escalating pain, work with the physician to adjust the pain management plan before it becomes an after-hour emergency. By staying ahead of potential problems, you can help prevent after-hour calls and ensure the patient’s comfort and well-bring.
Here’s how RN case managers can enhance care planning and coordination:
- Interdisciplinary Collaboration: Work closely with the hospice team, including physicians, social workers, chaplains, and volunteers, to ensure everyone is informed and aligned regarding the patient’s needs and goals.
- Regular Team Meetings: Facilitate regular team meetings to discuss patient progress, adjust care plans, and share insights or concerns. These meetings allow for early interventions, reducing the likelihood of after-hour calls.
- Clear Communication: Ensure clear and concise communication with patients and families, providing them with written care instructions, emergency contact numbers, and information about available resources.
4. Proactive Symptom Management
One of the primary reasons for after-hour calls is the management of distressing symptoms. Hospice RN case managers play a crucial role in assessing and managing symptoms during regular business hours, ensuring that patients receive appropriate interventions promptly. By addressing symptoms proactively, they can minimize the occurrence of severe symptoms that might require after-hour calls.
Proactive symptom management should be a priority. By addressing symptoms before they escalate, you can reduce the need for urgent after-hour interventions. Consider the following approaches:
- Regular Assessments: Conduct thorough symptom assessments during daytime visits to identify and manage symptoms promptly.
- Collaborate with Physicians: Work closely with physicians to adjust medication regimens and ensure optimal symptom management.
- Patient/Family Education: Educate patients and families on recognizing and managing common symptoms, emphasizing the importance of timely reporting and following the prescribed interventions.
5. Medication and Supply Refills
Assess for the need for medication refills and supplies every single visit as well as checking that any previous orders came in or are otherwise enroute within a reasonable timeline for arrival. This helps the patient maintain consistent comfort, reduces anxiety among the patient and family as well as reduces calls to triage for items easily handled during the scheduled visit.
Remember that it is extremely common for patients and families to forget what medications and supplies are covered/provided by hospice and those that are from other sources. Therefore, it is in everyone’s best interest during your visits to regularly check on those items not covered by hospice to see if they are getting low and provide education to the family on how to restock those items.
Your role as an RN Case manager is crucial in providing proactive care and support to patients and their families. By thoroughly educating patients and families, establishing trust and open communication, and engaging in collaborative care planning along with proactive symptom and medication/supply management, you can significantly reduce after-hour calls. This not only helps alleviate stress for patients and families but also allows you to provide more focused and timely care during your scheduled shifts.
Remember, each patient and family is unique, and their needs may vary. Flexibility, compassion, and adapting your approach to suit individual circumstances are key aspects of providing exceptional hospice
What Hospice Nurses should assess every visit: https://pmabraham.medium.com/what-hospice-nurses-should-assess-every-visit-154671974fc1
Preparing for a Good Death: Topics to Cover with Hospice Patients and Their Families: https://pmabraham.medium.com/preparing-for-a-good-death-topics-to-cover-with-hospice-patients-and-their-families-604c0ff09e64
The importance of caregiver journaling for the patient and family: https://pmabraham.medium.com/the-importance-of-caregiver-journaling-for-the-patient-and-family-3cc1d8a7f092
Triage of After-Hours Hospice Calls: https://www.stcc-triage.com/stcc-newsletter-blog/triage-of-after-hours-hospice-calls
A Descriptive, Retrospective Study of After-hours Calls in Hospice and Palliative Care: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3389760/
Utilization of after-hours telephone support in a home-based hospice service: https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-022-01049-5