Best Practices and Service Excellence In Action
Posted on February 17, 2010 in Featured-writers
by Lois Kinsella, RN, BSN, MS, HCS-D
Through many years of practicing the profession of nursing, I have learned that one of the best ways to teach is through the process of story telling. So here is our story. The saga began in December of 2008. My husband suffers for frequent gout attacks primarily in joint of his left great toe bunion. He decided he had had enough and wanted to get the bunion fixed, so he went to a local podiatrist who determined the circulation to his left foot was not the greatest. There was no palpable pedal pulse. My husband was referred to a vascular surgeon for further evaluation.
In early 2009, the vascular examination was done, with ultra sound exams of both legs: the left leg had a blocked popliteal aneurysm and the right leg had an open popliteal aneurysm about 4 cm long. Since his body created co-lateral circulation on the left, the doctor focused on the right aneurysm for further treatment: a fem-pop (femoral popliteal) bypass was planned for early August. During the pre-operative assessments and evaluations, a stress test was performed. Results showed an ejection fraction (heart function test) of 35% so further tests were ordered. An angiogram done in August 2009 revealed one coronary artery that was 100% blocked and one that was 95% blocked. With no acute cardiac symptoms whatsoever, it was hard to believe that my husband was scheduled for open heart surgery on September 1, 2009 instead of a bunionectomy!
My husband has been treated for high blood pressure for several years and has prided himself in the fact that he only had to take two medications a day, both for hypertension. After the surgery and the four day hospital stay, my husband came home on Friday to begin the healing and recovery process with all 21 of his new medications!
Having been a home health nurse for several years, I thought I could care for my husband until I ran into the biggest brick wall I had ever faced. He absolutely refused to take his medications. He vehemently said, "I don't need all these pills and I'm not going to take them." In fact, I found pills in his pants pockets and on the floor. I was very anxious for the home health nurse, Mike, to arrive on Sunday. Maybe he could talk some sense into my husband.
At the time, I was the Agency Supervisor for the home health program that was ordered to provide nursing and therapy services. Mike arrived at our house, introduced himself and began creating a miracle. I sat quietly in the room observing, hoping to not intimidate Mike by my presence. Clearly, Mike knew exactly what he was doing and what my husband needed.
First, he listened. He listened to the frustration my husband was feeling about his health decline and about the medication extravaganza. Mike did not make any judgment statements, he just listened.
Then he began to teach: each medication on the list, what its function was and why it was important for the healing process. He used terms such as "pipes," "garden hose," "engine," "spark plugs," "roto rooter" to name a few. I sat in amazement as I witnessed the transformation in my husband, watching him and listening to him, as he verbalized total understanding of the importance of each medication. Mike taught him using language and terms he could understand. Since that Sunday, my husband has been very diligent about taking each medication that has been ordered. I have celebrated with him each time one of the medications is discontinued and encouraged him if another new medication is ordered.
The best practices care plan for oral medication management includes providing a comprehensive medication review at the home health start of care: review the proper administration, side effects, contraindications, food and drug interactions, and adverse reactions; assess the client's ability to self-medicate and compliance with medication use; instruct on correct medication administration including information about the drug, time/frequency, dose, route and what to do if a dose is missed, and storage issues; instruct on signs and symptoms that require immediate attention; instruct on the importance of using one pharmacy and instruct on the importance of taking an updated medication list to each doctor's appointment. Our addition to the best practice care plan for oral medication management:
Listen to the concerns and fears of the client/patient and family in regard to their medications. Teach in terms the client/patient and family can understand, don't read from a drug book or expect understanding from pharmacy printed materials, though these can be used to guide your teaching. Teach using real life examples.
As Brian Parsley wrote in the Newswire article last month, "You can make a difference," and Mike certainly made a difference in my husband's healing journey. The use of best practices and attending to the real life needs of clients/patients and families fosters the creation of a world class service organization.
P.S. My husband's blood pressure is not responding to the medications very well, so a renal ultrasound was ordered. Guess what? Yep, a blocked renal artery. Getting ready for a stent!
Copyright© 2010 LK Publications and Consulting Services. All rights reserved.
Lois Kinsella, a diploma nursing graduate and forty-year veteran of the nursing profession, has extensive experience in long term care program development. After graduating from the University of Wisconsin School of Nursing, Lois developed Cedar Acres Adult Day Center in 1987, one of the original sites in the Robert Wood Johnson Dementia Care and Respite Services Program. A pioneer in Alzheimer's adult daycare, Lois provided leadership as President of the Wisconsin Adult Daycare Associaton for several years and had many opportunities to speak at state and national conferences. Lois is the author of "The Hundred Mile Road," a parable about the acceptance of hospice care. Lois developed and managed Alzheimer's assisted living facilities, an Alzheimer's special care unit in a nursing home, hospice programs, and most recently assisted with the development of ABLE Home Health in Rockford, Illinois, a HomeCare Elite top 500 agency. As Agency Supervisor, Lois provided leadership and guidance for the staff, always emphasixing service excellence through the use of best practices to produce quality outcomes. Currently, Lois is an independent contractor providing forms development, coding and data entry services for home health and other long term care programs.
To learn more about Lois Kinsella and LK Publications and Consulting Services, email l.kinsella@comcast.net.
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