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CAPC Palliative Care Discussion Forum
General Operational Topics
Daily Operations PC Nurse Consult ServiceAuthor: eriggall
Date: Nov 11, 2009 10:56 pm
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I am a single RN consult service in a 330 bed hospital. It is just me.I do have a per diem NP who covers for me when I am out and about once a week so I can keep up on paperwork/database. I have been doing this for 4 yrs and my referrals will be around 600 this year. We have chaplain residents whom I utilize and social workers assigned to specific units- some are better then others at EOL issues, and I work with the referring physician. I am based out of the case mgt dept, but am not a case mgr. The majority of my consults are for goals of care and a lot of withdrawal of support in the ICU's. The way I work with these services is to see if they are already involved before me, then I review their notes and/or talk to them. Once I have met with the pt/family (I do have a baseline knowledge of case mgt which I have picked up over the yrs), I will let the case mgr know the outcome of the meeting, if decisions were reached and if they need more info from case mgr on SNF/HH options or from the hospice liason. I will also call in the chaplain and LCSW based on my assessment of pt/family needs. Frequently I let the chaplain come by and do their own assessment because we have found that when I asked if they wanted to see the chaplain, they frequently said no, but when the chaplain just came by, stating they do so for all pt's on PC service, people are more open to them. There are a lot more case mgr's then there is of me, so I find that they don't necessarily look for my notes, and even though it is an extra step, it is easier if I call them to update them on why I am seeing the pt, and then they don't need to see the pt and add one more person to the mix until it is decided if they need to assist with dc planning. I frequently educate the case mgr's as they can be a great source of referrals, but I have to remind them and re-educate frequently.
I hope that was helpful. It's hard to give a blueprint of my day. I come in and look to see if I have new orders. Look through the pt's currently on service to see what happened over night or weekend, then I start rounding. You have to prioritize- if there is not much changing on someone you are following, they are probably at the bottom of the list to see. New referrals and ones with on-going issues are seen 1st. Call me if you have any questions. 858-939-3809. It is not the best of situations and I have been begging for a medical director and to give my perdiem more hours, but....