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Family caregivers play important role
Education can decrease number of needed visits
Staff members at Advance Care in Richmond, VA, have taken a two-pronged approach to controlling patient care costs for patients who typically fall into the outlier category.
In addition to educating the referring case managers and physicians, the staff also focus on educating the patient and family caregiver. "We identify a caregiver who can take care of dressing changes and manage the wound [with] V.A.C. [vacuum-assisted closure]," explains Lisa Stroud, RN, administrator of the home health agency. At the beginning of the episode of care, visits may be daily to enable the nurse to demonstrate and train the family member, she says. "We have the caregiver watch, and then we have them change the dressing while we give them positive reinforcement," she says.
"It's important that a wound care patient have a family caregiver who knows how to manage the wound V.A.C. or how to apply a wet-to-dry dressing," says Stroud. In Virginia, we can have snow storms that prevent our nurses from reaching some patients, so all families need to know how to provide care in an emergency, she explains. "Even if they have a basic knowledge, we can talk them through the process by telephone if necessary," she adds.
Stroud's staff do not automatically begin teaching wound care to family members at the first visit. "Timing is different for each family," she says. "If a caregiver is not squeamish and is ready to begin learning at the first visit, we begin teaching," she says. In other families, teaching may not begin immediately, but the goal is to get the family comfortable enough with the tasks, so that nurses can reduce the number of visits for dressing changes.
Even with difficult tasks for other types of care, a patient and family member can learn, says Stroud. "A few years ago, I had a patient [who] required a daily visit to change an IV," she says. Although the family member was certain that he could never handle the task, after two weeks, he was changing the IV with no problem. "I taught a little bit at a time and did not rush anything," she says.
Of course, there are times when a family caregiver may not be present or may not be able to handle some of the care, points out Stroud. She plans on having some of those patients and will continue to provide care for them on a daily basis if needed. She says, "The outcome is the most important thing to keep in mind. If we encounter a patient that requires daily visits, we'll see it out."