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'Tuck-in' calls prepare patients for weekend
Patient/family relationships strengthened
Before making her call to the patient each week, the volunteer makes sure she has a new joke to tell by checking the Internet for jokes she hasn't shared.
Fulfilling a patient's request that every week's call start with a joke is just one way that the "Tuck-in Program" volunteers at Covenant Hospice in Pensacola, FL, make sure that they help the hospice meet patients' needs for the upcoming weekend. Even though the volunteers' contact with the patients or family members is by telephone, they develop wonderful relationships and strengthen the family's satisfaction with the hospice's service, explains Sandra Huster, director of volunteer services for Covenant Hospice. The hospice's Tuck-in Program was developed to improve patient and family satisfaction scores for weekend care, says Huster.
"All aspects of our hospice care receive high scores, but our weekend care did not receive the same high marks that our care during the week received," she says.
After evaluating comments from families and gathering information from clinicians, it was evident that a reason for dissatisfaction was the feeling that the family did not have supplies or equipment needed during the weekend. After checking with nurses on call for the weekends, Huster also determined that many weekend calls were for delivery of supplies or explanation of equipment use that could have been handled prior to the weekend, she adds.
"We decided to take a proactive approach and call, or tuck-in, our patients before the weekend," says Huster. "I asked all of the individual diagnostic group leaders and members what questions should be asked of families to help them prepare for the weekend."
The decision also was made to make the calls on Thursdays so nurses would have an opportunity to deliver needed supplies or to make sure family members knew how to operate equipment on Fridays, she says.
After developing a script for volunteers to use, Huster asked a long-time volunteer who was a retired nursing administrator to lead the pilot program. "She helped me identify other volunteers who would be good on the calls, and she added a lot of credibility to the program because she has a clinical background," she explains. The volunteer also suggested changes in the script to overcome some nurses' concerns about someone "new" contacting the patient, she says. [See tuck-in script.]
Overcoming clinician objections was an important challenge to overcome, admits Huster. "At first, the nurses thought the volunteer calls were a way for the hospice to check on them to see if they were doing their job," she says. "They were also concerned that the family would become confused if someone they had never met was calling to ask if they needed anything."
The last objection was to the use of volunteers without clinical experience, even with a lead volunteer who did have clinical experience, she adds.
Some simple changes to the volunteers' script addressed several concerns at one time, she says. "At first, we had the volunteer identify herself by name and say that she was calling from Covenant Hospice," Huster says. The lead volunteer suggested changing the wording to add the phrase "I'm calling on behalf of your nurse," she says. Not only did the reference to the nurse reassure the family, but it reassured the nurse that the relationship with the family was reinforced. It also eliminated family confusion so the volunteer was able to gather information more efficiently without having to explain the program each time she called.
Another change addressed a clinical issue. "The first script had the volunteer asking the patient to rate his or her pain," says Huster. The revised script had the same question, but it prompted the volunteer to also ask about the timing of the last pain medication and the effectiveness of the pain medication. "This enables the nurse to better evaluate the pain level," Huster says. "If the pain is a 5 but the patient has not taken pain medication for six hours, that is different from the patient who took pain medication one hour ago and has a pain level of 5," she explains.
If the patient needs supplies, has a pain level over 3, or has had a change in medication, the patient's nurse is notified by the volunteer, says Huster. "If needed, the nurse schedules a visit on Friday to check on the patient or to deliver supplies," she says.
The script also serves as documentation of the call. Volunteers write the patient's responses to questions on the script page, then note if the nurse was notified, says Huster. All call scripts are kept in a Tuck-in log book and staff members have a place at the bottom of the page to document that needs identified during the call were resolved, she says.
Not only have patient satisfaction scores increased, but also calls to the weekend on-call nurses have decreased by 66%, says Huster. "The nurses report that the calls they do receive on the weekend are true emergencies, rather than calls for supplies to be delivered," she says.
The hospice's medical director also has noticed the change in weekend calls and tells Huster that he is using the fact that weekend calls are true emergencies as a way to recruit physicians to take weekend call for the hospice, Huster says. The medical director tells Huster that physicians are much more likely to take call knowing this, she says.
The addition of the program also has helped recruit volunteers, says Huster. "Not all patients want face-to-face interaction with patients and families, but this gives volunteers a chance to work with families without traveling to their homes," she says. "We've even had family members of patients who had received Tuck-in calls before their death volunteer with us because they appreciated the extra attention we were able to give through the volunteers."