Keeping Eyes And Ears Open

All home medical equipment companies brag and sell themselves on providing “quality services.” But do they really meet their claims?

Quality is often the little things HME providers do that seem routine. Routine assessments of both the home environment and the patient’s use of equipment will not only assure quality patient services but may also reduce the company’s liability, should something go wrong. While such assessments can be used for all patients, they can be particularly helpful with patients undergoing various types of respiratory therapy.

Each time a representative of your HME organization goes into a patient’s home, he or she should review both the environment and the patient for three important issues:

1. Compliance with the most recent physician’s orders
2. Compliance with basic cleaning and infection control instructions/guidelines
3. Compliance with basic safety instructions.

Whether it’s on follow-up service visits or just during delivery of supplies, customer service technicians and respiratory therapists should be alert to changes in the patient’s abilities or use of their home medical equipment. Such assessments need not be 50 questions, nor do they need to include another form that has to be completed. Technicians and therapists need only have good peripheral vision and big elephant ears to identify what is really going on in the home. In most cases, such an assessment won’t even add time to the visit or slow down the day.

If a staff member does identify a non-compliance issue, the patient should be reminded and/or re-instructed. A summary of the issue and the re-instruct should then be documented in the patient’s record per company policy. Such documentation is usually done on the delivery ticket, a communication log or a care plan update.

Check these examples to see how a technician or therapist can help.

Home Visit 1: A technician is delivering oxygen tanks to a patient whose oxygen prescription is for 3 liters per minute/24 hours per day. He notices that the patient is not wearing the cannula and that the oxygen concentrator is turned off. Before leaving, the technician should ask why the patient is not using the oxygen and encourage him or her to do so. The technician should remind the patient that it is important to follow the physician’s orders.

While we can’t force the patient to follow the physician’s orders, it is our obligation to remind them to do so. Clinically, once an individual’s saturation or blood gas values qualifies him or her for home oxygen, the patient will be healthier if it is used as prescribed. In some situations, it may be appropriate for the technician to go turn on the oxygen and hand the patient the cannula. In other situations, the technician may feel the need to forward significant non-compliance issues on to the supervisor or respiratory therapist for further follow-up.

Home Visit 2: The technician is on a service call to fix an electric bed and discovers that the patient lift has obviously been used to transport the patient down the hall and into the living room. Use of a patient lift for transporting a patient goes against the manufacturer’s safety guidelines. Before leaving the home, the technician should ask the caregiver why the lift is in the living room. After confirming the suspicion, the technician should caution the caregiver against such use and re-instruct them in safe use of this device. Lastly, the technician must make a record of the problem and the re-instruction on the service ticket and inform the company supervisor.

To be a true health care professional, technicians and therapists should be expected to take off the horse blinders when they knock on the patient’s front door. They need to break away from thinking that “I’m just here to deliver these supplies,” or, “I’m just here to check on your machine.”

The list below includes only a few situations that customer service technicians and therapists should be expected to address and document when they are identified in any patient’s home.

Technicians and therapists should ask the question, “What do I do if the patient …?”

• Is not using the equipment that was provided
• Needs to use the wheelchair to go to the doctor, but has six steps and no ramp leading outside the home
• Smokes while wearing oxygen
• Is not using the prescribed flow rate
• Is not wearing oxygen and says he is “trying to go without it”
• Cannot operate the back-up system
• Uses the emergency tank as a portable
• Stores oxygen tanks in a closet
• Doesn’t have a smoke detector
• Stores oxygen tanks in the trunk of the car
• Stores oxygen tanks standing along the wall, unsecured
• Has the bed, TV, CPAP, concentrator and lamp plugged into the same outlet
• Has not cleaned the filter on the concentrator, nebulizer or CPAP
• Has not changed the cannula — it looks stiff, brown and hard
• Indicates he or she doesn’t understand their bills from the company
• Can’t speak English
• Has used the concentrator for only 30 hours over the past 90 days
• Is using a medication cup or humidifier that looks old and dirty
• Is using a walker, but has clutter and obstructions throughout the home

Customer service technicians and respiratory therapists who keep their eyes and ears open during home visits will feel the pride of being true health care professionals. They will also turn routine home visits into quality services. Now that’s something to brag about!

Owner of Hogan Consulting Associates, LLC, in Columbia, Mo., Tim Hogan is a registered respiratory therapist with a Ph.D. in Education who has worked in home care since 1980. He has served as director of clinical education at the University of Missouri-Columbia, as president and managing partner of Med-Equip-Co, a multi-location HME business, and as a branch director of business development/managed care for Option Care. Hogan has been a JCAHO surveyor since 1992. He may be reached by phone at 573/445-8011 or by e-mail at [email protected].