Tools for Telephonic Care
Upon completion of this chapter, the nurse will:
1. Identify resource materials that would be beneficial when functioning in different nursing roles when providing telephonic care
2. Maintain a list of reputable and approved websites to access while providing telephonic care
3. Develop a practice pattern that maximizes success when providing telephonic care
Regardless of the organization, health plan, or program through which you will be providing telephonic care, it is always wise to have resources available to help facilitate your care. It’s not necessary to go out to buy tons of books and magazine subscriptions. A few choice items would be sufficient.
Resources that other telephonic nurses have found beneficial include:
A current medical–surgical textbook
A current manual of nursing practice
A current nurses drug guide (not a Physician’s Desk Reference [PDR])
A current manual of diagnostic and laboratory tests
A current International Classification of Diseases, Revision 10 (ICD-10) and Current Procedural Terminology (CPT) coding guide
Manual of medical nutrition
Most publishers consider “current” to be something that has been written with 5 years. Some nursing publishers realize, though, that things change more quickly than every 5 years and publish new editions every 2 to 3 years. For medical–surgical, nursing practice, diagnostic/laboratory tests, coding guides, and medical nutrition texts, updating every 5 years would be sufficient. Drug guides, however, should be updated yearly. New medications are being developed rapidly, and a drug guide that is 5 years old is considered outdated.
The organization should provide the following materials for all staff:
Policy and procedure manual
Guidelines for placing welcome calls
Guidelines for placing care calls
Guidelines to enroll members into a program
Guidelines to disenroll members from a program
Specific guidelines to address disease management program expectations
Specific guidelines to address wellness program expectations
Specific guidelines to support various nursing roles
VARIOUS NURSING ROLES IN TELEPHONIC CARE
Nurses are accustomed to having expertise in different areas of health care, and telephonic care is not an exception. Depending on the health plan or disease management or wellness program, nurses may be designated or assigned different care responsibilities. Types of different roles for telephonic nurses include:
Nurses who are assigned to provide posthospital care calls will be spending a large amount of time on each call. The purpose of these calls is to:
Find out the reason for the hospitalization
What occurred while hospitalized such as surgery or change in treatments
Any changes to medications
Next health care provider appointment
Future plan such as additional surgery
Update current health status
Update diagnostic and laboratory tests
Once all of the posthospitalization calls are completed, the nurse may be assigned to contact clients in another care category.
Oftentimes telephonic organizations, health plans, and disease/wellness programs will have nurses who are certified case managers provide telephonic care calls. These nurses will conduct case management activities to include making referrals and contacting the health plan and health care provider.
A welcome call introduces a client to the telephonic program. Of all of the different types of care calls, this one is probably the most important. This is the client’s first exposure to the process of telephonic care, and the way the program is introduced and the manner in which it is introduced depends on the nurse’s skill and comfort level.
Some organizations/health plans/disease management plans provide a cheat sheet or guide sheet to be used during the welcome call. This is to ensure that the client verbally receives all essential information before going forward in the program. As was mentioned in a previous chapter, the health plan or disease or wellness management program will most likely mail the client information about being enrolled in the program. The welcome call should occur after the materials have arrived and the client has had an opportunity to review them.
Unfortunately, this is not always the case and the nurse might find that a client has no idea what the program is or why they have been enrolled. In these situations, the nurse has to supplement information while encouraging the client to participate.
Care calls are those that occur after the welcome call. The frequency of calls will depend on the client’s health status and willingness to accept the calls. Some care calls are appropriate to make every week. Clients who are in the middle of an exacerbation of a chronic health problem or are experiencing a new health problem would qualify for weekly calls. The intention for these calls is to help identify any new issues, bring them to the attention of the health care provider, and strive to prevent the client from needing hospitalization.
Once the acute problem has subsided, the frequency of care calls can be reduced to biweekly. For some organizations, every 2 weeks is a standard for what is considered “routine” care calls.
Clients in wellness programs who are not experiencing any new or different health problems may receive calls every month. The option always exists to contact these clients more frequently, but once-a-month calls are usually sufficient to prevent the client from developing a new health problem or needing hospitalization.
These are calls that are made on a monthly or quarterly basis and serve to remind the client that “something” needs to be done. Reasons for reminder calls include:
Quarterly hemoglobin A1c levels to be checked
Seasonal influenza vaccination recommended
Annual eye examination recommended
Biannual podiatrist examination recommended
Annual urine albumin level recommended