The Non-Compliant Patient: Is It Really Them Or Is It Us?

Ahhhhhh. The non-compliant patient. How often is this heard in a typical day around the office? If it is more often than you would like, then maybe it is time to look at how we manage patient care. It may not be the patient that isn’t focused on getting better, but our agencies not focusing on what makes the patient safe.

What Does Your Consultant See?

My team and I work with agencies throughout the United States. So, when we see consistencies during clinical review, it is worth talking about in this blog. The ongoing finding: The care plan is not focused on the patient, but on the goals that look good in the care plan. So, what are we missing in our patient- centered care planning? We haven’t really made the patient the focus. Now, this is not to say that the clinicians in the homes of patients aren’t doing a good job. The reality is that the majority of agencies out there are trying really hard to be the best they can. The answer is to work smarter not harder. This will move you towards better outcomes and patient satisfaction. Now, let’s look at what that patient-centered care plan should look like today.

Is It Really A Non-Compliant Patient?

Most of the time, we have patients on service short term. Let’s take the patient with a history of CHF for 20 years. He is not new to your agency and this is the 5th time he has been on service in the last 3 years due to exacerbation. He is a long-term smoker and lives by himself. You can picture this guy, right? He is the person the staff would call a non-compliant patient because he won’t quit smoking, doesn’t eat right, and calls the squad a lot when he gets short of breath. Now, take out 5 care plans your agency has had on this individual and ask yourself these 5 questions:

1. Do the care plans look the same? This happens all the time. Since it is the same person and the same diagnosis, then the care plan never changes. In this, we see nothing ever changes for the patient outcome. We will tap into this further. Keep reading.
2. Is smoking cessation in your list of goals and interventions? You are looking at discharge with this gentlemen in 30 days or less. Did anyone even ask if he wanted to stop smoking or was it just put on the care plan? There is no way you can mark all goals met on a discharge summary when you have unrealistic ones on the care plan. We see this all the time. In a perfect world we want him to stop smoking, but it was never what he was going to do or wanted to do. So, document he has no desire to stop smoking and move on to realistic goals.
3. What did he say his goals were for this episode of home health? Maybe your patient has 2 goals for himself. One is to be able prepare something himself other than high-sodium tv dinners that he knows he shouldn’t eat. Our care plan needs to work with him on this. The second goal is to not call the squad the minute he gets short of breath. How would you address this goal of his? Check #4 in our list.
4. Have you addressed anxiety in a meaningful way? Here’s the reality: Many of our patients have anxiety even if they can’t pinpoint the feeling of anxious. Your patient could be in a constant state of some form of anxiety. He lives alone and has issues with meal prep. He admits getting scared the minute he starts to feel short of breath. Has anyone ever discussed with his doctor a low dose on anti-anxiety medication to take on an as needed basis? Has your staff taken a deep dive into understanding his anxiety? Is it during certain times of day or night? Is this patient someone who takes his blood pressure all the time? If his BP goes up, then I’ll take any amount of money to bet his anxiety follows it. Before long, your patient has taken his BP 20 times, called the doc with a reading of 210/110 and is now on the way to the hospital. Ask any home health nurse, it happens a lot more than you think. Could the entire episode be averted with taking BP once per day at a certain time and a low dose anti-anxiety med as needed for defined triggers? How many of your nurses who have a good understanding of the physiological changes associated with anxiety will tell you that just one dose may see certain patients drop to a normal range of BP within an hour of taking it? So, did we really have an exacerbation of hypertension or shortness of breath, or was it anxiety?
5. Are those care plans realistic? This is where we need to think about removing things like smoking cessation and focusing on the real issues for the patient. If you control anxiety and intervene when and where it makes sense, then isn’t this the point of safe and effective care? What changes for this patient really change his world? For instance, healthier meals he is able to manage and cook himself make a difference. Notice the focus is healthier and not necessary completely and totally healthy. This is the person who in the past has been told about low fat, low salt, low calorie diets and has failed. Help give him some better options so he doesn’t rely on tv dinners. That becomes a win. He doesn’t need a piece of paper that tells him everything he shouldn’t eat. He has gotten those for 20 years. Make a difference. If you help to control his anxiety and help him understand his triggers, have you just eliminated ER visits? This is what is realistic.

Now, is this really a non-compliant patient, or do we need to change the paradigm of how we see that patient?

Let Peek Consulting Help You!

At Peek Consulting, we work with agencies on goals that make sense for your agency and your patients. If you are looking for practical clinical, operational, and financial solutions, then we can help. Call us today at 419-790-4454 or contact us online to see how we can help you!