Monday morning, how I love you so....
Got up early and thought I was ahead of schedule... then decided to double check my email about the Homeworks Training I had to go to today and wouldn't ya know it, I read the time wrong. It started at 10:30am CENTRAL standard time meaning the training session actually started at 8:30am PST!!! I hurried up and ran to my car after lazily jaunting about the whole morning. Miraculously I arrived at work 7 minutes early (without speeding) and made it to the training session on time. Phew! So from 8:30am-12:30pm, I sat in the conference room with our new HCC and our director of education and quality as the computer trainer from our office in Illinois taught us how to do basic documentation on our pts. It was kind of neat that she was training people from 5 different states all at once. It was also nice that she would use music therapy examples and say things like, "Now for you Gina, you would go to the music therapy reassessment form here..." instead of just using all nursing examples. Our documentation program has music therapy stuff already programmed in! I just have to go to the form and check which MT interventions I used! It's so nice that they respect MT as an actual legit field of practice and provide its own place for documentation, instead of us having to use an "other" form or generic form and fill in the rest ourselves. If I use songwriting or lyric analysis in a session, I can just check the appropriate box! I guess it pays to have a MT as the Vice President of your company :)
After that 4 hour adventure through Homeworks, I got in my car and met the MT at a SNF about 12 miles away (in the direction of the beach--yay!) We went to see a pt, a very sweet man in his late 60's, with a terminal diagnosis of CHF. Sadly he has no immediate family to care for him or visit, but he does have a few very close friends who come by often. Apparently one of the friends (the one designated as a primary care giver) is over-stepping her boundaries and being a bit too forceful with her wishes, demanding that we give these supplies, and make this visit at this time, etc. etc. The MT has to see her 40 pts once every 2 weeks (which is the standards for the other members of the psychosocial team, mandated by Medicare... Medicare is yet to set specific rules for MT...) That means 40 pts in 10 working days! She doesn't really have the time or flexibility to schedule herself at the convenience of a pt's friend... unfortunately of course... but let's be realistic here. 40 pts, all within a 50-mile radius, and all in 2 weeks, every 2 weeks...
Continuing on!... this was the first time I met the pt, but the MT said he seemed a lot more tired today. He was sitting up in his wheelchair with his 02/nasal cannula. He is a conga player, so the MT makes sure to always bring a couple drums for him to play. At first, she handed him a new drum he's never seen before. He tried it out, tapped it a few times, but didn't really like the sound. She then gave him the drum he used at the last session. He hit the second drum once, then twice, then immediately nodded his head and chose drum #2 due to the better sound quality and dynamics. The MT asked if there was anything he was in the mood for, to which he responded, "a love song." The MT and I just looked at each other and laughed inside since my whole first week here was dedicated to playing love songs thanks to Valentine's Day and the two "celebrations" we were asked to play for. I went over to the MT's big binder of music and pulled out the lyrics I printed out for last week. We sang "Let Me Call You Sweetheart", "I Can't Help Falling In Love", "Stand By Me", and "My Girl" (to which the MT in the end changed it to "My guy and even inserted the pt's name). The MT then asked the pt's two friends who were there visiting if they had any songs they would like to hear. The man said he had nothing in particular in mind, and the woman requested "Ave Maria." The MT kindly offered to learn it for next time, but for now, if "Amazing Grace" would do. She agreed and we sang all four verses of "Amazing Grace". (didn't even know there was four verses to Amazing Grace! Heck now that I think of it, there's probably nine or ten verses...) In the middle of the session, one of the pts friends helped him set the drum down on the table in front of him -- poor guy was too tired to even hold it anymore. During one of the songs (I forget which one specifically) the MT asked who the pt loved, and he said he loved his two friends. Later I learned the significance of this -- the MT said that not only will the pt's friends remember that moment after the pt passes, but also, when they hear that song in the future, they will think of him -- I just thought that was the nicest thing! Sometimes you forget to think what affects a session can have on the friends and family! Hospice is very pt/family-oriented. I often think "patient patient patient what does the patient need how is he/she responding what should we do next" but everyone present needs to be accounted for. Remember, Medicare mandates us to follow the loved ones for 12 months after a pt's death! Ergo, it's not all about the pt, but about the loved ones "left behind" as well. (And our company in particular follows pts for at least 13 mos. so we can see them through the 1yr anniversary, since that time in particular can prove to be quite trying on a family. We truly are a can-do organization, and I'm proud to be able to be a part of it!)
We stayed for about 45 minutes, and left so the friends could continue their visit. The pt seemed to tire quickly (physically), which is something the MT could document as a decline, which is necessary in order for him to remain eligible for hospice in Medicare's eyes. (The MT pointed out that in a rehab/most cases, it's important to document a pt's improvement!, but in the case of hospice, a pt's decline is what's necessary to be continuously documented on paper so when the end of that 90-day (or 60-day) certification period arrives, the decline of the pt's health is proven on paper.
The second pt we went to see was only a few miles down the road. Unfortunately when we arrived at his room, he was sound asleep in his bed. Since he was snoring and looked so at peace, the MT decided to leave him be instead of wakening him for a session. She simply charted that we were there and that she stop back at another time.
From there, we stopped at a Starbucks so she could teach me a bit more about the documentation process and how to navigate the Homeworks and Calendar programs. The Starbucks was also quite conveniently located right next to the beach :)
And so, week #2 of my internship is underway. Tomorrow, 3 patients in the morning (yay!) followed by 3 staff meetings in the afternoon (boo!) You win some, you lose some :-P
BUENAS NOCHES A TODOS!