“I think it’s a mixture of communication errors and the system.”
For this month, we have chosen the municipal homecare as our focus. The municipal home care is experiencing a number of errors, which are presented in a previous report from the Patient Safety Board.
The home care use Kibodan’s Medimax, which can store a large number of pills.
We had a talk with Jannik, who work in the municipal home care. We get into subjects like the daily care, the use of Kibodan products, and how mistakes may occur.
Do you briefly want to tell about yourself and your duties and what you do?
My name is Jannik and I’m 24 years old. I am what they call a social and health assistant and finished my education 2 years ago, and then I started in the Home Care.
What does your day look like when you clock in Monday morning?
I clock in early Monday morning, then there is a morning meeting where we go through the plans for the week. We review what happened the last 24 hours, or maybe longer if you have had a vacation or a long weekend. Then we go through what to do the rest of the day, and then we prepare the medicine schedules, for example, update them in case we have to dose later in the day, so that you are updated even before you go and visit the citizens.
How many citizens do you typically have in a day?
It depends a lot on the visits, some visits take 10-15 minutes, while other visits take an hour or two. It varies a lot. We also have the entire task with citizens as an assistant, so we should also be able to help them with a bath when the need arises. So it depends what the patient or citizen needs, but usually, six in the morning and three to four in an afternoon, but that varies a lot from day to day.
Do you know them all personally, do you have any regular citizens or how does it work?
Yes, we have regular citizens. There has been a lot of talk about what is the best, but we have assessed that permanent citizens are the best solution, so that the citizens get to know us, we get to know the citizens, and we get a much better approach and can be allowed much more.
They feel safe, and we also feel that some personnel are not allowed to do so much unless you are the regular person, and you are allowed to get a little more done because they more feel safe with one regular person.
What do you think is your biggest challenge in one day?
Sometimes, we are time-constrained because in the homecare, the plan is planned before each visit, and it may take a little bit more time, but for the most part it fits and we have time to do our tasks, but people are good at helping each other if you were to run out of time.
What do you enjoy most about your day?
All the citizens who are happy to see me and the help I give them.
What do you think are the most important values when you work in the home care?
Being able to see things from the citizen’s point of view. When you visit the patients, you see yourself in very strange situations and some very pressured situations, because you do not know what to do right away, but you just have to remain calm and keep your head clear.
It’s easy enough, when you do the same tasks everyday, but most often you get involved in situations you aren’t prepared for.
Have you ever experienced that patients have been given wrong medication?
Yes, I feel that there is a challenge with that, not exactly wrongful medication, but challenges if they are getting their medicine from the doctor at all, ie. a mixture between us (home care professional), doctor and pharmacy. Then the medicine is not delivered on time, or it’s not delivered for a few days. It has happened once or twice in my two years.
Is it due to the time pressure that lies there?
I think it’s a mixture of communication errors and the system. It is typically the IT system and that there is an error that you are not aware of, and you cannot track it.
We have to call and ask the pharmacies and hear why the citizens cannot get their medicine.
There is another thing, when people come to the pharmacies and they pick up their medicine. They don’t always get all their medication because there is some medicine on some old prescriptions, and pharmacies only provide what has just been ordered, and not the ones from the old prescriptions.
So it’s not the responsibility of the patients to get their medicine?
Yes, the citizens must get the medicine themselves, but it is us who order it for those who cannot. We would prefer the citizens to pick up the medicine themselves, or order it and collect. If they do not, we will do that for them. We do it so they can keep the shape, their way of life and their activity.
It must also be a big challenge, keeping track of the right medicine?
Yes, and then you come to dose at the citizens home, and then they have not picked up their medicine, and then they have to pick it up the following day, but maybe that is on the weekend, so there are a lot of little things that can go wrong. If we miss one day, things might go very wrong.
It is also necessary to have a good overview?
Yes, definitely. An overview of the medicine, it is very important as it may change from time to time.
How does the dosage work?
It works so that in the morning we print the schedule. We have been told that now is the day to dose. Then we visit to the citizen who has the medicine in their home, the old medical schedule in the home, and then we have the new medical schedule with us, and of course we will dose after the new medical schedule, check if there have been any changes. If there have been no changes, then we just dose as the schedule says. If there have been any changes, we will go in and look at it ,if there has been a simple box from the end to be extra dosed or removed.
How often does it appear that you have to postpone if there has been a mistake?
In making mistakes, it is very rare. I do not even know if I can remember that has happened. But because we need to postpone the dosage, because some new medicine has come from a doctor. We are dosing for 14 days at a time, and if we have just been there and dosed and then the doctor doses some new medicine, we will have to visit the citizens again and put their new medicine in their boxes. It also happens that the citizen has not obtained any medicine, and you only get dosed for three days, with some of the medicine, you should also visit them again. But we would rather avoid post-dosing.
Do all your citizens use Kibodan products?
Yes, it is also a requirement we have. At least if we are going to dosage for them, then it should be them.
Why is Kibodan’s dosing boxes so necessary? Could it be done differently?
It can easily be confusing. They are very clear, your boxes. Morning, noon, evening, bedtime. It is quite clear and when you open them you cannot risk getting the medicine mixed up. They are transparent, and it is also an advantage. For us who dose the medicine, because we can count and fit, but also for the citizens to see whether the pills are taken or not. The days are displayed on top, which they obviously should be.
How often do you use the extra box? In the Medimax, we have 8 boxes. How often do you use the extra, for the PN medicine that it is used per. Need.
Yes, we also use that with some citizens. Because the citizens themselves have to take them so we write PN Panodil or Tramadol for these occasions, and then the home help can take from there.
What is important when sitting and dosing medicine? What are the most important values here?
It is important with some quiet, good light, good working conditions. The medicine must be bought and ready and that it is the correct medicine, of course. That the medical schedule has been updated is important as well.
Do you have a regular routine that you go through when you come and visit the citizens?
Not such a regular routine, I have normal courtesy, say hello, explain what I do, reviewing what I do, so that the citizens are also aware of what’s happening. It’s important they do not feel you take responsibility for everything. I would like to have them inward even though it’s actually me who does all of the work.
Are you satisfied with our products and what do your colleagues think?
I am certainly satisfied with them, and I have not heard anything about them at all.