What is Care Coordination?
Care coordination involves organizing patient care activities and sharing information among everyone involved with a patient’s care to achieve more safe, appropriate, and effective care. Nurse coordinated care means your loved one’s preferences and needs will be known and communicated to the right people at the right time. Especially for at home Alzheimer’s care, nurse coordinated care ensures your loved one’s needs are always monitored and met.
How Does Nurse Coordinated Care Work?
There are two ways of achieving nurse coordinated care: specific care coordination activities and broad approaches that are commonly used to improve healthcare delivery.
Examples of broad care coordination approaches include:
- Teamwork
- Care management
- Health information technology
- Medication management
- Patient-centered medical home
Examples of specific care coordination activities include:
- Helping with transitions of care
- Assessing patient goals and needs
- Creating a proactive care plan
- Linking to community resources
- Supporting patients’ self-management goals
- Agreeing on responsibility and establishing accountability
- Follow-ups and monitoring, including responding to changes in patients’ needs
The Benefits Of Nurse Coordinated Care
Nurse coordinated care is identified by the Institute of Medicine as a critical strategy that can improve the safety, effectiveness, and efficiency of, for instance, dementia care. Well-designed, targeted care coordination delivered to the right people dramatically improves outcomes for dementia care and dementia care costs.
Although the need for nurse coordinated care is clear, particularly a crisis safe Alzheimer’s caregiver, there are still obstacles that must be overcome. Mainly, redesigning at home memory care to better coordinate patients’ care is vital for the following reasons:
- Current healthcare systems are often disjointed, and processes vary among primary care sites and specialty sites.
- Patients are often unclear about how to make appointments, why they are being referred from primary care to a specialist, and what to do after seeing a specialist.
- Specialists do not consistently receive adequate information on tests that have already been done or clear reasons for the referral. And, primary care physicians do not often receive information about what happened during a referral visit.
- Referral staff deal with lost information and many different processes, which means that care is less efficient.
How Can Care Coordination Be Put Into Action?
Applying changes in the everyday routines and general approach of dementia care can be overwhelming. Fortunately, with the introduction of nurse coordinated care targeting dementia care patients treatment outcomes can improve while maximizing cost-efficiency.
Registered Nurses To The Rescue
Registered nurses’ contributions to care coordination have long been a core professional standard and competency for RNs. We understand the importance of having a healthcare advocate. It is what our nurses do. It is what we have always done.
Whether developing personalized care plans guided by a patient’s preferences and needs, educating patients and their families, and doing their best to facilitate continuity of dementia care across settings and providers—RNs make coordinated care possible.
Our RNs are trained to act as the patient’s voice. Personalized care plans tend to evolve as patients progress, which requires thorough communication and open collaboration between everyone involved. Nurses need to be intimately involved in the collaborative task of executing and planning care coordination strategies for dementia care patients.
Nurses take on a large portion of the day-to-day responsibilities of caring for patients, especially in the long-term care settings, like dementia care, that require comprehensive care plans to ensure that patients meet improvement milestones. As our nurses coordinate your loved one’s needs to other healthcare workers, a tailored-fit team can be built and maintained.
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