A good collaboration between the nursing home's doctor and the staff is a prerequisite for safe and secure care

The responsible doctor for the nursing home is often affiliated with a healthcare center and is funded by the region. The doctor usually visits once or a few times per week. In between, the doctor should be available by phone during the day. During on-call hours, consultation may occur in the form of the ability to reach a nurse and doctor. To avoid unnecessary hospital admissions, an on-call nurse can often visit the home in the evening and make assessments on site.

It is up to the individual to choose another doctor if they are not satisfied with the home's doctor or perhaps want to keep the family doctor they have had for many years. Sometimes it can be difficult to establish a functioning collaboration with a doctor who does not regularly come to the home.

Routines for how contact with licensed staff should exist

There should be routines for how and when employees should contact licensed staff. The nurse, in turn, should be able to reach a doctor for assessment. In many regions, doctors can make home visits even at night. In other cases, the individual may need to go to the hospital for assessment.

In municipally financed care, the "Medically responsible nurse" (MAS) is responsible for ensuring that there are routines for contacting licensed staff when needed. Each home should have a patient responsible nurse. The unit should inform about the times a nurse is available. Likewise, provide contact with other licensed staff in the team. A nurse should be available around the clock and there should be clear instructions on how to reach a nurse both during on-call and office hours.

One difficulty in some units is how the transfer of information should take place. Many journal systems have built-in functions for sending messages. But where this does not exist, you may have to resort to sending faxes. This may require special routines as fax is not secure from a confidentiality point of view.

Transferring patient information between two regular email addresses is not allowed. Possibly, you can have email contact with the patient if they themselves initiated the email contact. If you fax material, you can erase personal data or save initials and names and then call and leave these to the recipient. It has happened a number of times that journals that have been faxed have ended up completely wrong. Not so fun to end up in the fax at Aftonbladet maybe as is said to have happened on one occasion many years ago.

One tool that can be used when transferring information is SBAR which stands for Situation, Background, Current, and Recommendation. SBAR is a structured method used when handing over between different healthcare providers. The handover becomes safer if the reporting method SBAR is used between different healthcare providers during hospital admission.

Strengthening Collaboration between the Nursing Home and the Responsible Doctor: More Effective Care and Services for the Elderly

Ensuring a consistent and effective care and service for the elderly in a nursing home requires close collaboration between the home and the responsible doctor. Through a strong partnership, communication can be improved, adequate medical care can be ensured, and the quality of life for the residents can be increased. Here are some strategies to strengthen the collaboration between the nursing home and the responsible doctor:

Communication and information exchange: A continuous information exchange between the nursing home and the responsible doctor is crucial. This includes sharing information about new residents, medical changes, and treatment plans.

Regular meetings and coordination: By having regular meetings, the staff at the nursing home and the responsible doctor can discuss individual cases and evaluate care plans. This enables quick adjustments and ensures that the residents receive the best care.

Availability and feedback: Having a doctor who is available and provides feedback is crucial for handling emergency situations and rapid changes in the residents' health conditions. Good communication and a clear plan for contact paths are crucial.

Education and skill development: The staff at the nursing home should receive regular training and skill development in elderly care and management of common medical conditions. This can contribute to increasing understanding of medical care and facilitating collaboration with the responsible doctor.

Patient-centered care: By focusing on the residents' individual needs and wishes, the nursing home and the responsible doctor can work together to create a care plan tailored to each person's unique situation and preferences.

By strengthening the collaboration between the nursing home and the responsible doctor, it can be ensured that the elderly receive coordinated, quality, and individualized care and services that promote their health and well-being. It is also good to have written collaboration agreements that are regularly evaluated to jointly strengthen patient safety.

Reflection questions - interaction with doctors
Care staff:
- Do the routines for contacting a nurse around the clock work well?
- Do you feel that you receive good support?

Manager, nurse, occupational therapist, and physiotherapist:
- Is there a clear written routine for how to contact a nurse at all hours of the day?
- Is there a written agreement on how cooperation between the unit's nurses and the on-call organization should work?
- Are there secure routines for transferring information between the different nurses responsible over the day?  

Residents and relatives:
- Have you been asked if it is okay to contact you at night if something happens?
- Have you been asked who should be contacted first?
- Did you know that you have the right to choose a doctor?

Erland Olsson
Specialist Nurse
Sofrosyne
Better care every day