Co-operative team care for home care nursing

The process of establishing a network between several professions involved in the home care nursing system is reported. This system gave satisfactory support to patients in their home. The frequency of visits by occupational therapists was 45%, 44% for case workers, 44% for visiting nurses from our hospital, 7% for pharmacists, and 3% for dieticians other than doctors and community nurses. For patients residing outside the Okayama Central Hospital areas, the frequency of visits by assistants was 13%, 7% for day care units, and 6% for public health nurses other than doctors and community nurses. Co-operative involvement in the care management of patients was beneficial to the home care nursing system because the needs of patients could be more easily met by members of different professions and opinions from different perspectives improved the quality of patient care. The quality of care management was evaluated and two cases are described.

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