The pelvic home program handoff checklist

Before she gets off the table

• Cut the program to three items or fewerA first pelvic home program with nine items looks thorough in the chart and gets done by nobody. Pick the three that carry the most change for her presentation and hold the rest for later.
• Say the dose out loud in her wordsSets, hold time, rest, how many times a day, and what position. If she cannot repeat it back without looking at the screen, the dose is not set yet.
• Anchor each item to something she already doesFeeding, brushing teeth, the drive to daycare, the kettle boiling. An exercise attached to an existing daily event survives a hard week far better than one attached to a time of day.
• Agree on the minimum acceptable dayName a floor version she can do after a night of no sleep, usually one item at half the dose. This is what keeps a bad week from turning into a stopped program.
• Write down the stop ruleBe explicit about what means stop and message you: new pain with penetration, bleeding, a sharp increase in pressure or symptoms that worsen for two days running.

The first seventy two hours

• Confirm she opened the program on her own phone before she leavesWatch her open it once in the room. Anything left to be set up alone at home is where postpartum adherence quietly fails in the first week.
• Set the reminder to a time she pickedLet her choose the hour, not you. A reminder at ten in the morning is useless to a patient who works a hospital shift and gets home at eight.
• Check the first log entry within two daysOne glance is enough. A patient who has not started by day two rarely starts by day ten without a nudge, and the nudge is much shorter now than later.
• Reply once in the first week, brieflyTwo lines are plenty. Patients log when they believe a person reads it, and stop when the check off seems to disappear into nothing.
• Adjust the dose if day one already hurtIf she reports pain with the first session, change the dose or the position rather than asking her to persist. Persisting through a painful first week ends the program and often the plan of care.

Between visits

• Read the caseload list once a week at a fixed timeSame slot every week, before clinic. You are scanning for exceptions, not reading every entry, so thirty to forty patients takes about twenty minutes.
• Treat any three day gap as a design problemShorten the program rather than repeating the instruction. A gap almost always means too long, too vague or too uncomfortable, and repeating it changes none of those.
• Read symptom flags against the log, not aloneA flag for urgency on a day with three completed sessions means something different from the same flag on day nine of nothing. The pattern is the clinical information.
• Call rather than message when a flag is seriousNew pain with penetration, bleeding, fever or a sudden change in bowel or bladder control deserve a voice and a decision about whether she needs to be seen sooner or referred back.
• Record any dose change where your note will find it laterDate it and say why. This is the line that makes a records request straightforward and turns compliance with home exercise program into something with detail attached.

At the next visit

• Open with the log, not the questionStart with what you already know: the days completed, the gap, the flag. It saves several minutes and it tells her the logging was worth doing.
• Progress only what she actually performedAdvancing an exercise she did three times in a fortnight is how a plan of care ends at visit six. If adherence was low, shorten first and progress at the visit after.
• Retire anything with two weeks of zerosAn item nobody does is not a program item, it is a reminder of failure at the top of her list. Remove it and say plainly that you are removing it.
• State where she is in the plan of careSay the visit number and what remains. Patients who know they are at visit five of ten finish plans of care far more often than patients who are told to come back when they can.
• Paste the between visit summary into the progress noteDays completed, flags raised, changes made. It takes seconds at the time and it is the strongest home program documentation you will have if a payer asks.