1 pt. assessment a.alsagheir - 2015 prepared by dr. aeshah ibrahem al-saghier mbss,sbfm,abfm...
TRANSCRIPT
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1Pt. assessment A.Alsagheir -2015
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Pt. assessment A.Alsagheir -2015
طب دورةالشيخوخة
3/31- 2015/4/2
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HOME MEDICAL CARE Patient Criteria & Admission Process
Prepared by
Dr. Aeshah Ibrahem Al-Saghier
MBSS,SBFM,ABFM
Consultant Family Physician Advisor for Training and Development
Home Medical Administration
Ministry of HealthMarch. 2015
Care
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AIMS
What are the patient Admission Criteria? What are types and conditions of HHC patients? What is the importance of patient Assessment? Before accepting the patient what you will asses?
Care
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Referral
• From the Primary physician in the hospital Assessment team
• Patient Assessment before discharge• Assessment of patient home environment A
cceptance
• Providing patient with needed equipment • Training the care giverC
are Plan
• Patient care plan • Schedule 1st visit
STEPS TO HOME MEDICAL CARECare
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How the patient enters the HMP service?
HOME MEDICAL CARE
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Care
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CRITERIA FOR REFERRAL
Pt. should be referred 72 hr’s before discharged from the hospital
Home Health Care
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Pt. assessment A.Alsagheir -2015
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1- Patient Information
2- Medical history
3- Active problems
4- Type of care
5- Patient Support
Referral Form contents
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Case Scenario Home Health Care
Care
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Work shopgroups
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• Ms. Nora is a 65 y/o woman with metastatic breast CA. She is admitted to the hospital for SOB due to lung mets and malignant pleural effusions. There are no further chemotherapeutic options and efforts to provide symptomatic relief medications
• The patient lives at home with her husband & has 2 sons . She understands her prognosis and would like to be at home to spend as much time as possible with her family.
• Trained Care giver and Regular long term
nursing help .
CareCare
She Wants To Go Home
Pt. assessment A.Alsagheir -2015
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• Mr. Salh is an 52 y/o male with colon CA s/p resection with new colostomy. Hospitalization complicated by delirium and line infection requiring 2 weeks IV antibiotics.
• Pt. lives alone, scant family in Riyadh ,neighbors help with grocery shopping.
• Pt. Can do basic ADL’s but ambulation limited by osteoarthritis and deconditioning.
CareCare
He Wants To Go Home
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• Mr. Hasan is an 59 y/o man admitted with pneumonia and COPD exacerbation. Prior to admission he had been living independently. Due to prolonged intubation, he becomes profoundly deconditioned but is motivated to regain his pre-morbid ability to walk.
• You discuss post-acute care options with the patient and his family.
CareCare
He Wants To Go Home
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Mr. Ahmed 67 known DM , HTN with severe congestive heart failure for 10 years ago . Suddenly he developed sharp decline in his heart ejection fraction admitted it was decided that the situation is very advanced ..
There is no possibility of cure ….
CareCare
He Wants To Go Home
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Ms. Salha suffered a stroke and hemiplegia on the left side received hospitalization. despite the stability of the situation still needing
long term nursing help & physiotherapy
CareCare
She Wants To Go Home
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• Hasan 29 years old has Generalized muscle weakness. Diagnosed as Motor Neuron and was Tracheostomised and became Ventilator dependent.
• Conscious, alert with normal cognition Neuroligically he is quadriplegic on Mechanical ventilator and despite the stability of the situation still needing
• Trained Care giver and Regular long term nursing help .
CareCare
He Wants To Go Home
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Guidelines For Referral to HMC
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Care Care
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• Stable patients with requiring professional Care
living in geographical serving area of 50 Km.
Criteria Of PatientCare Care
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HMC Services started from hospitals
Criteria for acceptance 1. Coverage area 50 km or 30minutes
by driving
2. Stable medical condition
3. Approval of home owner
4. Appropriate home environment
5. Capable care giver
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• Decubitus ulcers
• CVA with paralysis
• Physical and mental disabilities
• Diabetic patients
• COPD
• Palliation
• Follow up and family teachingPt. assessment A.Alsagheir -2015
Care
COMMON MEDICAL CONDITIONS AMONG HMC PATIENTS Care
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COMMON MEDICAL CONDITIONS AMONG HMC PATIENTS
• Patients on NGT, and PEG (percutaneous endoscopic gastrostomy)
• Patients on tracheotomy • Patients with respiratory diseases• Bed ridden patients or chair bound patients • Chronic medical conditions • MS, CP and RTA • Wound care patients
PEG: percutaneous endoscopy gastrostomy
Care
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This service currently does not include: Neonate/Pediatric care. Obstetric and post partum care (non complicated). Patients requiring 24 hour Nursing care. Acute medical and surgical patients. Patients on haemodialysis. Demand for service beyond staff, equipment and transport
which will result in in-effective and compromised care.
LIMITATIONSCare Care
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شروط تقديم الخدمةتواجد شخص قادر على رعاية -يشترط
24المريض وتوفير العناية الالزمة له خالل في المنزل وفقا لخطة فريق ساعة يوميا
الرعاية الصحية المنزلية .-الوقت المتوقع للرعاية المقدمة يعتمد على
أسبوعين حالة المريض الطبية بحيث تبدأ من على أن يتم تقييم دوري للحالة كل ولمدة سنة
. شهور 3-عدد الزيارات الدورية يتم تحديدها من قبل
وتكرار الزيارات فريق الرعاية الصحية المنزلية حسب الحالة الصحية للمريض .قد يتغير
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شروط تقديم الخدمة تابع
-أهمية تواجد احد أفراد األسرة لتقديم والرد على استفسارات الفريق العون
الطبي عن صحة المريض أثناء تواجدهم في منزل المريض .
التعاون مع -يجب على أسرة المريض وحسن استقباله .الفريق الطبي
-موظفات الرعاية المنزلية يصاحبهن سائق ومساعدة ممرضة يشترط تواجدهم أثناء
الزيارة .في الفترة من الساعة -يتم تقديم الخدمات
الثامنه والنصف صباحا إلى الثانيه والنصف من االحد إلى الخميس .مساءا
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الحاالت التي بموجبها يتم إخراج المريض:
حالة المريض وتأهيل تحسنفي حالة •ذويه للرعاية به .
بتقديم العالج أو تناوله عدم االلتزام •كما هو مطلوب.
المريض أو أهله إيقاف الزيارات.طلب•عدم توفر الشخص الذي يقوم برعاية •
أو عدم قدرته على توفير المريض رعاية آمنة وفعالة في المنزل.
ألداء عمل عدم مالئمة البيئة المنزلية •الفريق الطبي .
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PATIENT ASSESSMENT
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Care
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Referral• From the Primary physician in
the hospital
Assessment team
• Patient Assessment before discharge
• Assessment of patient home environment
Acceptance
• Providing patient with needed equipment
• Training the care giver
Care Plan• Patient care plan • Schedule 1st visit
STEPS TO HOME MEDICAL CARECare
Pt. assessment A.Alsagheir -2015
• Patient Asse
ssment before discharge
• Assessm
ent of patient home environment
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In the hospital upon referral Patient assessment is done
Medical assessment Socio-economic assessment Caregiver assessment Environmental assessment
PATIENT & ASSESSMENT
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Assessment Care Team:
A- Physician ( Team leader )
B- Nurse
C- Social worker
Home Health Care
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Assessment form
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It is a comprehensive ongoing process
It is an integral part of managing patient care
It is vital to monitor progress in the various aspects
of patient care
Home Health Care
What is the Patient Assessment?
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Home Health Care
What is the Importance of
Patient Assessment?
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Important aspects About Patient Assessment
In the hospital prior to discharge to ensure
continuation of medical services and to ascertain:
HHC can offer the services
Medical equipment needed by the patient in
the home situation
Home Health Care
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• To ensure that the patients condition warrants nursing in the home situation, by doing a total medical and physical examination.
Importance: Assess a patient for Home Health Care
Home Health Care
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• To have a patient management plan in place, ensuring continuation of medical services.
Importance: Assess a patient for Home Health Care
Home Health Care
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• Allowing the caregiver/head of the family enough time to obtain the needed equipment before the patient is discharged.
Important aspects Assess a patient in Hospital upon referral
Home Health Care
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• All medical records will be studied and the accepting HHC physician can confer with the referring Consultant.
Important aspects Assess a patient in Hospital upon referral
Home Health Care
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• Current health condition & patient medical Hx
• Professional services needed for Optimal Outcome
for the care in a home environment
• Determine if the medical equipment available will
be adequate for the Safe & Effective Rx
Home Health Care
What to Assess?
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Work shopgroups
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• Ms. Nora is a 65 y/o woman with metastatic breast CA. She is admitted to the hospital for SOB due to lung mets and malignant pleural effusions. There are no further chemotherapeutic options and efforts to provide symptomatic relief medications
• The patient lives at home with her husband & has 2 sons . She understands her prognosis and would like to be at home to spend as much time as possible with her family.
• Trained Care giver and Regular long term
nursing help .
CareCare
She Wants To Go Home
Pt. assessment A.Alsagheir -2015
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• Mr. Salh is an 52 y/o male with colon CA s/p resection with new colostomy. Hospitalization complicated by delirium and line infection requiring 2 weeks IV antibiotics.
• Pt. lives alone, scant family in Riyadh ,neighbors help with grocery shopping.
• Pt. Can do basic ADL’s but ambulation limited by osteoarthritis and deconditioning.
CareCare
He Wants To Go Home
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• Mr. Hasan is an 59 y/o man admitted with pneumonia and COPD exacerbation. Prior to admission he had been living independently. Due to prolonged intubation, he becomes profoundly deconditioned but is motivated to regain his pre-morbid ability to walk.
• You discuss post-acute care options with the patient and his family.
CareCare
He Wants To Go Home
Pt. assessment A.Alsagheir -2015
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Mr. Ahmed 67 known DM , HTN with severe congestive heart failure for 10 years ago . Suddenly he developed sharp decline in his heart ejection fraction admitted it was decided that the situation is very advanced ..
There is no possibility of cure ….
CareCare
He Wants To Go Home
Pt. assessment A.Alsagheir -2015
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Ms. Salha suffered a stroke and hemiplegia on the left side received hospitalization. despite the stability of the situation still needing
long term nursing help & physiotherapy
CareCare
She Wants To Go Home
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• Hasan 29 years old has Generalized muscle weakness. Diagnosed as Motor Neuron and was Tracheostomised and became Ventilator dependent.
• Conscious, alert with normal cognition Neuroligically he is quadriplegic on Mechanical ventilator and despite the stability of the situation still needing
• Trained Care giver and Regular long term nursing help .
CareCare
He Wants To Go Home
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48
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Hospital Assessment
Home Health Care
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Hospital Assessment:
State of consciousness
Medication in use is noted.
Diet/feeding requirements
Ulcers/surgical incisions and proposed care
Skin status
Home Health Care
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After physical assessment of the patient, may
decide to incorporate other medical services in
the patient’s care plan such as:
• Physiotherapy
• Respiratory therapy
• Dietician
Hospital Assessment:
Home Health Care
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Assessment: Activities of Daily Living (ADL’s)
Assessment tool used to determine patient’s
ability to perform activities of daily living
Home Health Care
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Basic ADLS: Self Care
Personal Hygiene Dressing and undressing Eating Transferring from bed to chair
Home Health Care
Voluntarily control of urinary
or fecal discharge
Moving around
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Assessment: Instrument ADL’s
Not necessary for fundamentals functioning it allows
the individual to live independently in a community
Home Health Care
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ADLS: Instrument
Doing light housework Preparing meals Taking medication Shopping Use of telephone Management of money
Home Health Care
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Total number of family members sharing the home
Total rooms in the home
Equipment available to ensure good patient care
Financial Status (is the family head employed)
Assessment: Socio-Economic
Home Health Care
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Educational status
The relationship between the patient & caregiver -
relative or contract worker-
Time available for patient care
Previous experience in patient care
Assessment of: Care Giver
Home Health Care
Assessm
ent of caregivers needs fo
r education
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Determining the discharge date
Scheduled specialty clinic appointments
Discuss procedures to follow upon discharge
of patient until first home visit
Hospital Assessment:
Home Health Care
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59Pt. assessment A.Alsagheir -2015
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WHAT ARE YOU GOING TO ASSES AT HOME?
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Assessment: Home
Area of patient’s room
Is patient’s room shared
Type of care given to the patient
Safe storage of medication
Home Health Care
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Physical environment must be evaluated for Safety and suitability:Free of fire Health, and safety hazardsAdequate heating cooling, and ventilation Adequate electrical service Provide patient access and mobility & storage
facilities.
Assessment: Home
Home Health Care
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Infection Control:
- General hygiene and hand washing
- Correct disposal of sharps
- Correct handling of supplements for feeding
regime
Assessment: Home & Environment
Home Health Care
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Infection Control:
- Correct disposal of disposable supplies
- Correct handling of Catheter/ NGT/Peg tube
- Correct of suction apparatus
- Use of suction catheters
Assessment: Home & Environment
Home Health Care
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Assessment: Constructing Care Plan
Provides a written means of planning patient care
based upon the diagnosis of the patient
Enables provision of a holistic approach
It serves as a means to document change of the
patient’s condition
Home Health Care
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Conclusions…
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Summary
• Shorter hospitalizations of patient , more complex patients requires earlier, more skilled discharge planning.
• Important to learn hospital staff capabilities of the HHC services
• Excellent communication with patient, family, and providers essential.
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HMC Service based an strong partnership with hospital
Admission Criteria1- Coverage area 50 km
2- Valid Id
3- Eligibility
4- Capable care giver
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It is a comprehensive ongoing process
It is an integral part of managing patient care
It is vital to monitor progress in the various aspects
of patient care
Home Health Care
Patient Assessment
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Questions?
Comments?
Concerns?
Pt. assessment A.Alsagheir -2015