1 Pt. assessment A.Alsagheir - 2015 Prepared by Dr. Aeshah Ibrahem Al-Saghier MBSS,SBFM,ABFM Consultant Family Physician Advisor for Training and Development.

1Pt. assessment A.Alsagheir -2015

Pt. assessment A.Alsagheir -2015

طب دورةالشيخوخة

3/31- 2015/4/2

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

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?

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

How the patient enters the HMP service?

HOME MEDICAL CARE

CRITERIA FOR REFERRAL

Pt. should be referred 72 hr’s before discharged from the hospital

Home Health Care

1- Patient Information

2- Medical history

3- Active problems

4- Type of care

5- Patient Support

Referral Form contents

Case Scenario Home Health Care

Work shopgroups

• 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

• 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

• 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

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

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

• 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

Guidelines For Referral to HMC

Care Care

• Stable patients with requiring professional Care

living in geographical serving area of 50 Km.

Criteria Of PatientCare Care

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

• Decubitus ulcers

• CVA with paralysis

• Physical and mental disabilities

• Diabetic patients

• COPD

• Palliation

• Follow up and family teachingPt. assessment A.Alsagheir -2015

COMMON MEDICAL CONDITIONS AMONG HMC PATIENTS Care

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

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

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

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

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 .

PATIENT ASSESSMENT

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

• Patient Asse

ssment before discharge

• Assessm

ent of patient home environment

In the hospital upon referral Patient assessment is done

Medical assessment Socio-economic assessment Caregiver assessment Environmental assessment

PATIENT & ASSESSMENT

Assessment Care Team:

A- Physician ( Team leader )

B- Nurse

C- Social worker

Home Health Care

Assessment form

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?

Home Health Care

What is the Importance of

Patient Assessment?

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

• 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

• To have a patient management plan in place, ensuring continuation of medical services.

Importance: Assess a patient for Home Health Care

Home Health Care

• 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

• 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

• 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?

Work shopgroups

• 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

• 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

• 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

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

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

• 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

Hospital Assessment

Home Health Care

Hospital Assessment:

State of consciousness

Medication in use is noted.

Diet/feeding requirements

Ulcers/surgical incisions and proposed care

Skin status

Home Health Care

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

Home Health Care

Assessment: Activities of Daily Living (ADL’s)

Assessment tool used to determine patient’s

ability to perform activities of daily living

Home Health Care

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

Assessment: Instrument ADL’s

Not necessary for fundamentals functioning it allows

the individual to live independently in a community

Home Health Care

ADLS: Instrument

Doing light housework Preparing meals Taking medication Shopping Use of telephone Management of money

Home Health Care

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

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

Determining the discharge date

Scheduled specialty clinic appointments

Discuss procedures to follow upon discharge

of patient until first home visit

Home Health Care

59Pt. assessment A.Alsagheir -2015

WHAT ARE YOU GOING TO ASSES AT HOME?

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

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

Infection Control:

- General hygiene and hand washing

- Correct disposal of sharps

- Correct handling of supplements for feeding

regime

Assessment: Home & Environment

Home Health Care

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

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

Conclusions…

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.

HMC Service based an strong partnership with hospital

Admission Criteria1- Coverage area 50 km

2- Valid Id

3- Eligibility

4- Capable care giver

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

Questions?

Comments?

Concerns?

Thank you for listening

aal-sagheir@moh.gov.sa

1 Pt. assessment A.Alsagheir - 2015 Prepared by Dr. Aeshah Ibrahem Al-Saghier MBSS,SBFM,ABFM Consultant Family Physician Advisor for Training and Development.

home medical care carept

hospital home health

alsagheir 2015care6criteria

trained care giver

postacute care options

patient admission criteria

scant family

regular long term nursing

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