Transcript Home carex - KSU Faculty Member websites

Home Health Care
HHC
Lobna Al Juffali,Msc
Clinical Pharmacy Department
PHCL 311
Outlines
• Introduction.
• Definition.
• HHC-the past and the
present.
• HHC and clinical
pathway.
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Type of home visits.
Pharmacists Roles
HHC in SA.
Conclusion.
Introduction
• The growth of the elderly population and
patients with terminal diseases and disabilities
and limited options of nursing home means
increase number of patients will now receive
health care in their homes.
Definition
• Home Health Care (HHC) is a formal, regulated
program of care delivered by variety of health
care professionals in the patient home.
HHC service is provided by:
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Physicians.
Nurses.
Physiotherapists.
occupational therapists.
speech therapists.
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Home care aids.
Social worker.
Dieticians.
Drug and equipment
supply.
• Pharmacists.
Home Visits in the Past and Present
• In the last fifty years, there were a sudden
decline in home visits.
• The Major Reasons For Decline ????
– Lack of practice and experience in caring for
patients at home.
– Medical literature concerning HHC are very few to
none
Home Visits
• Then home visits started again and now it is
considered one of the fastest medical sector.
Major reasons for the change toward
home visits
• In-patient model of care may not be optimally
serving the needs of the growing number of
elderly and disabled people
• The comfortable home environment makes
patients choose to receive care at home.
Major reasons for the change toward
home visits Cont’d
• It makes them feel a greater sense of well
being which helps in improving their
participation in the management of their care.
Types of Home Visits
Type of visits
• The following are the different types of home
visits:
• Illness home visit.
• Dying patient home visit.
• Assessment home visit.
• Hospitalization follow up home visit.
Illness home visit
• Involves an assessment of the patient and the
provision of care in the setting of acute or
chronic illness.
• Often in coordination with one or more home
health agencies.
• Emergency illness visits are infrequent and
impractical for the typical office-based
physician.
The dying patient home visit
• Made to provide care to the home-bound patient
who has a terminal disease.
• Usually in coordination with a hospice agency.
• The family physician can provide medical and
emotional support to family members before, during,
and after the death of a patient in the home
environment.
Assessment home visit
• Can be described as an investigational visit at
which the physician evaluates the role of the
home environment in the patient's health
status.
• It is often made when a patient is suspected of
poor compliance or has been making
excessive use of health care resources.
Assessment home visit Cont’d
• Medication use evaluated in the patient who is
taking many drugs because of multiple medical
problems.
• Evaluation home environment of the "at-risk" patient
can reveal abuse, neglect or social isolation.
• A joint assessment home visit facilitates coordination
of the efforts of home health agencies and the
physician.
Hospitalization follow up home visit
• Follow-up home visits after a patient has been
hospitalized.
• Useful when significant life changes have occurred.
• E.g. a home visit after the birth of a new baby
provides an excellent opportunity to discuss wellness
and prevention issues and to address parental
concerns.
Hospitalization follow up home visit
Cont’d
• A home visit after a major illness or surgery.
• Useful in evaluating the coping behaviors of
the patient and family members
Home Care And Clinical Pathway
Home Health and Clinical Pathway
• Developing a clinical pathway is an important
issue to evaluate and can give measurable out
come.
• Help in following the patients with multiple
medical problems.
• Many pathway models are used to asses
multiple and different issues.
Home Health and Clinical Pathway
Cont’d
• One of these models is the INHOME mnemonic
which can be expanded to "INHOMESSS“.
• INHOME:
• I= immobility
• N= nutrition.
• H=housing.
• O= other people.
• M= medications.
• E= estimations.
Home Health and Clinical Pathway
Cont’d
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INHOMESSS:
The same.
S= service by home health care agency.
S= spiritual health.
S= safety.
INHOME
• Immobility:
• Functional activities includes assessment of
the activities of daily living e.g. bathing,
feeding.
• Instrumental activities of daily living e.g.
telephone, administering medications.
INHOME Cont’d
• Nutrition:
• Current state of nutrition, eating behaviors,
and food preferences.
• Healthy food preparation techniques can be
reviewed with the patient.
INHOME Cont’d
• Home Environment:
• The home should allow for privacy, social
interaction, spiritual and emotional comfort,
and safety.
• A safe neighborhood within close proximity to
services is important for many older patients.
INHOME Cont’d
• Other People:
• Social support system present at the home visit
clarifies the roles and concerns of family members.
• The availability of emergency help for the patient
from family members and friends.
• Evaluation of the caregiver's needs and risk of
burnout is critically important.
INHOME Cont’d
• Medications:
• In polypharmacy, the physician must evaluate the
type, amount and frequency of medications, and the
organization and methods of medication delivery.
• An inventory of the patient's medicine cabinet can
provide clues to previously unidentified drug-drug or
drug-food interactions.
• Direct estimate of patient compliance.
INHOME Cont’d
• Examination:
• Directed physical examination based on the needs of
the patient and the physician's agenda.
• The physician can have the patient demonstrate
proper technique for the self-monitoring of blood
glucose levels.
• Weigh the patient and obtain a blood pressure
measurement..
INHOME Cont’d
• Safety:
• determine patient's environment comfort and
safety (no unreasonable risk of injury).
• Modify potential safety hazards.
Pharmacists’ Responsibilities
I. Preadmission Assessment.
– The patient, family, and caregiver agree with provision
of care services in the home.
– The medical condition and prescribed medication
therapy are suitable for home care services
– The patient or caregiver is willing to be educated
about the correct administration of medications.
– The home environment is conducive to the provision
of home care services
– The home care provider has reasonable geographic
access to the patient.
Pharmacists’ Responsibilities
II. Initial Patient Database and Assessment
1. The patient’s name, address, telephone number, and
date of birth
2. The person to contact in the event of an emergency,
including the legal guardian or representative, if
applicable,
3. Information on the existence, content, and intent of an
advance directive
4. The patient’s height, weight, and sex
5. All diagnoses
6. Type of intravenous access and when it was placed
7. Pertinent laboratory test results
Pharmacists’ Responsibilities
II.
Initial Patient Database and Assessment
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Pertinent medical history and physical findings,
Nutrition screening test results
An accurate history of allergies
A detailed medication profile, including all medications
(prescription and nonprescription) immunizations home
remedies, and investigational and nontraditional therapies,
The prescriber’s name, address, and telephone number
Treatment goals and the expected duration of therapy
Indicators of desired outcomes
Patient education previously provided
Any functional limitations of the patient, and
Any pertinent social history
Pharmacists’ Responsibilities
III. Selection of Products, Devices, and Ancillary Supplies
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The stability and compatibility of prescribed medications in
infusion device reservoirs,
The ability of an infusion device to accommodate the
appropriate volume of medication and diluent and to deliver
the prescribed dose at the appropriate rate,
The ability of the patient or caregiver to learn to operate an
infusion device,
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The potential for patient complications and noncompliance,
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Patient convenience
Prescriber preferences,
Cost considerations
The safety features of infusion devices.
Pharmacists’ Responsibilities
IV. Development of Care Plans
• The care plan should be developed at the start
of therapy and regularly reviewed and
updated.
• The degree of detail of the plan should be
based on the complexity of drug therapy and
the patient’s condition.
Pharmacists’ Responsibilities
V. Patient Education and Counseling
• The pharmacist is responsible for ensuring
that the patient or caregiver receives
appropriate education and counseling about
the patient’s medication therapy.
• Supplementary written information should be
provided to reinforce oral communications.
Pharmacists’ Responsibilities
VI. Coordination of Drug Preparation, Delivery,
Storage, and Administration.
• The pharmacist should ensure that the delivery of
medications and supplies to the patient occurs in
a timely manner to avoid interruptions in drug
therapy.
• The temperature of home refrigerators or
freezers in which medications are stored should
be within acceptable limits and should be
monitored by the patient or caregiver.
Pharmacists’ Responsibilities
VII.Documentation in the Home Care Record.
• The pharmacist is responsible for
documenting all pharmacy clinical activities in
the patient’s record in a timely manner.
How home care differs from other
than Types of Pharmacy Practice?
• Caring for patients 24 hours a day, seven days
a week
• Managing infusion equipment and vascular
access devices
• Negotiating reimbursement for products and
services
HHC in Saudi Arabia
Home Healthcare in Saudi Arabia
• In the Kingdom of Saudi Arabia Home Health
Care services was started by the Green
Crescent Hospital in 1980, as a part of their
emergency program.
HHC in KFSH
• KFSH and Research Center implemented HHC service
in 1991 under the supervision of a committee to
oversee its ongoing planning and implementation,
following a pilot study which indicated that patients
and their families benefited from the nursing care
and psychosocial support.
KFNGH
• King Fahad National Guard Hospital (KFNGH)
in Riyadh started Home Health Care in spring
1995.
• It covers all patients referred from KFNGH
according to their selection criteria.
Conclusion
• Home Health Care helps the physician to fully
understand the social factors related to his
patient. This understanding will assist the
physician in patient management as well as
strengthen the patient-doctor relationship.
Thank You