1 assessment A.Alsagheir Pt.
2015
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 Administration
Ministry of Health
March. 2015
Care
AIMS
Care
 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?
Pt. assessment A.Alsagheir -2015
STEPS TO HOME MEDICAL CARE
Care
Referral
• From the Primary physician in the hospital
Assessment
team
• Patient Assessment before discharge
• Assessment of patient home environment
Acceptance
Care Plan
• Providing patient with needed equipment
• Training the care giver
• Patient care plan
• Schedule 1st visit
Pt. assessment A.Alsagheir -2015
HOME MEDICAL CARE
Care
How the patient enters the HMP service?
Pt. assessment A.Alsagheir -2015
Home Health Care
CRITERIA FOR REFERRAL
Pt. should be referred 72 hr’s before discharged from
the hospital
Pt. assessment A.Alsagheir -2015
Pt. assessment A.Alsagheir -2015
Referral Form contents
1- Patient Information
2- Medical history
3- Active problems
4- Type of care
5- Patient Support
Pt. assessment A.Alsagheir -2015
Case Scenario
Home Health Care
Care
Pt. assessment A.Alsagheir -2015
Work shop
groups
Pt. assessment A.Alsagheir -2015
She Wants To Go Home
Care
Care
• 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 .
Pt. assessment A.Alsagheir -2015
He Wants To Go Home
Care
Care
• 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.
Pt. assessment A.Alsagheir -2015
He Wants To Go Home
Care
Care
• 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 premorbid ability to walk.
• You discuss post-acute care options with the
patient and his family.
Pt. assessment A.Alsagheir -2015
He Wants To Go Home
Care
Care
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 ….
Pt. assessment A.Alsagheir -2015
She Wants To Go Home
Care
Care
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
Pt. assessment A.Alsagheir -2015
He Wants To Go Home
Care
Care
• 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 .
Pt. assessment A.Alsagheir -2015
Guidelines For Referral to HMC
Care
Care
Pt. assessment A.Alsagheir -2015
Criteria Of Patient
Care
Care
• Stable patients with requiring professional Care
living in geographical serving area of 50 Km.
Pt. assessment A.Alsagheir -2015
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
Pt. assessment A.Alsagheir -2015
Care Care
COMMON MEDICAL CONDITIONS
AMONG HMC PATIENTS
• Decubitus ulcers
• CVA with paralysis
• Physical and mental disabilities
• Diabetic patients
• COPD
• Palliation
• Follow up and family teaching
Pt. assessment A.Alsagheir -2015
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
Pt. assessment A.Alsagheir -2015
PEG: percutaneous endoscopy gastrostomy
Care
Care
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.
Pt. assessment A.Alsagheir -2015
‫شروط تقديم الخدمة‬
‫يشترط تواجد شخص قادر على رعاية المريض وتوفير العناية‬‫الالزمة له خالل ‪ 24‬ساعة يوميا في المنزل وفقا لخطة فريق الرعاية‬
‫الصحية المنزلية ‪.‬‬
‫الوقت المتوقع للرعاية المقدمة يعتمد على حالة المريض الطبية‬‫بحيث تبدأ من أسبوعين ولمدة سنة على أن يتم تقييم دوري للحالة كل‬
‫‪ 3‬شهور ‪.‬‬
‫عدد الزيارات الدورية يتم تحديدها من قبل فريق الرعاية الصحية‬‫المنزلية وتكرار الزيارات قد يتغير حسب الحالة الصحية للمريض ‪.‬‬
‫‪Pt. assessment A.Alsagheir -2015‬‬
‫شروط تقديم الخدمة تابع‬
‫أهمية تواجد احد أفراد األسرة لتقديم العون والرد على‬‫استفسارات الفريق الطبي عن صحة المريض أثناء تواجدهم في‬
‫منزل المريض ‪.‬‬
‫يجب على أسرة المريض التعاون مع الفريق الطبي وحسن‬‫استقباله ‪.‬‬
‫موظفات الرعاية المنزلية يصاحبهن سائق ومساعدة ممرضة‬‫يشترط تواجدهم أثناء الزيارة ‪.‬‬
‫يتم تقديم الخدمات في الفترة من الساعة الثامنه والنصف صباحا‬‫إلى الثانيه والنصف مساءا من االحد إلى الخميس ‪.‬‬
‫‪Pt. assessment A.Alsagheir -2015‬‬
‫الحاالت التي بموجبها يتم إخراج المريض‪:‬‬
‫•‬
‫•‬
‫•‬
‫•‬
‫•‬
‫في حالة تحسن حالة المريض وتأهيل ذويه للرعاية به ‪.‬‬
‫عدم االلتزام بتقديم العالج أو تناوله كما هو مطلوب‪.‬‬
‫طلب المريض أو أهله إيقاف الزيارات‪.‬‬
‫عدم توفر الشخص الذي يقوم برعاية المريض أو عدم‬
‫قدرته على توفير رعاية آمنة وفعالة في المنزل‪.‬‬
‫عدم مالئمة البيئة المنزلية ألداء عمل الفريق الطبي ‪.‬‬
‫‪Pt. assessment A.Alsagheir -2015‬‬
Pt. assessment A.Alsagheir -2015
PATIENT ASSESSMENT
Care
Pt. assessment A.Alsagheir -2015
STEPS TO HOME MEDICAL CARE
Care
Referral
• From the Primary physician in the hospital
Assessment
team
• Patient Assessment before discharge
• Assessment of patient home environment
Acceptance
Care Plan
• Providing patient with needed equipment
• Training the care giver
• Patient care plan
• Schedule 1st visit
Pt. assessment A.Alsagheir -2015
PATIENT & ASSESSMENT

In the hospital upon referral Patient
assessment is done




Medical assessment
Socio-economic assessment
Caregiver assessment
Environmental assessment
Pt. assessment A.Alsagheir -2015
Home Health Care
Assessment Care Team:
A- Physician ( Team leader )
B- Nurse
C- Social worker
Pt. assessment A.Alsagheir -2015
Assessment form
Pt. assessment A.Alsagheir -2015
Home Health Care
What is the Patient Assessment?
 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
Pt. assessment A.Alsagheir -2015
Home Health Care
What is the Importance of
Patient Assessment?
Pt. assessment A.Alsagheir -2015
Home Health Care
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
Pt. assessment A.Alsagheir -2015
Home Health Care
Importance:
Assess a patient for Home Health Care
•
To ensure that the patients
condition warrants
nursing in the home
situation, by doing a total
medical and physical
examination.
Pt. assessment A.Alsagheir -2015
Home Health Care
Importance:
Assess a patient for Home Health Care
•
To have a patient management plan in
place, ensuring continuation of medical
services.
Pt. assessment A.Alsagheir -2015
Home Health Care
Important aspects
Assess a patient in Hospital upon referral
•
Allowing the caregiver/head of the family
enough time to obtain the needed equipment
before the patient is discharged.
Pt. assessment A.Alsagheir -2015
Home Health Care
Important aspects
Assess a patient in Hospital upon referral
•
All medical records will be
studied and the accepting HHC
physician can confer with the
referring Consultant.
Pt. assessment A.Alsagheir -2015
Home Health Care
What to Assess?
•
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
Pt. assessment A.Alsagheir -2015
Work shop
groups
Pt. assessment A.Alsagheir -2015
She Wants To Go Home
Care
Care
• 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 .
Pt. assessment A.Alsagheir -2015
He Wants To Go Home
Care
Care
• 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.
Pt. assessment A.Alsagheir -2015
He Wants To Go Home
Care
Care
• 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 premorbid ability to walk.
• You discuss post-acute care options with the
patient and his family.
Pt. assessment A.Alsagheir -2015
He Wants To Go Home
Care
Care
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 ….
Pt. assessment A.Alsagheir -2015
She Wants To Go Home
Care
Care
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
Pt. assessment A.Alsagheir -2015
He Wants To Go Home
Care
Care
• 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 .
Pt. assessment A.Alsagheir -2015
48
Home Health Care
Hospital Assessment
Pt. assessment A.Alsagheir -2015
Home Health Care
Hospital Assessment:

State of consciousness

Medication in use is noted.

Diet/feeding requirements

Ulcers/surgical incisions and proposed care

Skin status
Pt. assessment A.Alsagheir -2015
Home Health Care
Hospital Assessment:

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
Pt. assessment A.Alsagheir -2015
Home Health Care
Assessment: Activities of Daily Living (ADL’s)
 Assessment
tool used to determine patient’s
ability to perform activities of daily living
Pt. assessment A.Alsagheir -2015
Home Health Care
Basic ADLS: Self Care

Personal Hygiene
 Voluntarily control of urinary
 Dressing and undressing
or fecal discharge
 Eating
 Moving around
 Transferring from bed to chair
Pt. assessment A.Alsagheir -2015
Home Health Care

Assessment: Instrument ADL’s
Not necessary for fundamentals functioning it allows
the individual to live independently in a community
Pt. assessment A.Alsagheir -2015
Home Health Care
ADLS: Instrument

Doing light housework

Preparing meals

Taking medication

Shopping

Use of telephone

Management of money
Pt. assessment A.Alsagheir -2015
Home Health Care
Assessment: Socio-Economic

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)
Pt. assessment A.Alsagheir -2015
Home Health Care
Assessment of: Care Giver

Educational status

The relationship between the patient & caregiver relative or contract worker-

Time available for patient care

Previous experience in patient care
Pt. assessment A.Alsagheir -2015
Home Health Care
Hospital Assessment:

Determining the discharge date

Scheduled specialty clinic appointments
 Discuss
procedures to follow upon discharge
of patient until first home visit
Pt. assessment A.Alsagheir -2015
Pt. assessment A.Alsagheir
-2015
59
WHAT ARE YOU GOING
TO ASSES AT HOME?
Pt. assessment A.Alsagheir -2015
Home Health Care
Assessment: Home

Area of patient’s room

Is patient’s room shared

Type of care given to the patient

Safe storage of medication
Pt. assessment A.Alsagheir -2015
Home Health Care
Assessment: Home
 Physical environment must be evaluated for Safety
and suitability:
Free of fire
 Health, and safety hazards
Adequate heating cooling, and ventilation
 Adequate electrical service
 Provide patient access and mobility & storage
facilities.
Pt. assessment A.Alsagheir -2015
Home Health Care
Assessment: Home & Environment

Infection Control:
-
General hygiene and hand washing
-
Correct disposal of sharps
-
Correct handling of supplements for feeding
regime
Pt. assessment A.Alsagheir -2015
Home Health Care
Assessment: Home & Environment

Infection Control:
-
Correct disposal of disposable supplies
-
Correct handling of Catheter/ NGT/Peg tube
-
Correct of suction apparatus
-
Use of suction catheters
Pt. assessment A.Alsagheir -2015
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
Pt. assessment A.Alsagheir -2015
Conclusions…
Pt. assessment A.Alsagheir -2015
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.
Pt. assessment A.Alsagheir -2015
HMC Service based an strong partnership
with hospital
Admission Criteria
1- Coverage area 50 km
2- Valid Id
3- Eligibility
4- Capable care giver
Pt. assessment A.Alsagheir -2015
Home Health Care
Patient Assessment
 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
Pt. assessment A.Alsagheir -2015
Questions?
Comments?
Concerns?
Pt. assessment A.Alsagheir -2015
Care
Pt. assessment A.Alsagheir -2015