1 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 20...

1Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 20Assessment of the Home Care

Patient

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Learning Objectives

After reading this chapter you will be able to: Describe the evolution and advantages of

respiratory home care Identify the type of patients who receive

home respiratory care Describe the role of the respiratory

therapist in home care

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Learning Objectives (cont’d)

List major tools and resources used in respiratory home care assessment

Identify key elements involved in assessing the respiratory home care patient

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Learning Objectives (cont’d)

Identify components of initial evaluation of the patient and home environment

Describe respiratory equipment commonly used to assess and treat patients at home

Explain the purpose and the procedure for developing a plan of care

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Learning Objectives (cont’d)

Describe strategies for educating patients in the home setting

Explain the importance of follow-up care

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Introduction

Because it is cost effective, home care is becoming increasingly more popular

9 million received home care in 2004 Many home care patients have some type

of chronic respiratory illness such as COPD

Home care often enhances the patient’s quality of life

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Introduction (cont’d)

AARC defines home care as “prescribed respiratory services provided in a patient’s personal residence”

Success as a home care RT depends on skills in patient assessment and treatment; in addition the RT must be skilled at communication, education, and problem solving

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Importance of Respiratory Home Care

Due to high costs, increased pressure to discharge patients from acute care facilities as soon as possible

Often results in home care providing many services that were previously provided only in the hospital

Number of people receiving home care is expected to grow to 12 million by 2016

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The Home Care Patient

A typical home care patient does not exist Commonly patients with COPD, cystic

fibrosis, asthma, or neuromuscular disease are seen in the home

The most common therapy needed by patients with respiratory illness in the home is oxygen therapy

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The Home Care Patient (cont’d)

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Home Care Assessment Tools

RTs assessing home care patients need to be highly skilled at using basic equipment (e.g., stethoscope) and their senses

High-tech equipment is not available Most common tools: stethoscope, blood

pressure cuff, and pulse oximeter Peak flowmeters used for patients with

asthma, other obstructive lung diseases

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Role and Qualifications of the Home Care RT

Role of RT depends on the role of the home care company who hired the RT

Some DMEs provide only equipment and education services

Some home care companies also provide clinical care services

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Role and Qualifications of the Home Care RT (cont’d)

Qualifications of the home care RT Excellent patient assessment skills Well versed in all respiratory care modalities Resourceful, versatile, possess critical thinking

skills Must excel at communication and interpersonal

skills Good attention to details

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Assessment and the Home Visit

The home care RT must be skilled at assessing the patient and the environment

Initial visit to assess patient and the home environment, set up equipment needed, and train the patient on its use

A review of the patient’s medical record prior to the initial visit is always helpful

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The Initial Visit

Physical examination Record height, weight, and vital signs Record findings during chest auscultation Observe for signs of cyanosis or edema

Pulse oximetry is checked if a physician’s order is in place

RT should ask patient’s permission before performing a physical examination

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The Initial Visit (cont’d)

Physical and functional limitations Patient evaluated for physical and functional

limitations that may interfere with self-care Patient should be checked for eyesight,

hearing, mobility, strength, endurance, balance, cognitive abilities

Caregivers in the home should be evaluated for cognitive function if they provide care

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Medication review RT should review all medications the patient is

taking with the patient and other caregivers The patient’s level of understanding and

cooperation are evaluated When patient is found to not be in compliance

with the use of the prescribed medications, the attending physician must be notified

The Initial Visit (cont’d)

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Psychosocial evaluation Depression and anxiety are common in

patients with chronic lung disease Home care patients may have trouble coping

with their reduction in independence RT should look for signs of anger, depression,

and anxiety and report them to the attending physician

The Initial Visit (cont’d)

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Nutritional review RT should briefly evaluate the patient’s eating

habits and nutritional needs and restrictions When significant problems exist, a clinical

dietitian should be called in to see the patient A review of oxygen safety while cooking may

be needed

The Initial Visit (cont’d)

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Cultural, ethnic, religious considerations Language barriers may require an interpreter Some cultures require shoes to be removed on

entry to the house Some religious groups do not want home visits

on their day of worship In all cases, the RT should respect the

patient’s cultural, ethnic, and religious issues

The Initial Visit (cont’d)

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Environmental assessment Home is checked for health, fire, safety issues Emergency exit routes must be identified Electrical outlets inspected for overloading and

grounding; electrician may need to be called Home is inspected for functional fire alarms

The Initial Visit (cont’d)

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Environmental assessment Oxygen equipment must be stored at least 6

feet from any source of heat The home should have a working telephone;

cordless or cellular phones are ideal The home of an asthmatic is inspected for

sources of triggers such as moldy rugs and pets

The Initial Visit (cont’d)

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Home Care Equipment

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Patient Education and Training

Each visit should include time to teach the patient and caregivers how to perform treatments and care for the equipment

The RT must be able to convey technical information in a simple way

Most patients learn skills best by practicing the skill while RT observes and gives feedback

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Patient Education and Training (cont’d)

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Patient Education and Training

RT must evaluate degree to which patient understands information being taught and review as needed

Patient and caregivers often overwhelmed on the first visit and will need significant reinforcement on the next visit

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Plan of Care

One goal of initial visit is to gather information that will help RT develop the plan of care for the patient

Goals and desired outcomes need to be identified

Treatment is planned to reach the goals Communication with the patient’s

physician is important

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Discharging the Patient

For most patients the treatment goals are achieved and the patient is capable of self- monitoring

At this point the patient is discharged from respiratory care services

If the patient continues to need RT equipment, visits will need to continue to monitor the function of the equipment

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Summary

Home care is a growing industry that often calls on the knowledge and skills of the RT

The home care RT must be skilled at communication, basic patient assessment, and many respiratory care modalities

The home environment must be assessed Patient education is an important part of

home care