1 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 20 Assessment of the Home Care Patient

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

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

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

5 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Learning Objectives (cont’d)  Describe strategies for educating patients in the home setting  Explain the importance of follow-up care

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

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

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

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

10 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. The Home Care Patient (cont’d)

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

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

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

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

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

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

17 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.  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)

18 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.  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)

19 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.  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)

20 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.  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)

21 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.  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)

22 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.  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)

23 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Home Care Equipment

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

25 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Patient Education and Training (cont’d)

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

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

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

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