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 Types of home visits  Pharmacist Role  HHC in KSA  Conclusion  Introduction  Definition  HHC- past & present  HHC and clinical pathway.

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Presentation on theme: " Types of home visits  Pharmacist Role  HHC in KSA  Conclusion  Introduction  Definition  HHC- past & present  HHC and clinical pathway."— Presentation transcript:

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3  Types of home visits  Pharmacist Role  HHC in KSA  Conclusion  Introduction  Definition  HHC- past & present  HHC and clinical pathway

4  The growth of the elderly population & patients with terminal diseases and disabilities and limited options of nursing home means an increasing number of patients will now receive health care in their homes

5  Home Health Care (HHC) is a formal, regulated program of care delivered by variety of health care professionals in the patient home

6  Physicians  Nurses  Physiotherapists  Speech therapists  Social workers  Dieticians  Pharmacists

7  The provision of specialized, complex pharmaceutical products and clinical assessment and monitoring to patients in their homes ASHP, Am J Health-Syst Pharm. 2000; 57:1252–7.

8  In the last fifty years, there was 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  Then home visits grew again and is now considered one of the fastest growing medical sectors

9 1. The growth of the elderly population with chronic diseases and disabilities 2. Rising healthcare costs 3. Improvement in the design of infusion pumps and telehealth diagnostic and monitoring equipment

10 4. The comfortable home environment makes patients choose to receive care at home 5. It makes them feel a greater sense of well being which helps in improving their participation in the management of their care

11  The following are the different types of home visits: ◦ Illness home visit ◦ Dying patient home visit ◦ Assessment home visit ◦ Hospitalization follow up home visit

12  Involves an assessment of the patient and the provision of care in the setting of acute or chronic illness  Emergency illness visits are infrequent and impractical for the typical office-based physician

13  Made to provide care to the home-bound patient who has a terminal disease  Provide medical and emotional support to family members before, during, and after the death of a patient in the home environment

14  Can be described as an investigational visit at which the provider 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

15  Medication use evaluated in the patient who is taking many drugs because of multiple medical problems  Evaluation of home environment of the "at-risk" patient can reveal abuse, neglect or social isolation

16  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

17  A home visit after a major illness or surgery  Useful in evaluating the coping behaviors of the patient and family members

18  A clinical pathway is important for evaluating patients and providing measurable outcomes  Helps in following patients with multiple medical problems  Many pathway models are used to asses multiple and different issues

19  One of these models is INHOME which can be expanded to "INHOMESSS“.  INHOME: ◦ I= immobility ◦ N= nutrition ◦ H= housing ◦ O= other people ◦ M= medications ◦ E= examination

20  INHOMESSS: ◦ S= service by home health care agency ◦ S= spiritual health ◦ S= safety

21  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

22  Nutrition:  Current state of nutrition, eating behaviors, and food preferences  Healthy food preparation techniques can be reviewed with the patient

23  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

24  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

25  Medications:  Evaluation of the type, amount and frequency of medications, & 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

26  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….etc.

27  Safety:  Determine patient's environment comfort and safety (no unreasonable risk of injury)  Modify potential safety hazards

28 I. Preadmission Assessment. 1.The patient, family, and caregiver agree with provision of care services in the home 2.The medical condition and prescribed medication therapy are suitable for home care services 3.The patient or caregiver is willing to be educated about the correct administration of medications ASHP, Am J Health-Syst Pharm. 2000; 57:1252–7.

29 I. Preadmission Assessment. 4.The home environment is conductive to the provision of home care services 5.The home care provider has reasonable geographic access to the patient ASHP, Am J Health-Syst Pharm. 2000; 57:1252–7.

30 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

31 II. Initial Patient Database and Assessment 5.All diagnoses 6.Type of intravenous access and when it was placed 7. Pertinent laboratory test results 8.Pertinent medical history and physical findings, 9.Nutrition screening test results

32 II. Initial Patient Database and Assessment 10.An accurate history of allergies 11.A detailed medication profile, including all medications (prescription and nonprescription) immunizations, home remedies, and investigational and nontraditional therapies, prescriber’s name, address, and telephone number 12.Treatment goals and the expected duration of therapy

33 II. Initial Patient Database and Assessment 13.Indicators of desired outcomes 14.Patient education previously provided 15.Any functional limitations of the patient 16.Any pertinent social history

34 III. Selection of Products, Devices, and Ancillary Supplies 1.The stability and compatibility of prescribed medications in infusion device reservoirs 2.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 3.The ability of the patient or caregiver to learn to operate an infusion device 4.The potential for patient complications & noncompliance

35 III. Selection of Products, Devices, and Ancillary Supplies 5.Patient convenience 6. Prescriber preferences 7. Cost considerations 8.The safety features of infusion devices

36 IV. Development of Care Plans  The care plan should be developed at the start of therapy and regularly reviewed and updated  The degree of details of the plan should be based on the complexity of drug therapy and the patient’s condition

37 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

38 VI. Clinical Monitoring VII. Communication with the patient and caregiver  Assess compliance with drug therapy  Assess progress toward the goal of therapy  Inform patient how to contact the pharmacist when needed  Assess drug therapy problems (e.g., failure to respond to therapy and adverse drug events)

39 VIII. 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

40 IX. 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

41 X. Adverse Drug Event Reporting and Performance Improvement XI. Participation in Clinical Drug Research in the Home XII. Training, Continuing Education, and Competence

42  Caring for patients 24 hours a day, seven days a week  Managing infusion equipment and vascular access devices  Negotiating reimbursement for products and services

43  Pharmacy Degree (BS or Pharm D) Plus  Residency,or  Specialized training, or  A minimum of 3 years of practice experience

44  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

45  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

46  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

47  Home Health Care helps the provider 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-provider relationship


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