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Clinical Pharmacy Part 4

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Presentation on theme: "Clinical Pharmacy Part 4"— Presentation transcript:

1 Clinical Pharmacy Part 4

2 Home Health Care (HHC)

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

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

6 HHC Service Is Provided By:
Physicians Nurses Physiotherapists Speech therapists Social workers Dieticians Pharmacists

7 Pharmacist Provided HHC
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 Home Care in the Past and Present
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 Major Reasons for the Change Toward Home Care
The growth of the elderly population with chronic diseases and disabilities Rising healthcare costs Improvement in the design of infusion pumps and telehealth diagnostic and monitoring equipment

10 Major Reasons for the Change Toward Home Care – Cont’d
The comfortable home environment makes patients choose to receive care at home It makes them feel a greater sense of well being which helps in improving their participation in the management of their care

11 Types of Home 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

12 Illness Home Visit 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 Dying Patient Home Visit
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 Assessment Home Visit 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 Assessment Home Visit Cont’d
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 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

17 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

18 Home Health Care and Clinical Pathway
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 Home Health Care and Clinical Pathway
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 Home Health Care and Clinical Pathway
INHOMESSS: S= service by home health care agency S= spiritual health S= safety

21 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

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

23 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

24 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

25 INHOME Cont’d 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 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….etc.

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

28 Pharmacist Responsibilities
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 ASHP, Am J Health-Syst Pharm. 2000; 57:1252–7.

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

30 Pharmacist Responsibilities
Initial Patient Database and Assessment The patient’s name, address, telephone number, and date of birth The person to contact in the event of an emergency, including the legal guardian or representative, if applicable Information on the existence, content, and intent of an advance directive The patient’s height, weight, and sex

31 Pharmacist Responsibilities
Initial Patient Database and Assessment All diagnoses Type of intravenous access and when it was placed Pertinent laboratory test results Pertinent medical history and physical findings, Nutrition screening test results

32 Pharmacist Responsibilities
Initial Patient Database and Assessment An accurate history of allergies 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 Treatment goals and the expected duration of therapy

33 Pharmacist Responsibilities
Initial Patient Database and Assessment Indicators of desired outcomes Patient education previously provided Any functional limitations of the patient Any pertinent social history

34 Pharmacist Responsibilities
Selection of Products, Devices, and Ancillary Supplies 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 The potential for patient complications & noncompliance

35 Pharmacist Responsibilities
Selection of Products, Devices, and Ancillary Supplies Patient convenience Prescriber preferences Cost considerations The safety features of infusion devices

36 Pharmacist Responsibilities
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 Pharmacist Responsibilities
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 Pharmacists Responsibilities
Clinical Monitoring 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 Pharmacists Responsibilities
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 Pharmacists Responsibilities
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 Pharmacists Responsibilities
Adverse Drug Event Reporting and Performance Improvement Participation in Clinical Drug Research in the Home Training, Continuing Education, and Competence

42 How Home Care Differs from other 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

43 Preparation for a Career in Home Care
Pharmacy Degree (BS or Pharm D) Plus Residency ,or Specialized training, or A minimum of 3 years of practice experience

44 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

45 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

46 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

47 Conclusion 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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