Preventing Re-hospitalizations
Primary goal for patients and home care staff
What is Preventing Re-hospitalizations?
An unpleasant sensory and emotional experience associated with, or resembling that associated with , actual or potential tissue damage.
What is Pain?
Every time you enter the patient's home
When do you assess patient's safety?
Homebound, under the care of a physician/allowed practitioner, and be in need of skilled care
What are conditions patients must meet for Home Health Services?
Conditions in which people are born, grow, live, work and age, not something an individual can have or not have, not positive or negative, differ from social needs, may represent social risk factors.
What are Social Determinates of Health (SDoH)?
Unrelieved chest pain, uncontrolled bleeding, unrelieved shortness of breath
What is when to call 911?
Psychological, Biological and Social
What are the 3 components of Pain Management?
Shower Chair/Bench
What DME equipment is required for patient to shower?
Personal care, part time and intermittent, can assist with activities to directly support skilled therapy, may provide incidental services if the above criteria is met.
What are Certified Home Health Aides Services?
Within the past 12 months, have you been worried that your food would run out before you could get more?, If you need help with day to day activities such as bathing, preparing meals, shopping, managing finances, etc, do you get the help you need?
What are the OASIS E SDoH Assessment Items?
Leaking catheter, medication questions, s/s of wound infection
What is when to call Nurse?
Pain that last 3 months or less, related to an injury or specific event, localized to the injured area, accompanied by swelling, warmth and redness in the injured area.
What are signs and symptoms of Acute Pain?
Unintentional change in position
What is the definition of a fall?
Skill provided, homebound status and education provided.
What is required to be documented in Clinical Notes?
Access to care, environment, identity, education/literacy, economic stability and neighborhood.
What are Social Determinate of Health (SDoH)contributing factors?
A VNAHG Intranet Resource for evaluating symptoms
What is the Clinician Triage Guide?
Somatic, Visceral and neuropathic
What are the 3 Types of Pain?
Have you fallen in the last year?
Do you feel unsteady when standing or walking?
Do you worry about falling?
What are the STEADI Fall Risk Tool questions?
Health care team
OASIS Reviewers
Managers
Insurance companies
Medicare auditors
State/CHAP surveyors
What is who reads the Medical Record?
Mobile x-ray, lab draw, med change , antibiotics.
What are alternative recommendations to Emergency Room?
Patients should be asked to describe their pain in terms of the following characteristics.
What is location, radiation, mode of onset, character, intensity and exacerbating and relieving factors?
^FallReporting (NJ Employees)
^OhioFallReporting
Florida
Brian.Pescatore@ccflvn.org (Therapy)
Maureen.McGowan@vnahg.org (Nursing)
Who do you contact with questions regarding Fall Occurrence reporting?
Information reflected in the Home Health Plan of Care, OASIS, documentation in clinical record, objective clinical evidence and the patients individual needs and the skilled care may be necessary to improve patient's condition, maintain patient's condition, prevent or slow further deterioration.
What determines reasonable and necessary?