Visit Types
Occurs after a patient is discharged from hospital.
What is a transition of care visit.
Teams is a safe place to share patient information/HIPPA compliant.
What is True.
PPS stands for...
What is Palliative Performance scale.
The process of identifying a complete and accurate list of all medications that a patient is taking is known as..
What is Med Reconciliation
occurs weekly, meet with team, agenda includes case presentations of patients, team news, disenrollment. last 1-2hrs.
What is Patient Care meetings?
Triggered by assessments/PHQ2, provide ongoing Therapeutic support.
What is a Social work visit.
Texting is ok with patients on our work cell.
What is False.
This PPS score, includes patients that are mainly in bed, and require mainly assistance with ADL's.
What is PPS 40?
Cost, side effects, miscommunication, transportation and cognitive impairment are...
What is Barriers to adherence.
Brief meetings to review day to day issues/updates such as coverage for acute visits.
What is a huddle?
Occurs as f/u to after hours call or pt is having active issues/symptoms.
What is an Acute Response visit.
Patients with a positive PHQ2 screening of 3 WOULD require SW referral.
What is True
Risk level assigned to a patient with stable CHF symptoms, last hospitalization 3months ago and no SDOH needs.
What is medium risk level
Supplements, vitamins, herbals, ointments, OTC, Prescriptions (inhalers/injectables)
What is included in a Med Rec?
Where the team discusses patient care including concerns, change in patient status, recommendations and discharges.
What is Patient care meeting (PCM)?
Follow up Medical visit that is 30-45mins long and assessment are chosen based on clinical judgement.
What is Routine ongoing visit.
Photos are allowed to be taken on Work phone using the microsoft lens app.
What is True.
Referral made when a patient transitions to a high risk level.
What is Social work?
Review, Reconcile and report are
What are the steps to a Med Rec?
Meets monthly, agenda includes team updates, organizational news, clinical education. last 1-3hrs.
What are Team Meetings?
completed by NP/PA, 60-90mins/must obtain consent
What is an Initial visit.
Half scores 35/65/75 are acceptable on the PPS scale
What is False?
What is High Palliative?
Resources used if you are unable to obtain Medication info from patient
What is Pharmacist, MD, or CG?
The tool/template used for patient case presentation.
What is SBAARR?