The approximate cost of a 1 day stay on a cardiac telemonitoring floor.
What is $2700/day?
100
Expected/normal number of Nursing and Therapy visits during the first cert period.
What is:
Skilled Nursing: 8-10 + 2 PRN visits within first 60 days
Therapy: 12-14 visits within first 60 days
**21-23 visits total in first cert is expected/normal**
Remember, that each pt's frequency and needs are individualized, this is only a guide!!
100
The time period within which all CDP patients should be admitted.
The time period in which all documentation from a visit should be completed.
What is a 24hr SOC turn around.
What is 48 hours to complete documentation.
100
A patient who has a history of CHF, HTN, and CAD who was just discharged from hospital for Right Total Knee with no surgical or medical complications and no change in his Lasix, Metoprolol, or Aspirin dosing.
Who is NOT appropriate for the CDP Program?
100
When is it appropriate to use the BORG vs Dyspnea scale for a patient.
When the patient has just cardiac dignosis use the BORG (How hard was the exercise?) vs. When the patient has a pulmonary diagnosis use the Dyspnea scale (How SOB where you with that activity?)
200
The average daily cost of Home Health services?
What is $40.72/day?
200
Patient declines to participate in the CDP Program.
What is admit them anyway!
(It will not change your assessment techniques, therapy, or education plan)
**Please notify Kathryn if someone is not receptive to the program**
200
A CDP patient is approaching the end of his first cert period, what should we do?
Recert the patient. It is impossible to teach on everything needed in just one cert period and expect the patient to be able to retain it.
200
A Patient with Home Health referral for wound care and Physical Therapy s/p Fall, who has a history of CHF,COPD, TBI and DM. Since opening her case, clinicians have noticed increase swelling to lower extremities, increase fatigue/sob when ambulating, and difficulty with comprehension of instructions.
What is admit her into the CDP program.
**Remember that we can utilize speech and occupational therapy to assist with breathing technique for our COPD patients and for evaluation of cognitive functioning level. **
200
The numbers on the BORG scale correlate to what VS measurement?
What is Heart Rate.
300
Describe the primary goal of the CDP program (2-Parts).
What is to keep patients out of the hospital/ER and provide patient's with the education/skills/tools to manage their disease process and maintain independence?
300
The only orders needed for initiation of CDP services.
What is the CDP Physician Verbal Order Verbage:
1. Oxygen sats every visit all disciplines.
Notify MD if VS/Biometerics are outside of parameters AND if the patient is exhibiting symptoms of an exacerbation of disease process.
2. Include 2 PRN SN visits for disease process exacerbation along with your frequency orders
3. Notify MD if weight gain of 3lbs in 24hrs and 5 lbs in 1 week.
4. Target Heart Rate Reserve range for activity
5. Orders for PT to eval/treat if not present on initial referral.
6. Consider need for all disciplines based on presentation/assessment.
300
The System activated when a CDP patient calls in with worsening symptoms or distress OR when the clinician identifies a concern with their assessment findings?
What is use the Triage System (if the case manager is unavailable and no other clinician available to evaluate/assess pt's concerns, contact Kathryn).
300
Name 5 Common Cardiac/Pulmonary Diagnosis that are appropriate for this program.
Formula used to determine their Target Heart Reserve during exerciese.
What is the Karvonen Formula.
Max HR= 220-age
Heart Rate Reserve= Max HR- resting HR
Target HR Reserve= (0.40xHRR) + resting HR
(0.60 x HRR) + resting HR
400
The survival rate/ratio in 1 year after a new Heart Failure diagnosis?
What is One out of every five people diagnosed with this disease process will die within 1 year of diagnosis.
400
Identify patients that would receive telemonitoring services.
What is NOT every CDP Patient. Only patients that are mentally and physically able to work with the monitors and do not already have home equipment available. Also excludes homes with bug infestations.
400
On the 2nd nursing visit and 1st PT visit, this ambulation test is to be completed.
What is the 2 Min. Walk Test.
**Nursing should plan to perform this with telemonitoring setup if applicable**
**Remember to check VS at 5 min. intervals post activity to ensure return back to set resting parameters, must be back in range before leaving the home. If pt is asymptomatic with an elevated HR post activity, it is ok**
400
The 3 Criteria questions we should be asking ourselves to determine if pt would be appropriate for the CDP program.
What is
1. Is the patient's condition r/t an exacerbation of a primary or secondary CDP Diagnosis?
2. Is this a new onset diagnosis?
3. Do they have any cardiac/pulmonary diagnosis that effects the POC or requires education?
400
The percentage range of the Max HR that should be used when calculating the Karvonen Formula for our typical elderly/frail CDP Patient
What is 40-60%.
500
Hospitals are penalized for any readmission within this time frame.
What is 30 days?
500
Steps needed to place a telemonitor in the home.
Duration of telemonitoring expected for these patients.
What is an MD order for telemonitoring and to determine if there is a working phone jack in the home and if they have 2 or 3 pronged outlets.
What is at least 30-60 days. Once discontinued, we should still remain in the home for at least 3 weeks after removal for O &A of ability to self monitor.
500
The 2 Min Walk Test is completed at these time periods during a patient's HH services.
What is within the first 2 visits for BOTH PT and Nursing and again at discharge of services.
500
Which button on the telemonitor will transmit the VS taken?
What is the Blue Button. (To be used when checking pre/post 2 Min. Walk Test VS)
Remember anyone can use the Grey button to check their VS including family, but it will not transmit. Please use the grey button on regular visits to check pt's VS.
500
Describe how to properly measure ankle, calf, and abdominal girth.
What is
Ankle: Find the malleolus, add 1 finger above, and measure around the ankle
Calf: Find the bottom of the patella, drop down 10 cm, and measure around the calf.
Abdomen: Find the naval and measure around the abdomen