Clinical Pharmacy Part 4

Home Health Care(HHC)

Outline Types of home visits

Pharmacist Role

HHC in KSA

Conclusion

Introduction

Definition

HHC- past & present

HHC and clinical pathway

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

Introduction

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

Defintion

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

The provision of specialized, complex pharmaceutical products and clinical assessment and monitoring to patients in their homes

Pharmacist Provided HHC

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

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

Major Reasons for the Change Toward Home Care

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

Major Reasons for the Change Toward Home Care – Cont’d

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

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

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

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

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

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

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

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

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

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

Home Health Care and Clinical Pathway INHOMESSS:

◦S= service by home health care agency◦S= spiritual health◦S= safety

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

INHOME Cont’d

Nutrition:

Current state of nutrition, eating behaviors, and food preferences

Healthy food preparation techniques can be reviewed with the patient

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

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

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

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.

INHOME Cont’d

Safety:

Determine patient's environment comfort and safety (no unreasonable risk of injury)

Modify potential safety hazards

Pharmacist ResponsibilitiesI. 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.

Pharmacist ResponsibilitiesI. 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.

Pharmacist ResponsibilitiesII. 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

Pharmacist ResponsibilitiesII. 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

Pharmacist ResponsibilitiesII. 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

Pharmacist ResponsibilitiesII. 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

Pharmacist Responsibilities

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

Pharmacist Responsibilities

III. Selection of Products, Devices, and Ancillary Supplies

5. Patient convenience

6. Prescriber preferences

7. Cost considerations

8. The safety features of infusion devices

Pharmacist ResponsibilitiesIV. 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

Pharmacist ResponsibilitiesV. 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

Pharmacists ResponsibilitiesVI. 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)

Pharmacists ResponsibilitiesVIII. 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

Pharmacists ResponsibilitiesIX. 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

Pharmacists ResponsibilitiesX. Adverse Drug Event Reporting and

Performance Improvement

XI. Participation in Clinical Drug Research in the Home

XII. Training, Continuing Education, and Competence

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

Pharmacy Degree (BS or Pharm D)

Plus

Residency ,or Specialized training, or A minimum of 3 years of practice experience

Preparation for a Career in Home Care

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

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

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

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