Home Visit Flashcards
Definition of Home Visit
A service made by the HCP to a patients home which allows the HCP to access the home and family situations in order to provide the necessary health related care.
Eg of a specific home based intervention
Adjusting the elderly pts home environment to prevent falls
Types of Home Visits
Illness visits
Visits to dying pt and their families
Assessment visits
Hospitalization follow-up or monitoring visit
Illness home visits involes
Emergency
Acute illness
Chronic illness
With home health agencies
Dying pt home visits involves?
Terminal care with hospice agency
Pronouncement of death
Grief support (med, psychosocial,env, & financial resources)
Need for assessment home visits involves
Role of home environment in pt health status
Polypharmacy
Multiple medical problems
Excessive use healthcare services
Immobility
Social isolation
Suspected abuse or neglect
Recent catastrophic diagnoses
Possible need for nursing home placement
Hospitalization follow up home visits involves
When significant life changes have occurred.
Acute illness
Injury or surgery
Parents with newborn infants
Planning how to conduct the home visit
Clarify the reason for the visit and carefully plan the agenda.
Gathering the necessary equipment
Patient education materials
Having a map
Pt telephone number
Directions to the pt home
Set formal appointment time for the visit
Presence of key family members or significant others
Confirming the appointment time
Essential Equipment for Home visit
Lubricant
Diagnostic set
Patients record and charting materials
Prescription pad
Sphygmomanometer
Stethoscope
Sterile specimen cups
Stool guaiac cards
Thermometer
Urine dipsticks
Optional Equipment for Home Visit
Glucometer
Laptop Computer
Patient education materials
Patient-supplied equipment
Glucometer
Peak flow meter
Scale
Issues to assess during Home Visit/ Elements of Home Visit
I - Immobility
N -Nutrition
H -Housing
O- Other People
M -Medications
E- Examinations
S -Safety
S -Spiritual Health
S -Services by home health agencies
These may be used independently, based on the needs of the patient and the physician’s agenda.
Immobility
Patients functional activities
Activities of daily living
Instrumental activities of daily living
Corrective intervention
Nutrition
Assess the current state of nutrition
Eating behavior
Food preferences
Look at the fridge
Check product labels
Review food preparation techniques
Home Environment
Privacy, social interaction, spiritual and emotional comfort and safety.
Close proximity to services
Reflect pride in fam, hobbies and interest
Do not make assumptions of wealth based on home env
Other people
Assess the pt support group
Availability of emergency help
Surrogate for pt in the event of incapacitation
Durable power of attorney
Living will
Caregiver need and risk of burnout
Medication
Polypharmacy
Type amount and frequency of drug
Drug-drug/ Drug-food interaction
Pt compliance
Doctor shopping
Home remedies
Use and abuse of OTC
Examination
Physical Exam based on the need of pt and Dr. agenda.
Practical function related Exam like getting up from bed, use of bathtub.
Self-monitoring of sugar level and BP
Anthropometry
Safety
Areas to assess include?
Kitchen safety esp use of gas
Bathroom safety
Stairs
Gas or electrical utilities
Hot water source
Heating and air conditioner
Emergency action and evacuation
Smoke dictators and fire extinguishers
Electrical cords
Lighting and night lights
Pets
Loose carpet and throw rugs
Table chairs and other furniture
Spiritual Health
Influence of Spiritual belief on pt sense of physical or emotional health
Spirituality as a coping and healing strategy
Services
Assess relationship with the home health agency
Existing orders, future cares and other perspective of care plan
Example of Targeted Home Visit Assessment
polypharmacy and safety in a patient with a recent fall, or to assess mobility and the extent of social support in a patient with newly diagnosed Alzheimer’s disease.
Factors impeding home visits
Lack of reimbursement
Busy pace of office practice
Poorly organized, sporadic home
Who can benefit from home visits
Everyone
patients who have difficulty accessing outpatient facilities because of sensory impairment, immobility or transportation problem
Way to make home visit make home visits more efficient
Clustering home visits by geographic location and within defined blocks of time
Nurse practitioners and physician assistants conducting visits as part of a home health care delivery team.
Use of Telephone Calls in Medicine
For Virtual Home visits
Provider-initiated telephone calls can be used to reassure family members after a patient has had an acute illness or has been hospitalized.
Reinforcing patient compliance with new medications,
Following patients with chronic diseases
Reducing inappropriate use of primary care clinic or office services
What is telemedicine
Use of communication technologies, such as two-way video-conferencing, to provide patient care across distances
