MANAGING RISK IN THE HOME CARE ENVIRONMENT

Maryanne Halligan MSN, RN, CCRN,CHSE Clinical Simulation Program Coordinator St. Mary Medical Center Langhorne PA

Objectives

1.  Explain concepts and competencies relative to Home Care

2.  Identify impact of using team skills and behaviors on patient safety

3.  Specify challenges and critical success factors to implementation and sustainment

4.  Describe best practices using simulation to address risks at your facility

Affordable Care Act

•  Funding for Home Care services •  Private vs public – ( Medicare

Guidelines) •  Primary Care visits •  Home Visits •  Nursing Homes

PACE Programs

•  Programs designed to integrate the financing from Medicaid and Medicare eligible individuals

•  Americans in need of long term care expected to rise to 27 million by 2050

•  Affordable Care Act

Risks in the Home

Fire Falls

Burns( water) Driving risk

Risks in the Home

•  Assessing the home Access in and out

Mobility and adjuncts to mobility

Risks in the Home

•  For the healthcare provider Vulnerable staff

•  Alcohol on breath – increase the potential for the

person to become violent •  Bathrooms and kitchens – have the ability to be

lethal for the provider Know your emergency system

•  Exit strategies •  Expanded Awareness •  Verbalizations and non-verbal

Risks in the Home

http://youtu.be/VjSiooKtJvs

Care Giver Stress

Risks in the Home

•  Disagreement with family members

•  Opportunity to introduce palliative care

Palliative Care Model

Philosophy of care that seeks to prevent,relieve, reduce or soothe the symptoms produced by serious medical conditions or their

treatment and to maintain patients quality of life

Palliative Care Model

•  World Health Organization Four foundation measures

1. Appropriate policies 2. Adequate drug availability 3. Education of the Public 4. Implementation

Palliative Care Model

•  Integration into the Home care setting

•  Can it be a part of the care?

•  What are the benefits ?

•  What are the potential burdens?

Scenarios for Vulnerable Populations

•  Pediatrics •  Non-English speaking patients •  Pregnant woman •  Individuals with disabilities

Population over 65

Population over 65

National League for Nursing’s Advancing Care Excellence for Seniors Framework ( ACES)

Essential Knowledge Domains

Individualized Aging

Complexity of Care

Vulnerability During Transitions

Essential Nursing Actions

Assess functions and expectations

Coordinate and mange care

Use Evolving Knowledge

Make Situational Decisions

QUALITY Care

forOlder Adults

Population over 65

Nurses Improving Care for Healthsystem Elders (NICHE)

•  Hartford Institute of New York University College of Nursing

•  Geriatric Nursing Program that addresses the needs of the hospitalized older adults

•  Designation given to hospitals. Over 300 in 40 states as well as Canada

Vulnerability During Transition

Rehabs

Assisted Living

Home care

Long Term Care

Developing Scenarios

•  Before Goals: Define learners –  Who is involved in home care? –  Shift Care

•  Nurses •  Nursing assistants •  LPNs

Scope of practice defined in home setting •  MD / NP •  Emergency medical systems •  Home visit nurses •  Hospice care

Developing Scenarios

Needs Assessment Who are the learners? What level are they ? Are there more then 1 type of learner? How do we define the prerequisite knowledge? How do they learn?

Population over 65

•  Creating realism

•  Moulage

•  Comorbodities

•  Patient Centered •  Community/Population Oriented •  Relationship focused •  Process oriented •  Linked to learning activities that are

developmentally appropriate for the learner •  Integrated across the learning continuum •  Sensitive to practice across settings •  Applicable across professions •  Stated in language common and meaningful

across the profession •  Outcome Driven

Core Competencies for Interprofessional Collaborative Practice

Theoretical Framework

•  Simulation Realism •  Reality •  Primary Frames •  Modulation •  As-if •  Social Practice of Simulation

Thinking about Reality

•  Physical Mode •  Entities that can be measured . Simulators

described in its physical mode ,weight , what it looks like.

•  Real equipment or supplies need to be “simulated” in some cases

Thinking about Reality

Semantical Mode •  Concepts and their relationships •  Theories, meaning and information presented

via text, pictures, sounds, events

Those portions of the world that are fact only by human agreement

Thinking about Reality

Phenomenal Mode •  Emotions , beliefs, and self aware cognitive

states of rational thought that people directly experience while in a situation

Scenario Design

•  All three modes are used •  All can help identify areas that need special

attention •  Should be addressed –  Preparation –  Design –  Conduct –  Debrief

Objectives

•  Measurable •  Clinical learning •  Human factors •  Achievable despite the variability of the

participant •  Realistic

Meet Dorothy

•  How would you approach this case?

•  What factors can you use for simulation exercises?

•  How do you address the needs of the elders and orient staff to this process?

•  What would you hope staff to gain presenting a case as this?

References

•  National League for Nursing (2013) Faculty Programs and resources. ACES Project. http://www.nln.org/facultyprograms/facultyresources/ACES/index.htm

•  Stjernsward, J(2007) Palliative Care:The Public Health Strategy. The Journal of Public Health policy, 28(1).

•  National Pace Association.(2014) Strategies for expanding PACE through new payer relationships. www.NPAonline.org

•  Fazzalaro, J. (2002) Elderly driver issues. OLR Research Reporthttp://www.cga.ct.gov/2002/olrdata/tra/rpt/2002-R-0021.htm

References

•  NYU College of Nursing( 2014) Nursing Improving Care for Healthsystem Elders. http://www.nicheprogram.org/

•  Dieckmann, P, Gaba, D. Rall, M( 2007 ) Deepening the theoretical foundations of patient simulation as social practice. Society for Simulation in Healthcare. 2 (3) DOI:10.1097/SIH.Ob013e380f637f5

•  Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative