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MANAGING RISK IN THE HOME CARE ENVIRONMENT
Maryanne Halligan MSN, RN, CCRN,CHSE Clinical Simulation Program Coordinator St. Mary Medical Center Langhorne PA
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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
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Affordable Care Act
• Funding for Home Care services • Private vs public – ( Medicare
Guidelines) • Primary Care visits • Home Visits • Nursing Homes
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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
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Risks in the Home
Fire Falls
Burns( water) Driving risk
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Risks in the Home
• Assessing the home Access in and out
Mobility and adjuncts to mobility
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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
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Risks in the Home
http://youtu.be/VjSiooKtJvs
Care Giver Stress
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Risks in the Home
• Disagreement with family members
• Opportunity to introduce palliative care
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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
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Palliative Care Model
• World Health Organization Four foundation measures
1. Appropriate policies 2. Adequate drug availability 3. Education of the Public 4. Implementation
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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?
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Scenarios for Vulnerable Populations
• Pediatrics • Non-English speaking patients • Pregnant woman • Individuals with disabilities
Population over 65
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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
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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
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Vulnerability During Transition
Rehabs
Assisted Living
Home care
Long Term Care
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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
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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?
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Population over 65
• Creating realism
• Moulage
• Comorbodities
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• 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
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Theoretical Framework
• Simulation Realism • Reality • Primary Frames • Modulation • As-if • Social Practice of Simulation
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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
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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
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Thinking about Reality
Phenomenal Mode • Emotions , beliefs, and self aware cognitive
states of rational thought that people directly experience while in a situation
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Scenario Design
• All three modes are used • All can help identify areas that need special
attention • Should be addressed – Preparation – Design – Conduct – Debrief
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Objectives
• Measurable • Clinical learning • Human factors • Achievable despite the variability of the
participant • Realistic
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Meet Dorothy
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• 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?
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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
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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