ginny dowell, rn, bsn has the following disclosures to … · coordination of patient care. ......
TRANSCRIPT
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EXCELLENCE EXPERTISE INNOVATION
PrinciplesofNurseCaseManagement
GinnyDowell,RN,BSNOctober21,2015
Comprehensive Care of Patients with Tuberculosis and Their Contacts
October 19‐22, 2015Wichita, KS
• No conflict of interests
• No relevant financial relationships with any commercial companies pertaining to this educational activity
GinnyDowell,RN,BSNhasthefollowingdisclosurestomake:
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PRINCIPALS OF TB NURSE CASE CARE
THE REASONS WHY WE ARE HERE
Ginny Dowell, RN, BSNOctober 21, 2015
PUBLICHEALTHTBGOALS
• Identify patients with TB Disease and treat them
• Find contacts to TB patients with TB Disease – test them and treat them
• Identify populations at high risk for TB infection due to exposure
• Identify populations at high risk for developing TB disease if infected
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AMERICANTHORACICSOCIETY,CDC,AND
INFECTIOUSDISEASESSOCIETYOFAMERICA
• The Responsibility for successful treatment is clearly assigned to the Public Health Program or private provider, not to the patient.
• It is strongly recommended that the initial treatment strategy utilize Patient-Centered case management/care with an adherence plan that emphasizes direct observation of therapy.
PATIENTCENTEREDCARE
• Take the time to know your patient medical, social, cultural and psychological history.
• Educate your pt --disease process, treatment plan, medications, DOT, and follow up testing.
• Together identify goals/barriers and how they will accomplish or managed.
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PRINCIPALSOFTBCASECARE
Objectives
Explain the Principals of TB Nurse Case Care – TB Nurse Case Management.
• Define TB Nurse Case Care
• Goals and elements of TB Case Care
CASEMANAGEMENT
Provides critical services to help patientsand their caregivers navigate, coordinate, and transition through a dynamic approach to better achieve their healthcare goals”
Case Management Society of America, 2009.
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CASEMANAGEMENTIS:
The assignment of primary responsibility for coordination of patient care.
Case Management ensures that a patient's medical and psychosocial needs are met through appropriate
utilization of resources.
TBCASEMANAGEMENT
• The role of the TB Nurse Case Manager requires a
PROACTIVE APPROACH
in which potential or anticipated problems are identified and measures are used to
address these problems before they develop.
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GOALSOFTBCASEMANAGEMENT
• Treat TB patient according with CDC Guidelines
• Complete treatment in appropriate time frames
• Prevent progression of TB and drug resistant
• Prevent transmission of TB with effective Contact Investigation (CI)
• Educate patient, family and community about TB
MAKESURETHETREATMENTPRESCRIBEDISAPPROPRIATE:
• For the diagnosis
• For pt age and wt
• For pt medical conditions
• Monitor the pt clinical response and make sure
length of tx fits the disease response.
.
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Ensure initiation and completion of
Appropriate Safe
TB treatment.
THUS
• Preventing the progression of Drug resistant TB disease.
• Prevent transmission of the TB Germ to the family and community.
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THENURSINGPROCESS
Case Finding
Assessment- Evaluating and identifying potential
barriers/problems
Planning
Implementation
Evaluation
Documentation
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Case Finding Assessment Identify Problems
Plan
EvaluationIncluding:
Asses existing and/or potential health problems
Coordinate team meetings to discuss patient’s assessment
Monitor outcomes and identify new problems
Including:
DOT administration (Adherence to treatment)
Initiation of Treatment
Monitoring (Clinical assessment for toxicity)
Referrals
Patient education
Including:
Clinical (H & P, D/C summaries, referrals)
Psychosocial and behavioral health
Chest X-ray
Labs, Microbiology results
Nutritional status
Past medical history and current condition
Concomitant diseases, Infectiousness etc.
Documentation
Implementation
Gather & analyze Relevant
data
Was TB treatment implemented in a timely manner?
Were expected outcomes achieved?
Was patient satisfied with services?
Were the TB staff satisfied with plan and outcome?
Case Finding Assessment Identify Problems
Plan
EvaluationIncluding:
Asses existing and/or potential health problems
Coordinate team meetings to discuss patient’s assessment
Monitor outcomes and identify new problems
Including:
DOT administration (Adherence to treatment)
Initiation of Treatment
Monitoring (Clinical assessment for toxicity)
Referrals
Patient education
Including:
Clinical (H & P, D/C summaries, referrals)
Psychosocial and behavioral health
Chest X-ray
Labs, Microbiology results
Nutritional status
Past medical history and current condition
Concomitant diseases, Infectiousness etc.
Documentation
Implementation
Gather & analyze Relevant
data
Was TB treatment implemented in a timely manner?
Were expected outcomes achieved?
Was patient satisfied with services?
Were the TB staff satisfied with plan and outcome?
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ASSESSING
• Gathering data
• Interviewing- TB assessment
• Evaluating the patient environment
• Identifying risk factors and potential barriers
• Identifying support systems
CREATINGAPATIENTCAREPLAN
• Short Term goals – successful completion of Initial phase
Sputum Culture conversion Release from isolationClinical improvement
• Long Term goals – Successful completion of continuation phase
• Education• Negotiations – Enablers and Incentives
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Continuous and Ongoing Assessments Reevaluating and resetting goals
Renegotiating with Patient Treatment recommendations and Patient
needsDOT/WORK/FAMILY
PATIENTEDUCATION
• Medications Information – dosage, potential side effects, and what the pills look.
• Disease process • Treatment regime• Do not forget that patient education is an ongoing
process• Use written materials• Culture sensitive education – Identify what are
his/her priorities – work? money? family?
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DOCUMENTATION
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REFERENCES
• American Thoracic Society, Center for Disease Control and Prevention, Infectious Diseases Society of America Treatment of tuberculosis. MMWR 2003.
• Tuberculosis Nursing: A Comprehensive Guide to Patient Care, 2nd Edition, v. 06/13/11.