Clinical Pharmacy Part 4

1. Clinical Pharmacy Part 4

2. Home Health Care(HHC)

3. Outline • Introduction • Definition • HHC- past & present • HHC and clinical pathway • Types of home visits • Pharmacist Role • HHC in KSA • Conclusion

4. Introduction • 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

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

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

7. Pharmacist Provided HHC • The provision of specialized, complex pharmaceutical products and clinical assessment and monitoring to patients in their homes ASHP, Am J Health-Syst Pharm. 2000; 57:1252–7.

8. 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

9. Major Reasons for the Change Toward Home Care • The growth of the elderly population with chronic diseases and disabilities • Rising healthcare costs • Improvement in the design of infusion pumps and telehealth diagnostic and monitoring equipment

10. Major Reasons for the Change Toward Home Care – Cont’d • The comfortable home environment makes patients choose to receive care at home • It makes them feel a greater sense of well being which helps in improving their participation in the management of their care

11. 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

12. 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

13. 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

14. 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

15. Assessment Home VisitCont’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

16. 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

17. Hospitalization Follow Up Home VisitCont’d • A home visit after a major illness or surgery • Useful in evaluating the coping behaviors of the patient and family members

18. 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

19. 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

20. Home Health Care and Clinical Pathway • INHOMESSS: • S= service by home health care agency • S= spiritual health • S= safety

21. 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

22. INHOME Cont’d • Nutrition: • Current state of nutrition, eating behaviors, and food preferences • Healthy food preparation techniques can be reviewed with the patient

23. 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

24. 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

25. 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

26. 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.

27. INHOME Cont’d • Safety: • Determine patient's environment comfort and safety (no unreasonable risk of injury) • Modify potential safety hazards

28. Pharmacist Responsibilities • Preadmission Assessment. • The patient, family, and caregiver agree with provision of care services in the home • The medical condition and prescribed medication therapy are suitable for home care services • 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.

29. Pharmacist Responsibilities • Preadmission Assessment. • The home environment is conductive to the provision of home care services • The home care provider has reasonable geographic access to the patient ASHP, Am J Health-Syst Pharm. 2000; 57:1252–7.

30. Pharmacist Responsibilities • Initial Patient Database and Assessment • The patient’s name, address, telephone number, and date of birth • The person to contact in the event of an emergency, including the legal guardian or representative, if applicable • Information on the existence, content, and intent of an advance directive • The patient’s height, weight, and sex

31. Pharmacist Responsibilities • Initial Patient Database and Assessment • All diagnoses • Type of intravenous access and when it was placed • Pertinent laboratory test results • Pertinent medical history and physical findings, • Nutrition screening test results

32. Pharmacist Responsibilities • Initial Patient Database and Assessment • An accurate history of allergies • 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 • Treatment goals and the expected duration of therapy

33. Pharmacist Responsibilities • Initial Patient Database and Assessment • Indicators of desired outcomes • Patient education previously provided • Any functional limitations of the patient • Any pertinent social history

34. Pharmacist Responsibilities • Selection of Products, Devices, and Ancillary Supplies • The stability and compatibility of prescribed medications in infusion device reservoirs • 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 • The ability of the patient or caregiver to learn to operate an infusion device • The potential for patient complications & noncompliance

35. Pharmacist Responsibilities • Selection of Products, Devices, and Ancillary Supplies • Patient convenience • Prescriber preferences • Cost considerations • The safety features of infusion devices

36. Pharmacist Responsibilities • 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

37. Pharmacist Responsibilities • 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

38. Pharmacists Responsibilities • Clinical Monitoring • 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)

39. Pharmacists Responsibilities • 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

40. Pharmacists Responsibilities • 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

41. Pharmacists Responsibilities • Adverse Drug Event Reporting and Performance Improvement • Participation in Clinical Drug Research in the Home • Training, Continuing Education, and Competence

42. 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

43. Preparation for a Career in Home Care • Pharmacy Degree (BS or Pharm D) Plus • Residency ,or • Specialized training, or • A minimum of 3 years of practice experience

44. 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

45. 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

46. 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

47. 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