Maryanne Halligan MSN, RN, CCRN,CHSE Clinical Simulation Program Coordinator St. Mary Medical Center Langhorne PA MANAGING RISK IN THE HOME CARE ENVIRONMENT
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 Burns( water) Falls 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 QUALITY Care forolder Adults Essential Nursing Actions Assess functions and expectations Coordinate and mange care Use Evolving Knowledge Make Situational Decisions
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 Home care Assisted Living 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
Core Competencies for Interprofessional Collaborative Practice 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
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