02 Oct Home Care Settings
382231.Describe the role of a respiratory therapist in the home care setting
2.List and describe the factors used to justify, evaluate and maintain home oxygen administration in alternative sites
Background
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Improved medical equipment has resulted in an increase in home respiratory care. Modern therapies for the treatment of newborns have resulted in more infants and pediatric patients requiring home oxygen and home mechanical ventilation. In addition to technological advances, changing demographics, and economic pressures, another key factor increasing home respiratory care is that most patients prefer to be cared for at home if possible.
Typically, from admission to discharge from the hospital, patients require some sort of respiratory care. For those patients admitted with chronic lung conditions discharge planning for subsequent home care usually begin on hospital admission. The respiratory therapist can add a tremendous amount of value to this process.
Today, great efforts are aimed toward reduction of hospital readmission. Hospitals are now penalized if patients with certain diagnoses are readmitted within 30 days, with Chronic Obstructive Lung Disease (COPD) being included. With this in mind, most healthcare facilities focus on better home care with the involvement of respiratory care professionals. The home respiratory therapist collaborates with the patient’s physician and other disciplines to develop a plan of care for the patient. While respiratory therapists have life support and critical care skills, they will have to develop techniques to meet the psychosocial needs of the patient and family in a home care setting.
The goals of homecare are:
•To help patients achieve the optimum level of function
•To educate patients and their caregivers of their disease process
•To administer diagnostic and therapeutic services to help manage disease
•To conduct disease management and promote a healthier lifestyle
The respiratory therapist is the most qualified healthcare professional to provide home respiratory care by virtue of education, training, and competency testing. Home respiratory care, especially for ventilated patients, can be highly complex. The risk of a negative outcome is high if a highly skilled professional does not provide the care.
The daily routine of a home care RT is very different from that of a hospital-based RT. Although home care RT’s see a variety of patients and families each day, they do not enjoy the same camaraderie with their coworkers. The home care RT often is on-call 24 hours a day, 7 days a week. The positive side is that the home care RT often develops long-term relationships with patients and their families.
During the initial home visit, the RT has several important tasks to complete:
1.Establish a rapport with the patient and family
2.Evaluate the home environment
3.Complete the equipment setup
4.Perform any ordered patient assessments and diagnostic or therapeutic procedures
5.Determine if there are unmet needs and make a plan for addressing those needs
6.Communicate, as appropriate, with other professional caregivers
7.Complete the required paperwork
Oxygen therapy in the home or alternate-site healthcare facility is indicated for the treatment of hypoxemia and has been shown to improve survival in hypoxemic patients with COPD. Home care therapists must be familiar and comfortable with a variety of oxygen therapy delivery devices and patient delivery interfaces.
There is no general agreement on the definition of a home mechanical ventilator. The Medicare program has categorized devices with exhalation valves, adjustable breath rates, and alarms as mechanical ventilators and places them in the group of devices requiring frequent and substantial service. The home care RT will make frequent and regular visits to the ventilator patient’s home to check the ventilator and related equipment.
Review the following resources. These resources will provide you with the understanding of patient care plans and factors relating to patients who live at home with ventilators. You will review the steps involved in preparing patients for home with respiratory equipment.
•Home care plans and home care training; please visit the Link (Links to an external site.)Links to an external site.
•Living with a ventilator and ventilator uses http://www.livingwithavent.com/pages.aspx?page=Living (Links to an external site.)Links to an external site.
Click on the tabs in blue: ventilator uses, daily activities, infection control, travel with a ventilator and ventilator weaning
Prompt
Review the subjective requirements of a home respiratory therapist below. After you have reviewed them, choose four and discuss their importance as it pertains to patients receiving respiratory care at home. Include in your answer how you would communicate these requirements to the patient’s caregivers.
Subjective requirements:
1.Highly skilled at patient assessment
2.Highly skilled at home safety assessment
3.Excelled critical thinking ability
4.Good teacher
5.Respects people from other cultures and socioeconomic backgrounds
6.Good communication skills
7.Intrinsically motivated
8.Good organizational skills
Submit your answers in at least 500 words on a Word document. You must cite at least three references in APA format to defend and support your position
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