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La dimissione vs 4
 

La dimissione vs 4

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Presentació a Volterra (18 de febrer de 2011)

Presentació a Volterra (18 de febrer de 2011)

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    La dimissione vs 4 La dimissione vs 4 Presentation Transcript

    • La dimissione Joan Escarrabill, MD Master Plan For Respiratory Diseases (PDMAR) Ministry of Health Health Studies Institute Barcelona [email_address]
    • Punti chiave 1 La dimissione è importante dal punto di vista de la sicurezza dei pazienti e de l'efficacia del trattamento 2 Il processo è complesso e richiede il lavoro di squadra. 3 Ogni volta che si verifichino dei cambiamenti di trattamento è necessario prendere in considerazione l'adattamento del paziente.
    • Agenda
    • Discharge planning
    • Discharge planning Long-term care facilities General ward ICU Emergency department Outpatient clinic Weaning center
    • Monaldi Arch Chest Dis 2007; 67: 3, 142-147. n = 792 patients 20% 45% 16% 36%
    • Monaldi Arch Chest Dis 2007; 67: 3, 142-147. n = 792 patients 18%
    • Escarrabill J. Eur Respir Mon, 2008, 41, 367–376
    • Neale G. J R Soc Med 2001;94:322-330.
    • CMAJ 2004;170:1235-40
    • Teamwork Communication Most problems (and accidents) relate with …
      • Feeling hurried by the physician (28%)
      • Finding a quiet place to call (25%)
      • Difficulty reaching the physician (21%)
      Barriers to effective nurse-physician communication
    • Effective team
      • Ha una gamma di individui che contribuiscono in modi diversi.
      • Obiettivi chiari .
      • Tutti capiscono i compiti che devono fare .
      • Co ordinatore
      • Atmosfera informale .
      • D iscussione ( I membri del gruppo ascoltare gli altri )
      • Sentitevi liberi di criticare.
      • Comodo con disaccordo.
      • Apprendimento dall'esperienza.
      www.kent.ac.uk/careers/sk/teamwork.htm
    • Il team ottiene risultati migliori rispetto alla somma dei risultati ottenuti da ogni singolo membro.
    • Wagner. BMJ 2000;320:569-72. Casas and Romeu in tandem (1897)
    • Aiken L. NEJM 2003;348:164-6 Increasing role of non-physcian health professionals .
      • Competenze relative alla ventilazione meccanica a casa (HMV), la tecnologia e l'assistenza domiciliare.
      • Capacità di valutare l'adeguatezza dei caregivers.
      • La conoscenza delle risorse della comunità.
      • Capacità di integrare casa, ambulatoriale e ospedaliera.
      • Progettazione di piani di cura a base di linea guida che integrano le esigenze cliniche e le preferenze del paziente.
      • Behavioral consulenza e l'insegnamento di auto-gestione.
      • Esperienza in consultazioni gruppo
    • BMJ 2009; 339:b3595
    • The network of discharge Financial issues Public/Private Discharge team Case manager Risk management Education Experience Health Service Health professionals Supplier Caregiver Home carers
    • Escarrabill J. Eur Respir Mon, 2008, 41, 367–376
    • Piper A. Breathe 2010;6:323-33
    • J Nurs Care Qual 2004;19:67-73 Case manager coordinates the discharge plan Confidence & competence Understanding of what is needed Confidence that the patient’s needs are being met Patient and caregiver Nurses & RRT Physician
    • Agenda
    • Thorax 1998;53:762–767
      • to enhance quality of life
      • to sustain and extend life without compromising quality.
      • to improve or sustain physical and psychological function
      • to provide cost effective care.
    • Discharge planning... ...is defined as the development of an individualised discharge plan... ...prior to them leaving hospital.
    • NIV: Feasibility
    • Aumento del rischio, i risultati clinici più incerto e più costosi. 103 pazienti 457 transitions
    • Needs assessment Home carers Equipment & supplies Communication Daily living Risk management Funding
    • Home carers Home carers Equipment & supplies Communication Daily living Risk management Funding O Noeregaard & J Escarrabill Tailored educational programmes for patients and caregivers Well-structured programme with theoretical knowledge and practical skills
    • Patient & Caregiver Training Source: Eurovent Survey Home carers Equipment & supplies Communication Daily living Risk management Funding Patients Caregivers Is training crucial before discharge? 97% 84% Is there a continued training after discharge? 36% 34%
    • Equipment needs for NIV Schönhofer B, Sortor-Leger S. Eur Respir J 2002;20:1029-38 Home carers Equipment & supplies Communication Daily living Risk management Funding
    • Augmentative and alternative communication (AAC) Home carers Equipment & supplies Communication Daily living Risk management Funding Speak slowly If able, use gestures Identify the topic first before Writing Boards Software: word prediction.... www.muscle.ca/ Specialized Telephone Equipment
    • Daily living activities Home carers Equipment & supplies Communication Daily living Risk management Funding
        • Strollers.
        • Standard Wheelchairs.
        • Rigid Frame Weelchairs.
        • Nonrigid Frame Weelchairs.
        • Seating Systems.
        • Motorized Weelchairs
    • Daily living activities Home carers Equipment & supplies Communication Daily living Risk management Funding
    • Room setting Home carers Equipment & supplies Communication Daily living Risk management Funding
      • Doors
      • Elevators
      • Alternative systems
      • (volonteers)
    • Room setting www.medame.com Home carers Equipment & supplies Communication Daily living Risk management Funding
    • Sostegno tecnologico
      • Architectural Elements
      • Communication
      • Computers
      • Home Management
      • Personal Care: eating, personal higyene
      • Orthotics & Prosthetics
      • Recreation
      • Seating
      • Sensory Disabilities
      • Therapeutic Aids
      • Transportation
      • Vocational Management
      • Walking
      • Wheeled Mobility
      Pazienti avrà bisogno di una vasta gamma di dispositivi di assistenza, in alcuni casi, per un breve periodo di tempo
    • Home carers Equipment & supplies Communication Daily living Risk management Funding
    • Home carers Equipment & supplies Communication Daily living Risk management Funding
    • Home carers Equipment & supplies Communication Daily living Risk management Funding
    • http://freespace.virgin.net/michael.bowell/equip.html
    • August 14 2000 Power cut kills man on home ventilator BY SAM TOWLSON AN INVESTIGATION has been launched into the death of a disabled man whose life-saving equipment failed during a power cut. Safety Home carers Equipment & supplies Communication Daily living Risk management Funding Feb 15, 2001 A Fatal Complication of Noninvasive Ventilation Lechtzin N., Weiner C. M., Clawson L. N Engl J Med 2001;344:533
    • Risk minimisation (i) Adapted from AK Simonds, 2001 Technical aspects Home carers Equipment & supplies Communication Daily living Risk management Funding
    • Risk minimisation (ii) Adapted from AK Simonds, 2001 Medical and social aspects Home carers Equipment & supplies Communication Daily living Risk management Funding
    • Check-list Piper A. Breathe 2010;6:323-33
    • HMV: Funding Home carers Equipment & supplies Communication Daily living Risk management Funding Tax-funded Social-insurance-funded
    • Agenda
    • Dimissione ospedaliera, in pratica Timing il processo di dimissione ospedaliera inizia il più presto possibile Fattibilità Identificare il caregiver competenti Istruzione Analizzare i problemi pratici Prenditi il tuo tempo Caratteristiche della casa Dimissione Evitare il week-end Case manager
    • Characteristics of care Source: Eurovent Survey 49% without home care
    • Systematic follow-up Escarrabill J. Breathe 2009;6:37-42. Population: 291.500.000
    • HMV in Europe Variability Chron Respir Dis. 2010 Jan 13.
      • History
      • Number of centers
      • Characteristics of the patients
      • Initiation of HMV: outpatient vs hospital
      • Educational issues and discharge
      • Follow-up
      • Wise enthusiasm
      • High competence
      • Spreading competence
      • Multidisciplinary collaboration
    • Eur Respir J 2009; 33: 411–418 Nurse-centred tele-assistance Tele-assistance Control Aveva meno ricoveri, meno ammissioni nel pronto soccorso, meno chiamate urgenti al GP di riduzione dei costi 33%
    • Follow-up
      • Home visits
      • Outpatient clinic
      • Hospital admission
      • Phone call
      • General practitioner
      • Community resources
      • e-mail
    • Am J Phys Med Rehabil. 2010 May;89:401-6. Thirty hospitalizations were avoided. On-demand consult and MI-E access program 29 ALS patients Oximetry feedback program
    • Respite care http://southlakemac.com Provision of short-term, temporary relief to those who are caring for family members
    • Respir Med 2007;101:62-68 Post-operative intubation time 3,8 + 3,2 h. Only 1 patient > 12 h. Stay un postsurgical reanimation unit 19 + 9 h. 19 + 6 h. in the general population n=16
    • End-of-life 57% of patients died at home The percentage of patients who die in hospital ranges from 18.7 to 62.5% (p=0.045). ERS 2010 (Barcelona) n = 77
    • Eur Respir J 2010; 35: 1064–1071 Family burden private assistance high financial burden 26 % 17 %
    • Conclusione
    • Grazie per la vostra attenzione Download la presentazione… www.slideshare.net/jescarra