Principles of Nurse Case Management Ginny Dowell, RN, BSN October 21, 2015 Comprehensive Care of Patients with Tuberculosis and Their Contacts October 19 22, 2015 Wichita, KS EXCELLENCE EXPERTISE INNOVATION Ginny Dowell, RN, BSN has the following disclosures to make: No conflict of interests No relevant financial relationships with any commercial companies pertaining to this educational activity 1
PRINCIPALS OF TB NURSE CASE CARE THE REASONS WHY WE ARE HERE Ginny Dowell, RN, BSN October 21, 2015 PUBLIC HEALTH TB GOALS 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 2
AMERICAN THORACIC SOCIETY, CDC, AND INFECTIOUS DISEASES SOCIETY OF AMERICA 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. PATIENT CENTERED CARE 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. 3
PRINCIPALS OF TB CASE CARE 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 CASE MANAGEMENT Provides critical services to help patients and their caregivers navigate, coordinate, and transition through a dynamic approach to better achieve their healthcare goals Case Management Society of America, 2009. 4
CASE MANAGEMENT IS: 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. TB CASE MANAGEMENT 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. 5
GOALS OF TB CASE MANAGEMENT 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 MAKE SURE THE TREATMENT PRESCRIBED IS APPROPRIATE: 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.. 6
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. 7
THE NURSING PROCESS Case Finding Assessment- Evaluating and identifying potential barriers/problems Planning Implementation Evaluation Documentation 8
Including: Clinical (H & P, D/C summaries, referrals) Gather & analyze Relevant data Psychosocial and behavioral health Chest X-ray Labs, Microbiology results Nutritional status Past medical history and current condition Concomitant diseases, Infectiousness etc. Case Finding Assessment Identify Problems Plan Implementation Documentation Including: 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 Evaluation 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? Including: Clinical (H & P, D/C summaries, referrals) Gather & analyze Relevant data Psychosocial and behavioral health Chest X-ray Labs, Microbiology results Nutritional status Past medical history and current condition Concomitant diseases, Infectiousness etc. Case Finding Assessment Identify Problems Plan Implementation Documentation Including: 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 Evaluation 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? 9
ASSESSING Gathering data Interviewing- TB assessment Evaluating the patient environment Identifying risk factors and potential barriers Identifying support systems CREATING A PATIENT CARE PLAN Short Term goals successful completion of Initial phase Sputum Culture conversion Release from isolation Clinical improvement Long Term goals Successful completion of continuation phase Education Negotiations Enablers and Incentives 10
Continuous and Ongoing Assessments Reevaluating and resetting goals Renegotiating with Patient Treatment recommendations and Patient needs DOT/WORK/FAMILY PATIENT EDUCATION 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? 11
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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, 2 nd Edition, v. 06/13/11. 13