Premier Home Health Care

Transitional Care

RN COPD CLINICAL PATHWAY - Visit 1

  • 1 Expected Outcomes
  • 2 Interventions
  • 3 Signature

Patient will verbalize S&S to be reporeted immediately

select "Yes" or "No"

Patient will verbalize understanding of compliance to medication schedule

select "Yes" or "No"

Patient will demonstrate tolerance of current activity level

select "Yes" or "No"

Patient will demonstrate/verbalize safe use /management of oxygen/inhaler device

select "Yes" or "No"

Patient will verbalize plan to meet basic ADL’s/IADL’s

select "Yes" or "No"

Patient controls ease of breathing

select "Yes" or "No"

Patient verbalizes understanding of POC/services, including telehealth

select "Yes" or "No"

Review inpatient discharge summary

select "Yes" or "No"

Complete comprehensive assessment

select "Yes" or "No"

Assess patient's knowledge of disease process

select "Yes" or "No"

Assess endurance level for activities

select "Yes" or "No"

Assess need for Rehab

select "Yes" or "No"

Assess and evaluates level of independence with ADLs/IADL/s

select "Yes" or "No"

Assess readiness to learn

select "Yes" or "No"

Complete med reconciliation process

select "Yes" or "No"

Instruct on emergency measures

select "Yes" or "No"

Instructs on coughing and deep/pursed lip breathing

select "Yes" or "No"

Instruct on oxygen use

select "Yes" or "No"

Initiate discussion on Smoking Cessation, if applicable

select "Yes" or "No"

Discuss/collaborate on POC. Include discussion on telehealth as part of Plan of Treatment

select "Yes" or "No"

Initiate discussion on discharge plan

select "Yes" or "No"

Coordinate with the clinical team as needed

select "Yes" or "No"

Finished

Please sign here! Go to Visit 2