Premier Home Health Care

Transitional Care

RN PNEUMONIA PATHWAY - Visit 1

  • 1 Expected Outcomes
  • 2 Interventions
  • 3 Signature

Patient will verbalize S&S to be reported immediately, including, SOB and S&S of sepsis

select "Yes" or "No"

Patient will verbalize knowledge of plan of treatment: medication, - ABX therapy, nebulizers, inhalers, adequate hydration, oxygen (if applicable) etc.

select "Yes" or "No"

Patient will demonstrate tolerance of current activity level

select "Yes" or "No"

Patient will demonstrate/verbalize safe use of inhaler device

select "Yes" or "No"

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

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 readiness to learn

select "Yes" or "No"

Identify potential barriers to compliance with Plan of treatment

select "Yes" or "No"

Initiate education as needed re: medication compliance, adequate hydration, energy conservation techniques and S&S to report to MD/RN

select "Yes" or "No"

Provide education on infection control

select "Yes" or "No"

Complete med reconciliation process

select "Yes" or "No"

Initiate discharge planning discussion

select "Yes" or "No"

Discuss telehealth as part of Plan of Treatment

select "Yes" or "No"

Assess for the presence of social supports

select "Yes" or "No"

o Assess need for Therapies

select "Yes" or "No"

Coordinate with the clinical team as needed

select "Yes" or "No"

Finished

Please sign here! Go to Visit 2