SCREENING FOR HEALTH RISK
MANAGING THE FATAL FIVE
Karen Green McGowan, RN, CDDN
WHAT IS SCREENING?
 COST BENEFICIAL MECHANISM FOR RULING OUT
PREDICTABLE CONDITIONS
 CHEAPER THAN MORE IN DEPTH ASSESSMENT
 TRAINS STAFF WHEN TO SEEK SPECIAL ATTENTION
AND WHY CERTAIN INTERVENTIONS ARE NECESSARY
 DRIVES SURVEILLANCE AND OTHER MONITORING
WHY, REALLY
 Meets health and safety requirements
 Prevents preventable deaths
 Early identification prevents other complications
 Raises red flags
flags-but
but you have to pay attention!!!
 Allows monitoring of health care
3
Importance of Early Identification




4
Easier to fix
Fewer irreversible consequences
Less costlyy
One risk usually leads to many others
FUNCTION OF SCREENING
 Early Detection of Destabilization
 Data for daily and retrospective use
 The ability to track health status over time
 Tracking individuals by provider, case management,
andd service
i di
division
ii
5
C
Comparative
i D
Data
 Hodges: 3.5 body systems average
 6 other clusters: 4
4.22 body systems
 Death rate @ Hodges: 1.98/100 months
 Death rate @ Sunland: .86/100 months
 Death rate @ other clusters: .42/100 mos
6
The Fatal Five
Aspiration
 GERD
 Bowel Obstruction
Seizures
Dehydration
7
PRIMARY RECOMMENDATIONS
 Early Detection of Client Destabilization
 Priority
P
order
d off care
 Staff are competent
p
in emergency
g y care
 Continuity of care across settings
 Data for daily and retrospective use
8
PERSONS WITH CHRONIC
HEALTH PROBLEMS
9

Immobility - slows flow through body
eg. Oral drugs may be trapped in GI tract

Liver/kidney function often altered

Swallowing problems = nutrient/fluid deficiency

P l h
Polypharmacy
Form vs. Function
 JJohn Needs PT=
FORM
 JJohn needs to move!!
FUNCTION
Physical Therapy is one way we do it!
There are other ways!
1
0
FORM or FUNCTION?
 JJohn needs nursingg care
 ?
 John needs to move
 ?
 John needs a group home
 John needs a barrier free
home
 John needs behavioral
therapy
 John needs to stop eating
butts
 John needs a tube
 ?
 ?
 ?
 ?
 ?
Behavioral Cues for GERD
 Hands in Mouth
 PICA
 Vomiting/Rumination
g
 Crying in Night
 Swallowing after meals
 Refusing Meals
 Coughing/raspy
h
voice quality
l
 Chest beating (Tarzan)
12
Whack – a - Mole Medicine
• Psychotropics
• Physical Restraint
• Tubes
u es (Gastrostomy,
(Gast osto y, Jeju
Jejunostomy)
osto y)
13
•
Bronchodilators,, asthma drugs
g
•
Cogentin, Phenergan
•
Behavioral intervention
•
12000 calories
l i a dday
What we should do:
 Presume
all behavior has a reason
 Teach
staff to know functional sitting and alignment
 Avoid
drugs that treat symptoms only
 Use
1
4
drugs
g wisely,
y, namelyy drugs
g for brain and gut
g
Things That Lead to the Fatal Five
 Dehydration may indicate insufficient fluid intake or not
providing fluids on outings on hot days
 Restricting fluids to prevent wetting the bed
 Uncontrolled seizures, status epilepticus or AED toxicity
may indicate problems with medication administration
 Bowel Obstruction or Ileus - look at diet and fluid intake
15
HEALTH RISK SCREENING TOOL
 Assessment vs. Screening
 A tool for oversight
g staff
 Meant to measure against a baseline
 Trains
T i folks
f lk to kknow when
h to “P
“Panic!!!”
i !!!”
 Drives surveillance and other assessment
PURPOSE OF THE HRST
 Meant as a screening tool for use by non
non-medical
medical
personnel
 Originally developed for case managers in Oklahoma
 Three RN’s for entire state
 Very
Ver complex
comple indi
individuals
iduals mo
moving
ing to small
community residences
SCREENING FOR HEALTH RISK
Managing the Fatal Five
Karen Green McGowan, RN, CDDN
[email protected]
Health Risk Screening, Inc.
877 748 4778
877-748-4778
www.HRSTonline.com
email: [email protected]