Best Practice Intervention Package - Kansas Foundation for Medical ...

CHECKLIST FOR AGENCY LEADERSHIPASSIGNEDNOTESDATESUGGESTED ACTIVITIES:TO:COMPLETE:preventing pressure ulcers and chronic disease maintenance.Confirm how your patients are made aware of their risk forhospitalization and how staff is documenting this.Incorporate the Self HRA for patient use to promoteunderstanding of their risk.Use the Personal Health Record for patients to takeownership of their health record—and provide acommunication tool that can be used between all settingsInclude a caregiver or patient representation to youragency’s teams (board, quality team, etc.).Use the Partnering with Patients and Families toAccelerate Improvement Readiness Assessment(page 43-44) to assess organizational readiness.Incorporate / expand your agency’s telehealth program(telephonic support and / or telemonitors).• Evaluate if protocols current.• Evaluate if all monitors are in use—if not set goals toincrease monitor usage until 100% are utilized.• Confirm your patients at high risk for hospitalizationreceive a monitor or phone support. (see PatientSelection Criteria: Home Telehealth for Heart Failure,page 48; Flow Chart for High-Risk Patient - AssociatedResources )Explore patient care alternatives for when you may not havethe staff to implement telehealth or if a patient continues torequire care but is no longer homebound. This couldinclude coordinating vendor service providing telehealth to