Presented By Ahmed Askar

2. Presented By
Ahmed Askar
Assistant lecturer of critical care& emergency nursing
Faculty of nursing – Cairo university

4. OUTLINES
At the end of discussion, every candidate will be able to:
• Glossary
• Abbreviations
• The challenges that face the patients in hospital ICU.
• The consequences of delay hospital ICU patient's discharge
• The cases that need for home ICU
• The requirements for home ICU set up

5. • Types of care packages for home ICU
• Care delivery process for patients during shifting from hospital ICU
to home ICU
• Tele nursing and the methods of tele nursing
• Advantage and disadvantages of tele nursing
OUTLINES

6. Learning objectives
At the end of discussion, every candidate will be able to:
• Identify the challenges that face the patients in hospital ICU.
• Discuss the consequences of delay hospital ICU patient's discharge
• Identify The cases for home ICU
• Discuss the requirements for home ICU set up

7. • Differentiate between types of care packages for home ICU
• Discuss care delivery process for patients during shifting from hospital ICU to home ICU
• Explain tele nursing and the methods of tele nursing
• Explore the advantage and disadvantages of tele nursing
Learning objectives cont.,

8. Glossary
• Intensive care refers to the specialized treatment given to patients who are acutely
unwell and require critical medical and nursing care.
• Hospital intensive care unit (ICU) is a specialized unit provides comprehensive
critical care and life support for acutely ill and injured patients, adopting high standard
of performance to assure patient safety and quality of care .
• Home intensive care unit (ICU) is a specialized unit provides comprehensive
critical care to critically ill patients of different etiology but not in acute phase , adopting
high standard of performance to assure patient safety and quality of care .

9. • Care packages : The package provide complete ICU setup at home with
high-quality medical and nursing services under the supervision of expert
critical care professionals
• consumerism is that patients are taking ownership of care decisions based
upon costs, their understanding of the full scope of options available to
them based on research and trustworthy sources of information, and
leveraging their use of technologies, This is important because that
increasing a patient’s participation in their care plan
Glossary cont.,

10. • Telenursing is the use of telecommunication and information technology
to provide nursing practice at distance. This cans something as simple as
faxing medical records to the more complex delivery of nursing care to
patients home through the use of cameras and computer technologies
• The telephone triage nurse is an experienced practitioner with excellent
communication and interpersonal skills, When a patient calls a medical
provider with questions or to report symptoms, a nurse experienced in
telephone triage will likely take the call
Glossary cont.,

11. • Digital Transmission: Internet technology also allows healthcare providers
to read scans, watch pre-recorded videos of patients, and review charts from
just about anywhere.
• Remote Patient Monitoring : is any technology that’s designed to monitor
a patient’s medical issues, such as blood pressure, blood sugar, heartrate, etc.
It can help healthcare providers track patient health data without the need
for numerous appointments.
Glossary cont.,

12. • ICU: intensive care unit
• RPM: Remote Patient Monitoring
• LOS : length of stay
• Bipap : Bilevel Positive Airway Pressure
• CPAP: continuous Positive Airway Pressure
abbreviations

13. Home ICU
Home ICU is for Patients who are no
longer in the acute phase of their
illness but still require intensive care

14. Consequences of delay hospital ICU patient's
discharge
ICU occupancy rates
the risk of acquiring
nosocomial infections
LOS
the admission of new
ICU patients
the initiation of
rehabilitative treatments
Costs

15. The cases for home ICU
Terminally ill
lung patient
Prolonged
ICU stay
Cancer
Care
Ventilator
at home
Accident
Cases
Stroke
Care

16. Requirements for home ICU
A client and a family ready and willing to go
home and consumerism
A team of experienced ICU
Equipment that enables intensive care at home

17. Basic equipments required to home ICU set up
• Equipment including ventilator
• Oxygen concentrator
• Patient care bed
• Wheelchair
• Anti decubitus Air mattress
• Physiotherapy equipment
• Bipap Machine
• Ventilator Support
• DVT Pump
• Suction machine
• nebulizing machine
• monitor
• other equipments according to
condition and disease of the
patient.

18. Care Packages
Critical care
package
Step down
package
supportive
package

19. Critical care package
Patient condition :
GCS: 8 or less | Vitals: Unstable | Mobility: Restricted | Ventilation: Dependent
Clinical team ICU Infrastructure
• 2 ICU trained nurses – 12 hours each
• 2 Nursing assistants – 12 hours each
• Physiotherapist (as advised by primary
physician)
• Respiratory therapist (1-2 visits/week)
• ICU consumables
• Weekly clinical quality audits
• Ventilator
• Infusion pumps
• DVT Pump
• Other equipment as per clinical
assessment
• Home visit reports
• E-Monitoring

20. Step-down package
Patient condition :
Patient condition :
GCS: 8 - 10 | Vitals: Unstable | Mobility: Restricted | Ventilation: on / off
Clinical team ICU Infrastructure
• 2 ICU trained nurses-12 hours each
• 2 Nursing assistants – 12 hours each
• Physiotherapist (as advised by primary
physician)
• Respiratory therapist (1-2 visits/week)
• ICU consumables
• Weekly clinical quality audits
• BiPAP
• Infusion pumps
• DVT Pump
• Other equipment as per clinical
assessment
• Home visit report
• E-Monitoring

21. Supportive package
Patient condition :
GCS: 10 or more | Vitals: Stable | Mobility: Restricted
Clinical team ICU Infrastructure
• 2 ICU trained nurses – 12 hours each
• 2 Nursing assistants – 12 hours each
• Physiotherapist (as advised by primary
physician)
• Respiratory therapist (1-2 visits/week)
• Weekly clinical quality audits
• Oxygen concentrator
• Other equipment as per clinical
assessment
• Home visit reports
• E-Monitoring

22. Care delivery process at home
Clinical assessment
Care plan & estimate
Hospital to home transfer
Service delivery
Monitoring & evaluation

23. Clinical assessment
Comprehensive assessment
Patients needs
Determine type of care
Environmental home check
Resources and facilities

24. Care plan & estimate
• Equipment including ventilator
• ICU nurses
• ICU consumables
• ICU physiotherapy
• Nursing attendants
• Equipment including ventilator
• Lab tests
• Medicine delivery
• Remote monitoring by invest
visits
• Complete ICU set up created at
home

25. Hospital to home transfer
• Equipment including ventilator
• Pre transfer check sheet
• Sheet patient transfer from ICU
to ICU

26. Service delivery
• Equipment including ventilator
• Tracheostomy care
• Wound care
• Consultations
• Lab tests
• Nutrition and diet consultation

27. Monitoring & evaluation
Treatment follow-up Clinical audits
• Doctor-guided care plan
• Online assessment forms and digital
record
• Home visit reports
• Daily documentation audits
• Weekly video/tele-audits
• Monthly on-site audits

28. Tele nursing
telenursing has been on the rise in recent years. An aging population,
coupled with greater acceptance of medical care delivered remotely, has
created demand for these services. Since the coronavirus pandemic began,
more people and healthcare organizations have gravitated toward
telemedicine to prevent the spread of the disease

29. Telephone Triage Protocols
• When a patient calls a medical provider with questions or to report symptoms, a
nurse experienced in telephone triage will likely take the call.
• The goals of the triage nurse are to gain the confidence of the patient, relieve
anxiety, obtain relevant information about the patient's symptoms, assess the
information, and determine the level of medical intervention needed

30. Methods of telenursing
Video Conferencing
Digital Transmission
Mobile Health: Smartphones and tablet technology
Remote Patient Monitoring (RPM)

31. Advantages to Tele nursing
Convenient
Save Money
Expand Access
Increase Patient Engagement

32. Disadvantages to Tele nursing
Technology Barriers
Not Good for Every Situation
Reduced Continuity of Care
Insurance Issues

33. Summary

34. Any Question

35. References
Razavi, S. S., Fathi, M., & Hajiesmaeili, M. (2016). Intensive care at home: an
opportunity or threat. Anesthesiology and pain medicine, 6(2). available at
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885143/
Lafferty S., Marijo Baird M., ( 2011) : Tele-nurse: Telephone Triage Protocol
care at home: MULTIDISCIPLINARY CRITICAL CARE AT HOME
Retrived on: https://www.carehome.in/services/icu-at-home

36. Kumar S. & Snooks H.(2011): telenursing, Developments in telenursing; the
globalisation of telenursing procedures
nightingales ( 2020): the home health specialty; Benefits of choosing ICU Care at
Home retrived on https://www.nightingales.in/services/long-term-nursing-
care/home-icu-care
Portea health home(2020) : critical care at home like ICU, retrived on :
https://www.portea.com/critical-care