The Health Insurance Portability and Accountability Act (HIPAA) of 1996 went into effect in the spring of 2003 to strengthen and protect patient privacy. Health care providers (such as doctors, nurses, pharmacies, hospitals, clinics, and nursing homes), health insurance plans, and government programs (such as Medicare and Medicaid) must notify patients about their right to privacy and how their health information will be used and shared. This includes information in the patient’s medical record, conversations about the patient’s care between health care providers, billing information, health insurers’ computerized records, and other health information. Employees must also be taught about privacy procedures.

Under HIPAA, the patient also has the right to access his medical information, know when health information is shared, and make changes or corrections to his medical record. Patients also have the right to decide if they want to allow their information to be used for certain purposes, such as marketing or research. Patient records with identifiable health information must be secured so that the records aren’t accessible to those who don’t have a need for them. Identifiable health information may include the patient’s name, Social Security number, identification number, birth date, admission and discharge dates, and health history.

When a patient receives health care, he will need to sign an authorization form before protected health information can be used for purposes
other than routine treatment or billing. The form should be placed in the patient’s medical record. (See Documenting patient authorization to use personal health information.)

Hearing loss occurs in varying degrees that range from the loss of only certain tones to total deafness. Hearing loss is most commonly classified by the cause of the impairment. Conductive loss results from the failure of sound waves to be transmitted through the external ear, middle ear, or both. Sensorineural loss results from pathologic changes in the inner ear, 8th cranial nerve, auditory centers of the brain, or all three. Mixed loss is a combination of conductive and sensorineural loss. Central hearing loss is a result of damage to the brain’s auditory pathways or auditory center. Gross or precise assessment can be done to determine the extent of the hearing loss.

A syndrome characterized by myocardial dysfunction, heart failure leads to impaired pump performance (reduced cardiac output) or to frank heart failure and abnormal circulatory congestion. Congestion of systemic venous circulation in right-sided heart failure may result in peripheral edema or hepatomegaly; congestion of pulmonary circulation in left-sided heart failure may cause pulmonary edema, an acute, life-threatening emergency.

Although heart failure may be acute (as a direct result of myocardial infarction), it’s generally a chronic disorder associated with the retention of sodium and water by the kidneys. Care for a patient with heart failure centers on symptom management, fluid balance, and prevention and management of complications.

Heat therapy is warmth applied directly to the patient’s body that raises tissue temperature and enhances the inflammatory process by causing vasodilation and increasing local circulation. This promotes leukocytosis, suppuration, drainage, and healing. Heat therapy also increases tissue metabolism, reduces pain caused by muscle spasm, and decreases congestion in deep visceral organs. Moist heat softens crusts and exudates and penetrates deeper than dry heat.

Continuous pulmonary artery pressure (PAP) and intermittent pulmonary artery wedge pressure (PAWP) measurements provide important information about left ventricular function and preload. This information is useful not only for monitoring, but also for aiding diagnosis, refining your assessment, guiding interventions, and projecting patient outcomes.

Nearly all acutely ill patients are candidates for PAP monitoring—especially those who are hemodynamically unstable, who need fluid management or continuous cardiopulmonary assessment, or who are receiving multiple or frequently administered cardioactive drugs. PAP monitoring is also crucial for patients with shock, trauma, pulmonary or cardiac disease, or multiorgan disease. It’s also used before some major surgeries to obtain baseline measurements.

Current pulmonary artery (PA) catheters have up to six lumens. In addition to distal and proximal lumens used to measure pressures, a balloon inflation lumen inflates a balloon for PAWP measurement and a thermistor connector lumen allows cardiac output measurement. Some catheters also have a pacemaker wire lumen that provides a port for pacemaker electrodes and measures continuous mixed venous oxygen saturation.

The PA catheter is inserted into the heart’s right side with the distal tip lying in the pulmonary artery. Fluoroscopy may not be required during catheter insertion because the catheter is flow directed, following venous blood flow from the right heart chambers into the pulmonary artery.

Home care aides provide hands-on personal care to the patient or services needed to maintain the patient’s health or facilitate his medical treatment. Aides also provide respite to caregivers. Remember that Medicare will reimburse only for care provided by a certified level III home care aide.

You’re responsible for developing the aide’s care plan and supervising her activities in the patient’s home. Most agencies use a standard care plan or duty assignment sheet for this purpose that can be adapted to fit each patient’s needs.

To maintain state licensure and certification from Medicare and the Joint Commission, your agency must require the home care aide to follow the patient’s care plan and to complete a separate home care aide note or entry in the patient’s clinical record for every visit.

After you have received a referral and orders to begin home care, you need to perform a thorough assessment of the patient and his home environment to set reasonable goals and tailor the care to the patient’s specific needs. Assessments vary slightly from agency to agency, but the basic information required for completion is the same.

The proposed Conditions of Participation for Home Health Agencies requires that Medicare-certified agencies complete a comprehensive assessment of home care patients using a standardized data set called the Outcome and Assessment Information Set (OASIS). OASIS was developed specifically to measure outcomes for adults who receive home care. Using this instrument, you’ll collect data to measure changes in your patient’s health status over time. Typically, you’ll need to collect OASIS data when a patient starts home care, at the 60-day recertification point, and when the patient is discharged or transferred to another health care facility, such as a hospital or subacute care facility. (See OASIS — Be careful how you chart.)

Communication between members of the home health care team is essential when caring for a patient at home. Ideally, the team works together toward similar goals to help the patient reach the expected outcomes. Agencies accomplish interdisciplinary communication in various ways. During patient care conferences, the team discusses the patient’s care plan and any changes needed in treatment. Between these conferences, team members may communicate with one another through voice mail systems. However, the most important form of interdisciplinary communication is the agency’s interdisciplinary communication form. Surveyors place a great deal of emphasis on this form, which shows when, why, and by whom a care plan was changed. It clearly defines deviations from the original care plan. Because the information documented on this form becomes part of the legal chart, follow the guidelines for accurate documentation.