Home Glycemic Control and Monitoring if diabetic BS and A1C are within recommended range per responsible physician or NP Use of glucose log book (Diabetes Passport) Adequate insulin supplies Glucometer and required supplies Assess for barriers in monitoring glycemic control Patient’s nutritional status optimized Calculate Body Mass Index (BMI) Determine recent weight loss/gain Complete Mini Nutritional Assessment (MNA) If screening section results < 11 = complete assessment section If assessment section results< 24 = Registered Dietician referral required Recent dietary consult Identify barriers or risk factors to healthy eating Link to EatRight Ontario to talk to dietician 1-877-510-5102 Patient and caregiver concerns and goals integrated into Review for changes: the care plan and shared with care team Cardiff Wound Impact Questionnaire OR World Health Organization Quality of Life (WHOQOL) form Ensure all patient/caregiver goals and concerns been addressed Patient counselled on the benefit of activity and rest for Recent changes in overall activity level Pressure relief device &/or redistribution comfort measures and wound healing Daily routine including continence Assess barriers to sleeping in bed concerns and/or access to bathroom Assess mobility and dexterity aids currently Personal assistance available to perform being used (bedrail, superpole, trapezebar, activities of daily living airbed) Determine where patient sleeps at night Recommendations for exercise and sits during day Consider Occupational Therapist referral for Safety of transfers pressure relief device Patient/caregiver educational plan continued Rest/Activity Dietary Turning and sitting schedule for Dietary requirements as per dietician Blood repositioning glucose testing and recording in diary Pillow between knees Link to EatRight Ontario to talk to dietician Safety 1-877-510-5102 Diagnostic Tests Prevention of injury – friction, shearing Results understood by patient When to call primary caregiver (eg. signs and symptoms of infection, deep vein Diagnostic testing (nutritional blood work and thrombosis, cellulitis, impaired blood flow, cholesterol levels) difficulties with compression) If diabetic, target ranges for A1C and blood Pressure Relief/redistribution surface sugar Skin Care Offloading is required ‘for life’ Wound self care Understands need of debridement Holistic self care of skin Encourage appropriate footwear to be Incontinence and prevention/treatment of
Home Glycemic Control and Monitoring if diabetic BS and A1C are within recommended range per responsible physician or NP Use of glucose log book (Diabetes Passport) Adequate insulin supplies Glucometer and required supplies Assess for barriers in monitoring glycemic control Patient’s nutritional status optimized Calculate Body Mass Index (BMI) Determine recent weight loss/gain Complete Mini Nutritional Assessment (MNA) If screening section results < 11 = complete assessment section If assessment section results< 24 = Registered Dietician referral required Recent dietary consult Identify barriers or risk factors to healthy eating Link to EatRight Ontario to talk to dietician 1-877-510-5102 Patient and caregiver concerns and goals integrated into the care plan and shared with care team Review for changes: Cardiff Wound Impact Questionnaire OR World Health Organization Quality of Life (WHOQOL) form Ensure all patient/caregiver goals and concerns been addressed Patient counselled on the benefit of activity and rest for comfort measures and wound healing Recent changes in overall activity level Daily routine including continence concerns and/or access to bathroom Personal assistance available to perform activities of daily living Determine where patient sleeps at night and sits during day Safety of transfers Pressure relief device &/or redistribution Assess barriers to sleeping in bed Assess mobility and dexterity aids currently being used (bedrail, superpole, trapezebar, airbed) Recommendations for exercise Consider Occupational Therapist referral for pressure relief device Patient/caregiver educational plan continued Rest/Activity Turning and sitting schedule for repositioning Pillow between knees Safety Prevention of injury – friction, shearing When to call primary caregiver (eg. signs and symptoms of infection, deep vein thrombosis, cellulitis, impaired blood flow, difficulties with compression) Pressure Relief/redistribution surface Offloading is required ‘for life’ Understands need of debridement Encourage appropriate footwear to be Dietary Dietary requirements as per dietician Blood glucose testing and recording in diary Link to EatRight Ontario to talk to dietician 1-877-510-5102 Diagnostic Tests Results understood by patient Diagnostic testing (nutritional blood work and cholesterol levels) If diabetic, target ranges for A1C and blood sugar Skin Care Wound self care Holistic self care of skin Incontinence and prevention/treatment of