Visit 1

General Assessment of Patient

Objectives:

  1. Demonstrate interprofessional professionalism in interacting with assigned patient and team.
  2. Re-establish rapport with the team and establish rapport with assigned patient.
  3. Take a health history including chronic diseases and family history.
  4. Take patient's vital signs; get list of medications.
  5. Identify/describe patient's current wellness strategies (nutrition, exercise, safety practices, etc.).
  6. Assess patient's access to needed acute, chronic, and/or preventive care (financial, transportation, language barriers, etc.).
  7. Assess patient's level of independence--frailty, muscle strength, nutrition, advance planning and fall risk).
  8. Introduce home safety checklist; ask patient to complete for Visit 2.
  9. In Google Drive, prepare report for Visit 1 review session and complete reflection prompts.
  10. Prepare for Visit 2.

Activities:

  1. Review materials and guide; work with team to prepare for Visit 1.
  2. Complete Visit 1 with elder.
  3. As a team, prepare a patient presentation report for the review session.
  4. Locate community resources appropriate to meeting the patient's needs.
  5. Be prepared to share what you found with your patient at Visit 2.

Guide for Visit 1:

  1. Introduce your team, role and purpose.
  2. Ask about past medical history.
  3. Ask about current medications and the reason they're prescribed.
  4. Assess patient's vital signs, heart and lung sounds, distal pulses, etc. Record.
  5. Ask patient what they do to stay healthy (nutrition, exercise, safety, etc.). Reinforce healthy behaviors.
  6. Ask about patient's use of community resources, including possible resources the patient needs, but has not located.
  7. With your patient, assess his/her:
    • RGA--Rapid Geriatric Assessment -- Use the sub-scales to assess Frailty, Muscle Strength, Nutrition, and Advance Planning (omit the RGA Rapid Cognitive Screen for now)
    • Falls Risk Assessment - Use CDC Stay Independent Checklist
    • Explain Home Safety Checklist. Ask patient to complete in preparation for Visit 2.
  8. FOLLOW UP the 3 RGA sub-scales as appropriate using
    • Nutrition - Use nutrition screen
    • Level of Independence - Use Katz ADL or Lawton-Brody IADL tool as appropriate
    • Health Literacy - Use 3 Question Screen to assess patient's comfort level with printed medical information. Follow up with Newest Vital Sign tool as appropriate
  9. Close this visit with an overview of next visit.

Tools:

  • RGA: Rapid Geriatric Assessment (Two-ply self-copying form to be distributed at orientation; video review available at https://www.youtube.com/watch?v=z79-UQvTOXs&t=139s )
  • CDC Stay Independent Checklist
  • Home Safety Checklist (BrightStar)
  • Nutrition Screen
  • Katz Activities of Daily Living or Lawton Brody Independent Activities of Daily Living as appropriate
  • Health Literacy - 3 Question Screen and/or Newest Vital Sign Tool as appropriate
  • Advance planning guide booklet