Acute illness requiring initial assessment/teaching.
Assistive device teaching, CPM use reinforcement.
Chronic illness with an exacerbation, requiring follow-up assessment/teaching to prevent further hospitalization.
Diabetic teaching/monitoring including BG monitor, insulin administration.
Foley care/replacement-catherization teaching.
Heart failure telemedicine
Infusion patient that requires teaching/assessment/monitoring when discharged to home (PICCs, Ports, Broviacs, Hickma).
Injectable medication administration/teaching (i.e. Fragmin).
Limited supports especially in elderly or frail patients.
Long-Term Home Health Care – program patients or prior to admission home care involvement.
Medication regime that is new or complex requiring follow-up teaching at home (including multiple oral meds, inhalers, nebulizers, anticoagulants).
Non-compliant patient who may need ongoing monitoring to prevent further crisis/hospitalization.
Nutrition therapies (tube feedings, TPN).
Oxygen, nebulizers, inhalers that are new, teaching or assessment needed.
Palliative care requiring symptom management (pain/nutritional/respiratory).
Rehab for change in functional status, transition to home, fall history, safety risk, or development of a maintenance program (OT, PT).
Speech Therapy for cognitive, speech or swallowing deficits.
Surgical procedures requiring assessment/monitoring/teaching.
Tube, drain or stoma requiring care and teaching.