Fast Forward Rounds Game board and Questions

Instructions for Running the Game • • Slide 3: the game board (use a poster company to print a large laminated copy) Slide 7: the game questions (each colored square represents one question) To open a question, click on the colored square corresponding to the location of each team’s marker on the game board. All teams start in the “HOSPITAL, ” so Team 1 should receive question 1 under “Hospital” The presentation is set up with an automatic timer allowing 1 minute for each team to provide an answer; after 1 minute the “Time’s up” sign appears If you want to bypass the timer before 1 minute is up, hit enter after the question appears. Continue to hit enter until the answer appears. To return to Slide 7, click on the house icon at the bottom of each question slide To maximize efficiency and ensure all teams get sufficient play time: – – – Use the team numbers to delineate the order of play, i. e. Team 1 goes first, Team 2 second, etc. Allow each team to answer one question before moving on to the next team. If a team gives an incorrect answer, they remain on that square and in the next round receive another question from the same content area.

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From Hospital to Home Hosted by The Fast Forward Rounds Course

Rules of the Game • The object of the game is to get from The Hospital to Home • Each team must answer a “discharge summary” question correctly to get out of The Hospital • Each colored square represents a different question category • Your team will have 1 minute to answer each question • If you get the question wrong, you must repeat that square • The 1 st team to get “Home” and answer a case question correctly wins!!!!

Official Judges • • Veronica Lo. Faso Sharda Ramsaroop Karin Ouchida Primary care resident

REHAB/ HOUSING COMPREHENSIVE CARE HOME CARE 1 1 1 2 2 3 COMMUNITY RESOURCES HOSPITAL HOME 1 1 1 2 2 3 3 3 4 4 4 5 5 5

$Name 2 reasons for a PT consult in the hospital other than a fracture.$

Name 2 reasons for a PT consult in the hospital other than a fracture. Time’s Up ! üGait evaluation üStrengthening exercises üRange of motion Row 1, Col 1

Describe 3 consequences of poor transitional care. üInadequate or no follow-up üConfusing or incorrect med regimen üInsufficient patient and/or caregiver education üPatient/caregiver dissatisfaction üIncreased health care utilization Time’s Up ! 1, 2

Name 3 examples of durable medical equipment (DME). üShower chair üGrab bar üBedside commode üCane, walker üWheelchair, chair pad, etc. üAlternating pressure mattress Time’s Up ! 1, 3

Who pays for adult day programs? A. B. C. D. Medicare Medicaid Both Medicare and Medicaid Neither Medicare nor Medicaid Time’s Up ! Answer: B 1, 4

Does your team’s discharge summary have a complete list of medications? A complete list includes: üName üDose üFrequency üDuration (if applicable) üIndication for all prn medications Time’s Up ! 1, 5

A 65 -year-old man is admitted with pneumonia and treated with 3 d of Ceftriaxone™ and azithromycin. He is going home on levofloxacin and needs to complete a 14 day course of antibiotics. What discharge instructions do you want to give him? Time’s Up ! Name of antibiotic How to take it Potential side effects Indication Duration Signs/sx to report 1, 6

Name 2 reasons for an OT consult in the hospital other than a swallowing evaluation. üADL training üCognitive training üUpper extremity range of motion üUpper extremity strengthening üSplint application Time’s Up ! 2, 1

Define medication reconciliation at the time of discharge from the hospital. The act of comparing the patient’s discharge medication list with the inpatient list and the previous home medication list Time’s Up ! 2, 2

Name 3 examples of skilled care. üSkilled nursing care Wound care Administration of IV/SQ meds Education about meds, conditions Diet instruction Time’s Up ! üPhysical therapy üOccupational therapy üSpeech and language therapy 2, 3

Name 2 functions of a senior center. üMeal site üScreening (e. g BP check) üRecreational center üSocial service agency üMental health counseling üVolunteer coordination üCommunity meeting place Time’s Up ! 2, 4

Does your team’s discharge summary have a complete and succinct hospital course? Litmus test: If you were the patient’s next provider would you have enough information to know what happened during the hospitalization? Time’s Up ! 2, 5

A 70 -year-old woman who takes ibuprofen for OA is admitted with an upper GI bleed and found to have a gastric ulcer. Her baby ASA and ibuprofen are discontinued. She will go home only on a PPI bid. What discharge instructions do you want to give her? Time’s Up ! Name of PPI Reason for PPI How to take PPI Avoid NSAIDs Warning signs/sx of GI bleed 2, 6

Who reimburses for short-term sub-acute rehabilitation in NY? (Medicare, Medicaid, Both or Neither? ) Time’s Up ! Both! 3, 1

Within 10%, what percentage of patients experiences an adverse event during the transition from hospital to home? Time’s Up ! 20%! 3, 2

Name 3 reasons why it is important to perform a functional assessment on patients in the hospital. Time’s Up ! It is a predictor of mortality It helps anticipate needs upon discharge It helps uncover deficits/limitations 3, 3

Name an inexpensive community service you could recommend to a recently hospitalized, homebound 65 -year-old patient who requires help with shopping and cooking Time’s Up ! üMeals on Wheels üShop and Escort program 3, 4

Does your team’s discharge summary have complete followup information? Time’s Up ! üName(s) of providers üContact information üAppointment date/time (ideally) 3, 5

A 65 -year-old man is admitted with his 4 th CHF exacerbation this year. He reports taking all of his meds but privately his wife tells you he often skips his diuretic when he goes to Yankee games. While at Yankee stadium he also eats hot dogs and fries. How would you: (1) assess for medication compliance and (2) give dietary instructions? Time’s Up ! üHow do you take your diuretic? üDo you ever miss doses? Why? In what settings? üWhat is your understanding of your disease? üInstructions for limiting/avoiding salt 3, 6

Name 2 services provided in an assisted living facility. üMeals in a common area üLaundry üHousekeeping üPersonal care assistance (some) üMedication management (some) Time’s Up ! *REMEMBER: NO SKILLED CARE PROVIDED! * 4, 1

Within 10%, what percentage of adverse events is related to medications? Time’s Up ! 66%! 4, 2

You perform a functional assessment and discover your patient has limited proximal range of motion in her upper extremities. Name 3 actions she may find difficult to perform. Time’s Up ! üReaching for objects üFastening her bra üCombing her hair üBrushing her teeth 4, 3

Describe 2 characteristics of a patient for whom you would recommend a personal medical alert system. üLives alone üHistory of falls or gait impairment üCardiac or pulmonary disease üUnable to use or reach phone üCognitive impairment Time’s Up ! 4, 4

Does your team’s discharge summary include relevant signs and sx the patient should report to a physician? Time’s Up ! The signs/symptoms should be relevant to the pt’s recent illness, e. g. if admitted for CHF should report increased weight, LE edema, SOB, CP etc. 4, 5

A 70 -year-old woman is admitted with new onset atrial fibrillation and started on warfarin. What discharge instructions would you give her regarding this new medication? What follow-up does she require? Time’s Up ! Reason for taking How to take it Possib drug interactions Diet instructions Warning signs/sx PT/INR monitoring 4, 6

How many hours per day does a patient need to be able to participate in restorative therapy to qualify for acute rehabilitation? Time’s Up ! THREE! 5, 1

Describe 2 ways to assess a patient’s health literacy. Ask pt to describe how to: Take a medication Perform a health-related action Adhere to a prescribed diet Ask pt to explain their disease or condition Time’s Up ! 5, 2

In which of the following patients will Medicare NOT cover home health aide services? A. Pt who requires daily dressing changes B. Pt who requires PT for strengthening exercises C. Pt who requires OT for help with daily activities D. Pt who requires speech-language therapy E. Pt who requires help with dressing and bathing Time’s Up ! Answer: E 5, 3

Name 3 health-related services offered at a medical-model adult day care program. PT OT Speech therapy Nutrition Wound care Med management Blood sugar, BP, HR monitoring Time’s Up ! 5, 4

Does your team’s discharge summary have a complete problem list? A complete problem list includes: üReason for hospitalization üComplications during hospitalization üCo-morbidities Time’s Up ! 5, 5

A 75 -year-old man with DM is admitted with cellulitis and a foot ulcer. He admits to not knowing how to follow his blood sugars at home and his Hgb A 1 c is 12. He is started on twice daily insulin injections. He completes a course of antibiotics for the cellulitis. The ulcer remains open with drainage. He now has difficulty ambulating because of pain from the ulcer and confesses he has already had two falls at home. Name 5 home care services that should be set up prior to his discharge. Time’s Up ! Wound care FSBG teaching Physical therapy Insulin admin/teaching Nutrition Home safety eval 5, 6