Domain | Level I | Level II | Level III |
Skin | | - High risk for/mild breakdown
- Dressing changes 2-3x/day
- Frequent turns
| - Major skin ulcerations/wounds
- Dressing changes 3+/day
|
Airway | | - Occasional or positional stridor
- CPT, vest, cough assist, IPV BID
- Intermittent O2, BIPAP/CPAP
- Trach without vent dependence
| - Airway clearance >2x/day
- Continuous O2 or mostly BIPAP/CPAP dependent
- Need for bagging ( trach, apnea)
- Vent dependence
|
Elimination | | - Daily cathing
- Single ostomy
| - Daily venting
- Indwelling cath
- Multiple ostomies
|
Behavioral | - No issues
- Intermittent agitation
| - Impaired cognition, vision or hearing
- Self injury from aggressive behavior
| - Severe agitation, requires 2 caregivers for procedures
- Attempts to strike staff, pulls out tubes
- Awake q2h
|
Feeding | - No issues
- Requires monitoring during PO feeds
- Bolus GB <4x/day
| - Bolus GB>4x/day
- Continuous GB feeds
- Difficult or prolonged PO feeds
| - Central line with TPN, lipids, or both
|
Medications | | - Multiple medications (>6/day or frequent prns)
- IM injections
| - PICC or portacath
- CVAD with meds or infusion therapy
- Blood draws; IV site dressing changes
|
Seizures | - No issues
- Seizure in past year
| - Frequent seizures without need for rescue
- Seizure rescue with meds or VNS<1x/month
| - Seizure rescue with meds or VNS>1x/month
- Complex seizure requiring airway monitoring/support
|
Complex vitals | | - BP monitoring
- Strict ins/outs
| |
Activity | | | - 2 person transfer, stander, Hoyer lift use
- Attends school
|
Assessment | | | |
RN case management | | - >4h/week phone intervention
| - >6h/week phone
- Onsite 1x/month +
|
Suggested hours/week | 20 | 40-84 | 96-144 |