Laura Pearson

• Excellent communication skills including telephonic, in person, patient gateway, and e-mail
• Ability to assess patient condition and status telephonically and triage to the appropriate provider in a timely manner
• Assessing and prioritizing incoming patient calls or walk-ins while utilizing established protocols to determine their medical needs and directing them to appropriate care path
• Care coordination and timely post discharge calls
• Administration of immunizations and other treatments such as dressing changes, ear lavage, and medication
• Team huddle with Providers and interdisciplinary team to ensure excellent care coordination and care planning

- Acute Medical Unit consisting of 25 inpatient beds

- Provide complex, holistic, and compassionate care to patients with a wide variety of acute medical illnesses and chronic diseases

- The patient population on this unit has multi-system complexities including alterations in gas exchange, airway clearance, cardiac function, renal function, nutrition, hepatic function, and mental states and often transfer from the Medical ICU.

- Frequent physical assessment is essential to patient care with the use of EKGs, cardiac monitors, and oxygen saturation devices as aids to assessment.

- Working in a strong, teamwork oriented environment with daily collaboration with other disciplines to deliver the highest level of quality patient care.

• Provide on-going education and support to patients and/or their caregivers to enable effective self-management of their chronic illness including but not limited to: CHF, Diabetes Mellitus type 2, A-fib, COPD, Hypertension, CVA, Post-op follow up and management of various procedures, Dementia, Substance use disorders
• Excellent communication skills including telephonic, in person, and e-mail
• Ability to assess patient condition and status telephonically and triage to the appropriate provider timely
• Comprehensive case management and care coordination for a panel of high risk patients (medicare/masshealth ACO)
• Development and communication (with patient, caregiver and primary care physician/health care team) of a comprehensive care plan based on evidence-based best practice for chronic illness and diseases
• Management and coordination of all transitions in care, including post discharge follow up and education
• Communicate care plan to all providers in all settings of care (Emergency Department, hospital, rehabilitation facility, long term acute care, home care and specialist’)
• Facilitation of patient and caregiver access to community resources relevant to patient's needs, including referrals to transportation programs, Meals on Wheels, senior centers, chore services,
• Provide high-quality patient care to ensure comfort and safety.
• Collaborate with healthcare team to optimize patient treatment plans.

• Comprehensive care management and care coordination for a panel of high risk patients
• Post discharge follow up and education, care coordination
• Communicate care plan to all providers in all settings of care (Emergency Department (ED), hospital, rehabilitation facility, nursing home, home care and specialist)
• Ensure that relevant providers receive timely clinical data for care treatment decisions in all settings of care (ED, hospital, rehabilitation facility, nursing home, home care and specialty care)

• Care for patients at the end of life while supporting family through dying process
• Symptom control and management for patients nearing the end of their lives as well as providing education to the patient and/or family as to what to expect
• Individualization of care plans for each patient to meet their needs in order to achieve patient centered goals
• Collaboration with other members of the interdisciplinary team in order to provide excellent care to patients and their families

• Responsible for direct patient care of 21 patients on the acute rehab unit and 22 patients on the long-term care unit
• Responsible for the supervision and delegation of the supportive nursing staff when covering for the unit manager
• Meticulous time management skills and ability to prioritize care based on patients’ medical conditions and needs
• Provide nursing care and education to post-op patients
• Administration of PO and IV medications/fluids/antibiotics
• Care of PICC and central lines, JP drains and wound vacs