Class 8 Flashcards
according to Goldman, administrators and HCP are focused on…
- minimizing pt LOS and reducing readmissions
according to Goldman, what is pt flow***
- a process which aims to optimize bed availability, minimize ED wait times, and reduce costs
according to Goldman, what kind of position do physicians occupy in healthcare?
- a dominant position which affords them autonomy over their own work and the work of other clinical groups
according to Goldman, in the division of healthcare labor & discharge, physicians are responsible for… (3)
- discharge (however decision making about discharge should occur in collaboration with the IPC team)
- medical discharge
- med reconciliation (in collab w pharmacist)
according to Goldman, in the division of healthcare labor & discharge, pharmacists are responsible for… how do they prioritize pts?
- med reconciliation
- prioritize pts r/t workload
according to Goldman, in the division of healthcare labor & discharge, social work, PT, and OT are responsible for (2)
- social & functional discharge
- PT & OT performed physical and cognitive assessments r/t readiness for discharge
according to Goldman, describe the nurse manager’s role in discharge (2)
- less involved in individual discharges and more the status of the unit as a whole, represents bedside nurses during morning rounds
- worked at a higher lvl to ensure metrics were met
according to Goldman, describe bedside nurse’s role in discharge issues
- encouraged to speak directly to MD regarding discharge issues, less likely to be listened to than other allied health disciplines
according to Goldman, what challenges do bedside nurses face within their responsibilities w discharge (4)
challenges as they:
- take on the majority of time-consuming pt care
- reducing their availability to mesh w the IPC team
- participate in IPC decision making regarding discharge
according to Goldman, rounds are designed for… they are often _____ and may exclude ____
- designed for efficient pt discharge
- they are often rushed
- may exclude nursing
according to Goldman, what are referrals ? they should be …. (2)
- required to activate services of OT, PT, other IPC team members
- should be appropriate and timely
according to Goldman, what are routine interactions
- informal interaction resulting from run ins w IPC team members on the ward
according to Goldman, competing priorities are often…
- poorly communicated between physicians and nurses
according to Goldman, physicians feel pressured to….
- address organizational expectations regarding pt flow
according to Goldman, implementation of EPR has been shown to…
- decrease face-to-face IPC communication and workmen overall agreement regarding plan of care
according to Goldman, why might nurses be unable to attend rounds
- may be unable to leave pts for the duration of pt rounds
according to Matmari, the primary method of coordinating discharge planning is…
- verbal communication during daily rounds
according to Matmari, which methods of communication related to discharge planning are less common (2)?
- electronic communication
- phone referals
according to Matmari, which IPC members are most involved in discharge planning? (5)
- PT
- OT
- social work
- charge nurses
- physician
according to Matmari, what guides discharhe planning?
- hospital policies
according to Matmari, what is Alternate Lvl Care (ACL) ***
- place to send pts who are medically stable
- hospital days shall be designated as ACL when pt is medically stable and has finished the acute, chronic, mental health, or rehab phase of their treatment, but remains in that setting for more than 24 hrs
who can authorize ALC designation? ***
- any professional staff member who is assigned to the service/unit and has been trained on the theory and application of ALC
according to Matmari, discharge planning should begin when??
- the day of admission
according to Matmari, what factors are involved in discharge (5)
- internal
- external
- mobility
- discharge destination
- family supports
according to Matmari, what is an example of an internal factor involved in discharge
- pressure to reduce the pt LOS (facilitator of rapid discharge)
according to Matmari, what are examples of external factors involved in discharge (3)
- lack of resources
- availability of PCH beds
- unrealistic pt or family expectations on availability and type of post-discharge support (barrier to rapid discharge)
according to Matmari, what is the most important aspect of discharge planning
- communication between IPC members
according to Matmari, ideal dc planning requires…
- a highly functional team that uses IPC practice and effective communication strategies to ensure the pt is safe and ready to be discharged to the appropriate destination
according to Matmari, ideal dc planning should be driven by??
- not be hospital policy but informed by pt condition
according to Matmari, ideal dc planning involves the team working w…
- pt/family to ensure awareness and understanding of dc plan & date
according to Matmari, with ideal dc planning the pt and family should receive?
- sufficient education to feel prepared and confident
according to Matmari, with ideal dc planning all services/equipment required should be _____ before dc
arranged
according to Matmari, on average how many HCP are involved in dc planning?
- 8 or more HCP
according to Matmari, what are 2 essential components of dc planning? ***
- IPC and communication
according to Matmari, what are barriers to communication (3)
- informal communication
- lack of clarity
- lack of timely communication
according to Matmari, describe communication with the family & pt (5)
- timely
- clear
- transparent
- they should know pt status, plans, and potential discharge date
- should allow for adequate time to ask questions and receive answers prior to discharge
according to Matmari, what communication strategy should be used for IPC discussions (2)
- IPC discussions should not be left up to chance meetings w team members
- specific team meeting should be organized to discuss pt with all members of the IPC team present
see document on guidelines for discharge planning for first nations pts returning to home community for palliative care ***
…
manitoba’s population growth rates vary by region with higher rates in… (2)
- winnipeg
- southern region
44% of manitoba’s population is
rural
manitoba has the highest ______ population of any province in canada
- Indigenous )18%)
the largest population growth is projected to occur within which age cohorts?
- the 80+ and 60-70 year old cohorts
literature refers to negotiations amongst members of different IP teams as an individual’s ability to…
- argue and make alliance
what barriers might nursing experience r/t their ability to argue and make alliances?
- limited in nurses as they are so busy they often can’t fully interact with the IPC team
according to Goldman, what role does the pt care coordinator have in discharge planning?
- attended rounds
- presented bedside nurses’ concerns
according to Goldman, what role do charge nurses have in discharge planning
- attended rounds and presented besides nurses’ concerns
when does discharge planning start and what does it consider?
- when you are admitted –> consider barriers, get referalls started asap
- considers your needs after your hospital stay
according to Goldman et al., the planning and implementation of pt discharge is therefore a…
- a complex process involving multiple HCP, driven by a range of & possible competing, health, political, and economic factors
describe how competing health, political, and economic factors impact discharge planning
- politics & economics impact funding for hospitals & bed availability –> health competes w this as we may need to discharge sooner than avisable to open up hospital beds
according to Goldman et al., discharge planning in general internal medicine is…
- particularly complex, given then multifacted and challenging nature of patient’s health and social care needs, and the varied discharge destinations of this pt group
what is Jordan’s principle
- involves care & funding for Northern communities
- stems from a situation where a palliative care pt was not allowed to return to home community up North as there was dispute over whether his care would be funded federally or provincially
according to Goldman et al., describe physicians view of the importance of teamwork to discharge, their ability to function within a team, and what this contributed to?
- viewed teamwork as important to discharge but did not necessarily know how to lead or function effectively within a team, which in term was described as contributing to experienced conflict & inefficiency
describe Goldman’s findings about the importance of biomedical vs psychological needs during discharge
- biomedical is viewed as more important
ex. if INR too low the nurse could say the pt cant be discharged and that would be accepted. however, if the nurse felt that the pt can’t cope at home, that may not be accepted
why is discharge planning considered a complex event and major priority in hospitals?
- pt flow is essential to keep acute care beds open for when they are needed
to be effective, discharge planning must…
- prepare the pt for dc but also assess the pt’s ability to function outside of the hospital setting
ideal discharge planning process requireds… ***
- a highly functional IP team that demonstrates effective communication to ensure that the pt is safe and ready to be discharge
the HCT must work with ________ to ensure discharge plan & date
- pts and their families
what is meant by a pt’s medical readiness for discharge? social?
- medical = health issues resolved
- social = supports, etc.
on an IP healthcare team, who is “in charge” of pt discharge?
varies based on context
- if barrier is discharge orders = physicians
- if barrier is accomodation of mobility needs, OT is in charge
what is pt flow ***
- the smooth and seamless mvmt of pts to ensure they receive the right care in the right place at the right time
what is the impact that dc process has on the pt flow within an acute care setting? ***
- tremendous –> keeping pt flow mvmt helps open beds for people who need it, allows people to receive care tailored to their needs
what are some consequences of impaired pt flow (2) ***
- pts in hallways
- long wait times
what are the 3 R’s of pt flow ***
- right care
- right place
- right time
why improve pt flow? (4) ***
- access to care for more pts
- access to the right type of care
- less exposure to hazards of hospitalization (ex. nosocomial infection, loss of mobility, psychological harm d/t separation from family/community)
- allows for best setting for convalescence
what is the best setting for convalescence (recovery)?
- home –> due to love and support from family, comfortable enviro, food you’ll eat, etc.
what impact does COVID have on pt flow (4)
- limitations on admitting facilities/wards based on COVID status
- constantly changing situation
- capacity and staffing issues
- pt and family involvement
what are examples of complex dc planning considerations (5)
- labs & diagnostic results have been received
- consultation completed w approp documentation
- if consultations have not been completed, can they safely be performed on an outpt basis
- date/time and location of appts and/or contact info of outpt clinics and allied health consultants
- pt must be able to safely manage at home either on their own or w identified assistance that is readily available for them (ex. ADLs)
what is the WRHA home care mandate? ***
- to provide effective, reliable and responsible community health care services to support independent living, develop approp care options w clients and/or family and facilitate admission into long-term care facilities when living in the community is no longer possible
home care services include… (7) ***
- personal care
- nursing
- household assistance
- respite/family relief
- OT & PT assessment
- referal to other agencies such as mental health, meals on wheels
- assessment for long-term care and specialty services
what are 3 tools for IP dc planning
- daily or weekly rounds
- bullet rounds
- communication boards
what are bullet rounds
- take place daily on units & involve a multi-disciplinary team involved in the care of the pt
- designed to discuss the pt’s case w the entire care team and identify any challenges the pt may be having & plans for dc
daily or weekly rounds include… (2)
- dc rounds
- teaching rounds
what is the impact of increased use of technology on face-to-face interactions during discharge process (4)
- more opportunities for miscommunication
- impacts timeliness of communication
- greater risk for written communication being ignored
- PHIA consideration
successful dc planning = (4)
- lower risk of re-admission
- high lvl of communication between the acute care setting & the community
- working in partnership w pts and families ensuring they understand the dc plan
- highly functional team that uses IPC practices & effective communication
what are pt related barriers to dc planning (6)
- medical complexity
- lack of family supports
- housing
- geography or home community
- financial concerns
- equipment needs
what needs to be considered prior to dcing a pt to a First Nations/remote community? (3)
- availability of meds –> may need to send them w a large stock
- medical transport needs
- need to notify receiving facility –> ex. nursing station
what are some strategies to transform our language? (8)
- “do you need help w this task?” –> dont accept “not rlly”, ask if need help w some elements, break down into sub-tasks
- “do you think you can follow the plan?”
- “what would help you or not?”
- “are comfortable talking to agency staff?”
- facilitate informed decision making
- use non-judgemental language (no “why”)
- elicit pt narrative
- ask if there is something that makes it difficult to participate in adherence to plan? what parts they succeed in vs are challenges?
see slides and document on dc to remote communities, not rlly sure how break it up into flashcards ***
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