Discharge and Planning (Final) Flashcards
Who authorizes discharge planning?
The Dr. but if the nurse doesn’t think someone is safe to go home they should speak up
Make sure what before discharge
Appointment and plans are in place for patients to come back
Collaborate with social work and other teams
Why is discharge planning so important?
-Lots of changes like medications, health treatment, majory surgery or diagnosis, wounds and equipment
-Improves health outcomes
-Decreases readmission
Poor discharge planning can lead to
-Medication management
-Health decline
-Safety issues/concerns
-Result in readmission to hospital
What is important to consider when discharge planning?
-Enough time to teach and return demonstration?
-Assistance/help at home. 24 hrs/day versus minimal
-Learner type (verbal, written, hands on etc)
-Need caregiver at bedside to hear discharge instructions
What make discharge planning difficult?
-Healthcare issues
-Lack of time
-Trying to get patient out quickly due to demand of room
-Family hesitancy to go home
-Social issues / transportation
Appropriateness for discharge
-Is patient ready for discharge
-Do they have a place to go?
-Do we have a safe discharge plan?
-If patient or caregiver feels like it is too early, you can appeal.
Determining Post-Discharge Site of Care
-Home
-Home with HH (IV antibotics) (Come in once a day)
-Skilled nursing facility (ADLS) (COOK) (HYGEINE)
-Inpatient versus outpatient rehab (Different Injuries) (Need to be taught how to in and out cath)
-Long term acute care facility (24 hr care for patients who need it) (Where I do not want to work lol)
Discharge Planning: Medication Reconciliation
-Review home medications
-Review hospital medications
-Anticipate new medications. (Clinical application) (Teach them about them)
-How are they going to obtain medications? (Insurance or not?) (Co-pay?)
Discharge Plannning: Diagnoses
-Give a breif description of the diagnosis
-How did we treat it in the hospital
-Special requirements/reccommednations
-When to call HCP vs when to go to nearest ED
Discharge Planning: Procedure / Surgery
-Give brief description of procedure or surgery
-Home care
-Follow up care
-When to seek medial attention vs ER
Discharge Planning: Diet
-What diet? - not just the name, they need specifics
-What foods are good / bad?
-Consult dietician
-Plan a grocery list
-Talk through favorite foods - do they need to modify?
Discharge Planning: Activity
- What can / cant they do?
-New mobility issues?
-Need DME (Medical Equipment
-House layout. Stairs. Bedroom
Discharge Planning: Case management / Social Services
-Need any durable medical equipment (DME)
-Home Health (Skilled nursing) (Wound Care) (AIDE) (PT OT SLP)
-Financial assistance with medications?
-Home life - running water, electricity, etc.
Discharge Planning: Follow up Appointments
-Follow up with HCP within 1 week
-Follow up specialty (Live far from main office, maybe satelite or tele health)
-Who should they contact give phone numbers
-Do they have transportation to and from
