Discharge planning Flashcards
who is apart of the interdisciplinary team
Nursing, family and friends, case manager, MD, discharge planner, healing and spiritual services, OT, PT, infectious disease team
what do we need the help from for a safe discharge?
the whole interdisciplinary team
Skilled services
the skills of a therapist are necessary to provide safe and effective interventions whose goal is to improve in impairments of functional limitations
example of skilled PT
- ther ex
- sit to stand or other transfers
- assistive device training
non skilled services
services that can be safely and effectively provided by non-skilled personnel family member/caregiver without the supervision of therapist such as maintenance or restorative services
examples of non-skilled services
- use of a hoyer lift for bed transfers
- assisting pts with personal hygiene
- completing ADLs with safe level of assist that is recommended by therapist unless pt is completely independent
key elements for examination
- examination
- evaluation
- DX
- PX
- innervention
- outcomes
- discharge planning process
- reassessment
ADLs examples
- eating
- bathing
- grooming
- dressing
- bed mobility
- transfers
Instrumental activities of daily living
- cooking
- shopping
- housekeeping
- balancing a checkbook
- driving a car
- ability to use public transportation
who do you take information from in discharge planning
- structural impairments, activity limitations, participation restriction
- pt ability and willingness to participate
- familys wants and needs
- discharge worker and social support network
what areas do you funnel discharge planning through
- prognosis for recovery
- insurance constraints
- therapist experience
home health care
given to a patient who is expected to reach an acceptable level of recovery who is returning home after discharge and going to appointments is a hardship so they need someone to come to their home
home health professionals
- PT
- OT
- Nursing
- SLP
examples of skilled home health services
- wound care
- pt and caregiver education
- injections
- IV or nutrition therapy
length of time of home health
depends on dx, px, need and practitioner recommendation. PT can be 2-3 times a week for 4-6 hrs.
SNF
high level of medical care that is need from health professionals. Services are necessary for short term rehab from an illness or injury or long term for pts who need high-level of care on a constant basis due to a chronic medical condition
- NOT INTENSIVE THERAPY
national length of stay in a SNF
28 days
how many therapy sessions does a pt receive in SNF?
- can receive 1+ therapy a day (PT, OT, speech)
- therapy lasts 1-2 hrs total and it is not considered skilled therapy
Sub acute is for people who need treatment that involves
- intensive wound care
- IV treatment
- GI tube issues
- Major, long lasting stroke issues
- any malnutrition or eating disorder issues
- any critical illness
sub acute is less intensive therapy that includes the following
- therapy less then 2 hours a day
- frequent meetings with pt, family, and care team
- focus on regaining strength, mobility, and long-term functionality over the course of therapy
- returning pts to their normal, daily activities with the highest level of strength and functionally possible
inpatient rehab/ acute rehab
- for pt who will benefit from an intensive multidisciplinary rehabilitation program
- receive PT, OT, and speech as needed
- average of the stay is 16 days
- pt will receive a minimum of 3 hours per day of therapy 5 days a week
Long term Acute Care (LTAC)
- hospital specializing in treating pts requiring extended hospitalization
- stay is longer then 25 days
- for pts with prolonged medical ventilation
- can be within the hospital or it can be a separate standing building.
our job with discharging as a pt
- make recommendations based on pts safety
- if pt does no have the ability to care for themselves or someone to care for them at home it is best if they go to sub-acute, SNF, or inpatient rehab
