Discharging Patients Flashcards
discharging requirements?
often job of VN
should be familiar with routine procedures and their associated discharge requirements
- what had done
- what need to go home with
- when should next come back
protocols will vary between practice and may slightly between patients
planning discharge? what is consider?
if a discharge to referral
- need to call referral practice to hand over
- give directions to patient?
condition of patient
- fit to go home
- fully recovered from anesthetics
home circumstances
- can’t be using stairs/jumping on furniture
transportation home
- discuss with owner
owners capability of carrying out necessary aftercare
- write down instructions clearly
- make sure understand quickly - “it is protocol t repeat”
- consider difficulties (eg. sight/hearing)
transporting home?
not all owners have their own transport
- need to call in advance/ arrange pick up day so can make arrangements
- taxis may not accept pets
need to consider transport type
- mare and foal will need more space but post op fracture will need little space
- cats and small mammals need carrier
- dogs need lead nd collar
consider previous travel experience
- used to it?
- likely to panic?
- sedation needed?
discharge step 1?
confirm with vet if patient is ready to leave
establish who will be discharging
- sometimes vet will want to speak to owner
- but often vet who has been looking after all day
ensure correct patient
- use collar/labels
- name on kennel/stable
- include any possessions
ensure patient is clean and tidy with all catheters removed
- no blood around wound
- brush shampoo out
- if not letting you, let owner know. must acknowledge attempt
check all wounds
- not bleeding/discharging
- check all stitches in place
check an bandages are clean, secure and dry
- may need to redress
check all extras are done
discharge step 2?
check patients records
- ensure billing is up to date
- receptionists wont know what in for unless recorded
ensure discharge form is ready/correct
- plus any extra forms/information sheets (eg bandage care or referral forms)
ensure patient belongings are collected and ready
check correct strength and mount of medications has ben prepared
- don’t assume something by kennel is correct
ensure food, buster collars, bandage bag (equine) are ready if needed
discharge step 3?
take client to quiet/consult room for privacy
explain procedure (everything involved an extras) and any aftercare to client
- good time to go through invoice to stop disrepute
- bring in printed copy aware of what it includes
ensure client understanding
- use written information (eg discharge forms and drug charts)
- talk through drugs - when, how, amount - demos are good (you and them)
ensure all client questions are answered
explaining procedure?
state procedure
- eg. routine spay under general anesthetic
- eg. emergency colic surgery to correct a 360° colon torsion under general anesthetic
confirm any extra procedures performed
explain any medication given
- amount and when
- explain when next and how to administer
- explain taken fine - ease owner
explain how patient is recovering
- awake?
- toileting well?
general aftercare?
first evening/day requirements once home?
- keep warm
- small but frequent meals
general monitoring necessary for few days
- explain what owner needs to be monitoring
- often demeanor
general after care?
medications?
explain medications
- when should be taken - write on box
ensure happy and capable to administer
- demonstration both ways
explain any precautions
- eg. PPE
- eg risks for pregnant women
need clear dispensing label
general after care?
wound management?
explain what to expect and what to look for
- show where it is
- explain that it is healing nicely
explain importance of preventing interference
- responsible for any additional costs
provide bandage care if relevant
- how and when to change/remove
- not case for SA
general after care?
returning to exercise?
ensure owner understands plan and is capable of adhering to it
physiotherapy? why?
gently moving limb in its full capacity
- my need to demonstrate basics to owner
improves range of motion
maintains muscle tone
improves muscle strength
rehabilitates normal gait pattern
controlled exercise program to regular performance
discharge step 4?
book follow up appointment
- do with them in consult
ensure client has all practice contact details including OOH provisions
send to reception to pay
then bring patient through/the owner through to yard to collect horse
- so all focus has been on information given and payment nd not on seeing pet again
payment?
types?
check practice policy - certain payment types not allowed itemised bill should be available once payment is processed, record it provide receipt - must have price, TAX/VAT, and practice info
cash - check it
cheques - signature must be same as guarantee card
debit/credit cards
standing order - fixed amount transferred by client
direct debits - amount paid can be altered by practice
post-op care for neutered dogs
process?
bitch spay - removal of womb and ovaries
castration - removal of testicles
post-op care for neutered dogs
diet?
note if already given some
- eat it or not?
- how much?
advice reduced portion that evening, little and often
- due to increased risk of vomiting caused by anesthesia - monitor
- bland/gastrointestinal food (eg boiled chicken and rice)
monitor appetite
- not eat at all = issue
- eating a little= fine
- should be to normal next day
bowel movements may be reduced 24-36hrs after
- urination should be fine
