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Key Principles of Effective Discharge Planning

Discuss about thePrinciples Of Effective Discharge Plan.

Discharge from hospital is not an isolated/solitary event, rather, it is a process. it should involve developing and implementing a plan so as to facilitate the transfer of a client from the hospital to the most appropriate setting. The client and the care givers should be involved in this process. they should be informed and updated of the care of plan regularly. The discharge plan is an ongoing process, it should start before admission, at admission for all planned admissions and as soon as all admissions have been done. For timely and effective discharge, it requires: availability of alternatives, availability of appropriate care options so as to ensure recuperation, rehabilitation, continuation of health and the social care needs can be identified and met (Sandy, 2010).

The following are the key principles in effective discharge plan; one, the unnecessary admissions should be avoided while effective discharges facilitated by the ‘whole system approach’ through assessment process, commissioning and in provision of services (Conway, 2012). Two, by engaging/ensuring that the individual and his/her care givers participates actively in provision of the care and in planning/formulating a successful discharge. Third, understanding that a discharge is a process and not solitary/isolated event so it should be planned earliest so as to ensure that the individual and the care givers get an understanding and be able to contribute to decision making for plans of care (Reid & Kennie, 2009; Maramba, Richards, Mylers, Larrabee, 2014). Four, the discharge process to be effective requires coordination by a person who has the responsibility of coordinating all the stages of the patient has taken (patient’s journey). Five, the staff should ensure that they integrate the multidisciplinary/multi-agency team so as to effectively manage the aspects of a discharge plan/ process. Six, the acute hospital capacity is used appropriately by effectively using the transitional and the intermediate care services. Lastly, there should be an assessment for and the delivery/provision of continuing health and the social care should be organized so that the individuals understand the continuum of health and the social care services, the rights they possess and receive information and advice so as to be able to formulate informed decisions for their future care (Mukotekwa & Carson, 2007).

It benefits the patients, care givers, the staff and the organization. The patient’s needs are attained, they are able to get maximum independence, they are made part of the care process, there is no unnecessary gaps, the patients are able to understand their plan of care, the experience of care becomes a coherent pathway and lastly, they feel supported and lastly, they feel like they have made the right/correct decisions about their future care. The care givers feel valued as they are involved in the discharge process, they feel like their knowledge has been considered/used appropriately, they are made aware of their rights to have their needs met, and they feel confident of being supported in care delivery. The staff benefit as they feel their professionalism is being used and recognized, they promptly receive key information, they get an understanding of their part in the system and lastly, they are able to develop new roles and skills. The organization benefits as the resources are used effectively, the services they provide to the community are valued, the staffs feel valued which in turns causes retention of the workers and improved recruitment, they meet targets and there are a few complaints (Mukotekwa & Carson, 2007).

Case Study of Kevin Johnson

The third post operation day, it is decided that Kevin should be discharged. His vitals are as follows; blood pressure 115/70 mmHg, heart rate of 90 beats/minute, respiration rate of 18 breaths/minute and an oxygen saturation of 99% in the room air. This indicates that he is vitally stable. His blood sugar is 6.4mmols. This means that the sugars are well monitored. On neurovascular observation, it is observed that the left leg is pink, warm to touch, he can wiggle the toes and he has sensation below and above the knee. The capillary refill of the toe is normal. The patient is also able to mobilize himself using crutches and on the activities of daily living, he showers with minimal assistance.

This paper will focus on effective discharge planning, its key principles, and its importance aspects in hospital avoidance. Secondly, a brief case study of Kevin Johnson, the key aspects of effective discharge plan that relates to him, and critically analyzing it. Thirdly, use the nursing process to discuss the activities of daily living that emerges or are relevant to the client Kevin during discharge. Fourthly, identify the multidisciplinary team that a nurse would include in his post discharge care stating the rationale. Lastly, a conclusion that will summarize the discussion above.

Kevin is a fifteen years old young man from the indigenous community, sustained multiple injuries which resulted from a trail bike accident. During transportation to the hospitals, his blood pressure was 130/80mmhg, heart rate 110 beats/minute, 22 breaths/minute, saturation of oxygen 98% on oxygen via a mask, Glasco Comma Scale (GCS) of 13, both limps were pink although the left limb was cold on touch and was numb. On arrival to the emergency department the blood pressure was 135/80mmHg, respiration rate 22breaths/minute, heart rate 120beat/minute, GCS 14, the left leg was warm on touch and there was sensation above and below the injury. The plan of care for Kevin is manipulation of the left leg under anesthesia as he sustained left tibia fracture and surgical washout or/and debridement or/and minus surgical closure for his right knee laceration and right thigh abrasion. After three days Kevin is ready for discharge. He gets discharged home with guidelines on continuing health and social care.

Kevin’s discharge plan, observed the first principle for effective discharge plan as mentioned earlier, “the unnecessary admissions are avoided while effective discharges are facilitated by the ‘whole system approach’ through assessment process, commissioning and in delivery of services.” Kevin’s wound will heal in the next 6-12 hours as communicated by the surgeon, although he gets discharged on the third day, as he is out of danger now and the care can be continued at home.

Nursing Process in Relation to Activities of Daily Living

Secondly, as mentioned earlier, the individual and the care givers should be involved in the discharge plan. Kevin’s aunt was informed and updated on Kevin’s care plan, that is the surgery, the duration that the wound would take, and the discharge plan. she arrived very early to take him home with her.

Thirdly, the discharge plan is effective as it demonstrates an understanding that the discharge plan is a process as Kevin is given discharge cast guidelines, the exercising instructions, a referral letter for clinical reviews by a physiotherapist, instructions to plastic outpatient clinics on wound care and suture removal, a connection with Jane, a diabetic instructor/educator, a pharmacist to dispense medication and lastly a speech pathology appointment.

Fourthly, there is coordination between different disciplines on discharge to ensure continuation of health and social care (Conway, 2012). He has sessions with an occupational therapist weekly, a consult with a physiotherapist for two days every week, a review in the plastic outpatient clinic in one week so as to change dressing and remove sutures, a review by an orthopedic in the outpatient clinic in two weeks, a review by a credentialed diabetes educator and lastly a speech pathology.

In summary, the discharge plan for Kevin was effective as it involved multi-disciplines/multi-agencies, two, it ensured that unnecessary admissions were avoided as he was discharged for alternative options of care as an outpatient in the community. Three, the individual and the care givers were at all times informed and updated of Kevin’s care plan. they participated in care delivery. Four, the discharge plan was able to demonstrate that the discharge plan is a process as it continued even at the community level. Lastly, there was continuation of health and social care as his needs were met as an out-patient (Reid & Kennie, 2009; Maramba, Richards, Mylers, Larrabee, 2014).

The major nursing process that emerges in relation to activities of daily living is the self-care deficit/inability to perform daily living activities related to immobilization/fracture as evidenced by the need to be assisted with bathing, assisted in toileting, dressing and oral hygiene (Johnson et al., 2016; Almeida, SeganFredo, Unicovsky, 2010). Kevin sustained a fracture of the tibia, his limb was manipulated under anesthesia and a cast was applied. His abrasions on the thing were debrided. The cast makes his immobile. He needs assistance to perform the activities of daily living. As mentioned above they include; oral hygiene, toileting, bathing, dressing, and feeding. Previously, before discharge the nurse in charge of Kevin was the one who performed all these roles, now after discharge the care givers will be the one responsible of this. They are expected to perform/ aid Kevin to perform these roles until he gains total independence.

Multidisciplinary Team for Post-Discharge Care

There was coordination of different disciplines so as to deliver the best care to Kevin after discharge. He was given a referral letter for clinical reviews by a physiotherapist. Kevin has a fracture on the left tibia, the left leg has a cast that passes the knee joint so as to ensure that the leg remains immobile for effective healing. He needs a physiotherapist to ensure that the other joints of the limbs still function as the physiotherapist exercises the limb at least twice a day (Burke & Coleman, 2013).  Two, he has an appointment with an occupational therapist. The occupational therapist plays a huge role in rehabilitation and recovery of the patient. he/she will be important to Kevin as he will help him in overcoming the obstacles that he faces as a result of the injury. Thirdly, instructions to plastic outpatient clinics on wound care and suture removal. This is very important as it will ensure that the wound healing process is accessed and aseptic wound care/wound dressing are observed (Reed, Pearson, Douglas, Swinburne & Wilding, 2012). Fourthly, a review by an orthopedic in the outpatient clinic in two weeks. At this point the left tibia will be filmed for an x-ray so as to assess healing process (MacKay, Davis, Mahomed & Badley, 2009). this is important in planning the Kevin’s care. Fifthly, a review by a credentialed diabetes educator (Jane) which is important as Kevin is diabetic. Diabetic condition influences healing, many patients with uncontrolled diabetic tends to develop diabetic wounds (they are chronic wounds (Falanga, 2015; Guo & DiPetro, 2010). To avoid this Jane will be of importance to ensure that Kevin sugars are controlled so as to achieve an effective healing. Sixthly, the pharmacist, who dispenses drugs; analgesics and diabetic medication for Kevin. Lastly, a speech pathology, as mentioned earlier in part one of Kevin’s care, he has a problem communicating. Ensuring that he gets helps from a speech pathologist is very important as he will improve and will be able to express himself better (Missiuna & Pollock).

Conclusion

In summary, for effective discharge plan, it is important to ensure that, the individual and the care givers are involved, there should be coordination among different disciplines, it should depict/demonstrate an understanding of the discharge plan to be a process and not an isolated event, unnecessary admissions should be avoided and lastly, the discharge plan should start prior admission. Kevin, who sustained multiple injuries, fracturing his tibia, is discharged after three days. The discharge plan is effective as it utilizes all the mentioned principles above. There multi-discipline team work. The care continues after discharge as he is given guidelines and referrals to outpatient clinics and most important he participates in his care and also his care givers are involved. On the activities of daily living, the care givers are educated so as to ensure he gets assistance until he gains independence.

References

Almeida, M.D.A., Seganfredo, D.H. and Unicovsky, M.R., (2010). Nursing outcome indicator validation for patients with orthopedic problems. Revista da Escola de Enfermagem da USP, 44(4), pp.1059-1064.

Burke, R.E. and Coleman, E.A., (2013). Interventions to decrease hospital readmissions: keys for cost-effectiveness. JAMA internal medicine, 173(8), pp.695-698

Conway, G., (2012). Effective Discharge Planning. In Short Stay Management of Acute Heart Failure (pp. 207-215). Humana Press, Totowa, NJ.

Falanga, V., (2015). Wound healing and its impairment in the diabetic foot. The Lancet, 366(9498), pp.1736-1743.

Guo, S.A. and DiPietro, L.A., (2010). Factors affecting wound healing. Journal of dental research, 89(3), pp.219-229.

Jaganathan, S.P., Conway, G. and Dunlap, S., (2017). Effective Discharge Planning. In Short Stay Management of Acute Heart Failure (pp. 233-242). Humana Press, Cham.

Jha, A.K., Orav, E.J. and Epstein, A.M., (2009). Public reporting of discharge planning and rates of readmissions. New England Journal of Medicine, 361(27), pp.2637-2645.

Johnson, M., Bulechek, G.M., Dochterman, J.M., Maas, M.L., Moorhead, S., Butcher, H., Swanson, E. and North American Nursing Diagnosis Association, (2016). NANDA, NOC, and NIC linkages: Nursing diagnoses, outcomes, & interventions. Mosby.

MacKay, C., Davis, A.M., Mahomed, N. and Badley, E.M., (2009). Expanding roles in orthopaedic care: a comparison of physiotherapist and orthopaedic surgeon recommendations for triage. Journal of evaluation in clinical practice, 15(1), pp.178-183.

Maramba, P.J., Richards, S., Myers, A.L. and Larrabee, J.H., (2014). Discharge Planning Process: Applying a Model for Evidence?based Practice. Journal of nursing care quality, 19(2), pp.123-129.

Missiuna, C. and Pollock, N., (2011). Play deprivation in children with physical disabilities: The role of the occupational therapist in preventing secondary disability. American Journal of Occupational Therapy, 45(10), pp.882-888.

Mukotekwa, C. and Carson, E., (2007). Improving the discharge planning process: a systems study. Journal of Research in Nursing, 12(6), pp.667-686.

Mulholland, S.J. and Wyss, U.P., (2011). Activities of daily living in non-Western cultures: range of motion requirements for hip and knee joint implants. International Journal of Rehabilitation Research, 24(3), pp.191-198.

Reed, J., Pearson, P., Douglas, B., Swinburne, S. and Wilding, H., (2012). Going home from hospital–an appreciative inquiry study. Health & social care in the community, 10(1), pp.36-45.

Reid, J. and Kennie, D.C., (2009). Geriatric rehabilitative care after fractures of the proximal femur: one year follow up of a randomised clinical trial. BMJ: British Medical Journal, 299(6690), p.25

Sandy, L.P., (2010). Case management in the emergency room. Professional case management, 15(2), pp.111-113.

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