Discharge planning of a patient using a patient profile - Essay Example

?  Discharge planning of a patient using a patient profile Grade 13th March, Introduction Discharge from hospitals is non- standardized, and it is mainly characterized by poor quality. Discharge from hospitals is marked with complications, and in one out of five discharges, re-hospitalisation or visit to emergency unit is done within a span of 30 days. These readmissions crop up as a result of mistakes resulting from lack of proper care for the patients after discharge, or discontinuation of medication (DOH, 2005). Low health literacy being in high rates gives rise to increased rates of re-hospitalisation, especially, in urban patients, who earn low income. Lack of coordination between the in-patient and out-patient process, boosts the risk of readmission in hospitals, together with gaps in social care and supports. Primary care physicians find it hard to understand the complex process of hospitalisation, since the inpatient care is provided in the hospitals (Bortwick et al., 2009). A discharge plan is the key tool used by the primary care- providers so as to go on with the care of the patient. Therefore, a safe and comprehensive discharge plan is essential when discharging a patient, in order to aid the primary care providers and social workers in their duties. A safe discharge plan helps to reduce many potential medical mistakes, and re-hospitalisation of patients, as well as the billions of money used during readmission. A discharge plan Discharge is a vital component of care management in any aspect. It makes sure that social care and health systems remain proactive when supporting patients, their families and carers, when there is the need to go home, or move to a different setting (SPLG, 2010). Mr. Sharma, 87 years old man has been hospitalized and, due to the considerable progress he has made in recovery, he will be discharged after ten days. A safe and comprehensive discharge plan needs to be developed which will suit him, and which will ensure his recovery without re-hospitalisation. Mr. Sharma’s discharge plan is supposed to prepare the home for him, to meet all his needs, reduce the probability of readmission, as well as saving on social care services (SPLG, 2010). Putting in mind that Mr. Sharma has multiple conditions, an open wound, he is taking many drugs, and that he is an old man, the following discharge plan will best suit him. A discharge plan will help his carers after he is discharged, to coordinate services and care (Katikireddi and Cloud, 2009). This paper will address the probable problems, the interventions, and the rationale behind the decisions made. Problem The patient is an old man aged 87 years old. Outcome Being an old person, the patient requires careful and extra care since he is exceptionally delicate. Close supervision should be done always to ensure all the medical requirements are done (Lindenberg, 2010). Intervention 1. Meet with the family members and the carers of the patient, in order to discover who takes care of the patient most time, prior to discharge (Roberts, 2002). 2. Explain the need to have a person close to Mr. Sharma always, and close supervision. 3. Ensure that the patient will be kept busy and occupied. This can be through the provision of a television set or even constant company, to avoid boredom. 4. Discover if there is polypharmacy. Rationale The patient is an elderly person and hence the need to meet with the family members and the carers to enlighten them on the complications faced by old people after discharge, and the factors that can lead to readmission. According to the National Service Framework for older people, old people are likely to suffer multiple complications, unlike, young people. They can have different conditions requiring different and specific treatment (DOH, 2001). The need to meet with the family members and carers of the patient is to make them understand how to care for the old person to reduce the case of readmission. The elderly patient needs a person close to him to monitor the recovery progress. National service framework for older people spent 10 billion pounds on old people aged over 65 years old in 1998/99. Older people have more need for health and social services compared to the young people. Therefore, close monitoring is vital, to observe the development of the patient, and administer the prescriptions given to the patient. Old people need constant company to avoid boredom and depression. Depression can accelerate a patient’s condition like diabetes and hypertension, and these conditions can only lead to worsening of the patient condition, and in some cases, readmission. Polypharmacy is a case where one patient is required to take four or more than four types of drugs, and this is incredibly common in old people. It is necessary to take a close look on the elderly patient to establish all the ailments or conditions he has, in order to make sure all conditions are taken care of. National Service framework of Older people has discovered that older people get more prescriptions per person than any other group (DOS, 2001). Problem The patient is taking four medicines. Outcome The patient should take medication carefully and seriously so as to minimize the risks of complications, and aid recovery, by following the prescriptions. Intervention 1. Order medication from the pharmacy before the patient is discharged. 2. Make sure the right medication and prescriptions for each disease have been dispensed before discharge. 3. Explain the importance of medication, timing of dose, completion of the dose, and the purpose of each medicine to the carers and the patient prior to discharge. 4. Ensure the carer and the family members understand what each medicine is for, and the prescription for each. 5. Find out if there are cases of drug reaction. Rationale Ordering medication from the pharmacy before discharge ensures that, the right drugs have been prescribed with the correct prescription. This ensures that the patient does not miss any medication while awaiting discharge and the outpatient care will only continue the health care done when the patient was admitted. It also makes sure that, any case of polypharmacy is attended to. Dispensing of the right medication ensures the treatment is administered to treat the conditions present. Prescribing the wrong drugs cause secondary morbidity and drug incompatibility. These cases can lead to readmission with chronic conditions. Medication, timing of the dose and completion of the dose needs to be followed carefully and precisely to ensure completion of the treatment process. According to the National service framework report on implementing medicine- related aspects for older people, inadequate, inappropriate and excessive consumption of medicines cause illnesses (DOH, 2001). 50% of older people fall short of taking their drugs as intended. There are also cases where medicines are changed by GPs and the patients, either intentionally or unintentionally (Martens, 1998). On discharge, the patients and the carers need to understand what each medicine is for and the prescriptions in order to avoid unnecessary medical and social care mistakes (DH, 2004). This includes understanding the medicine labels. Research has it that, 25% of medicines are wrongly prescribed as ‘Take as required’ instead of ‘Take as directed’. This causes adverse drug effects especially in old people due to wrong medication, and this can lead to readmission of patients with adverse conditions (Lindenberg, 2010). Prior to discharge, the health practitioners ought to address any case of drug effects. A risk assessment should be done to provide a solution for medicine related features, mostly associated with older people (DOH, 2005). Risk assessment should be done to reduce the rates of readmission in hospitals. This is because, 5%- 17% of the patients admitted in hospitals result from adverse reactions to medication. Older people suffer the most with 6%- 17% of old patients admitted in hospitals suffering from adverse reactions to medicine (DOH, 2001). Mr. Sharma can suffer adverse drug reaction due to the fact that he is old, and is suffering from multiple conditions, and he is using four drugs. His fall is attributed to the drug effects. Problem The patient is suffering from multiple conditions; minor strokes, type two diabetes, mild Osteo- arthritis, raised blood pressure, and a wound on the leg. Outcome The patient needs close monitoring and treatment in order to contain all the conditions, prolong his life, as well as reduce readmission occurrences. Interventions 1. Ensure a risk assessment is done when prescribing drugs and understand all the conditions being suffered by the patient. 2. Determine the lifestyle and diet- controlled conditions. 3. Cross- Check the patient’s diet. 4. Explain the need to eat the right food to the patient, his carer and the family members. Rationale Risk assessment is needed in order to reduce adverse drug effects, which is, extremely common in old people. The drugs prescribed might be treating one condition while accelerating the other. Some conditions give rise to others, for example, hypertension and diabetes are risk factors for stroke. According to National Service Framework, in every year, 110, 000 people in Wales and England suffers their first stroke, and 300, 000 continue suffering further strokes. Therefore, there is a necessity to reduce the likelihood of stroke reoccurring to Mr. Sharma. Tension for prescribers is created when trying to control multiple conditions, because, there is the need to control common condition, and the need to avoid risks brought about by Polypharmacy (DOH and OPD, 2006). There is the need for a lifestyle change and promoting health promotion for the patient suffering from hypertension and diabetes. This will help reduce the reoccurrence of other conditions like stroke (DOH, 2005). Some conditions suffered by the patient are diet and lifestyle influenced like type 2 diabetes and hypertension. These conditions are critical to the physical condition of the patient, as they give rise to other conditions like stroke. Sharma has type 2 Diabetes and raised blood sugar level. Although these conditions are stable, poor diet can lead to reoccurrence of these conditions, hence, the recurrence of stroke. By understanding the lifestyle and diet influenced, conditions, the patient, carer and the family members can work towards changing the diet and lifestyle to suit the patient (Age concern, 2006). This understanding helps the carer and the family of the patient to take proper care of the patient upon discharge, and hence avoid readmission. Malnutrition especially to old people is extremely common, and it promotes diet related conditions. Eating of fruits and fresh, cooked food is also advisable and not frozen foods. Malnutrition also causes dehydration in old people (Wotton, Crannitch and Munt, 2008). Problem Falls. Outcome Great care should be taken on the patient to reduce the risks of falling, and reducing the increase of the patient’s ailments, like infliction of wounds or bone breakages. Intervention 1. Determine the causes of the fall. 2. Install rails in the places where the patient will be alone, like bathroom, toilet and the bedroom, before discharge. 3. Ensure there is partnership working and communication between the health care and social care providers. 4. Advise the carers how to prevent falls through specialised fall service. Rationale Falls cause major disabilities in human beings, and they can even lead to mortality or disability, especially to the older people aged above 75 years. According to the Department of Health (2001), England registers over 400,000 old people attending A&E Department as a result of falling. A fall might not result to injury, but it can reduce an old person’s confidence in walking for fear of falling. This fear can lead to disability and dependency, as well as isolation and depression. Partnership working between health and social carers is essential in preventing falls in old persons, as well as helping those who have fallen to resume a normal life or cope with their situation. Carers should work together to prevent falls through specialised fall service. These prevention measures including avoiding slippery floors, lighting staircases, putting on well fitting clothes, as well as installing safety equipments like rails. Preventing falls in old people will reduce disability and save lives, hence the need to establish a specialist fall service and multi-agency services for older people, who has a high risk of falling. The influence of recent health service legislation/ innovation on their care plan Forces for change There have been recent innovations and legislations in the care plan of patients especially the old. The forces behind these legislations and changes include; demography, public interest and pressure, and research. The problems in the service provision, in the past, contributed enormously to the implementation of legislations and innovations which have improved the care plan. Studies of population size and disease effects have led to implementation of legislations in order to try and curb the surging conditions like stroke, and falls. The NHS policy involves co-ordination, prevention, public involvement, clinical leadership as well as shifting and moving care nearer to home. National Service Framework sees to it that older people’s needs are also being addressed, unlike initially, when the older people were being neglected (DOH, 2001). The social care and NHS services provided in England are the leading in the world, in terms of caring for the older people. NHS provides free sight tests for people aged 60 and above, and breast screening programme has been extended to 70 years old women and above. Services supporting independence assist in avoiding unnecessary admission in hospitals, and recovery is speeded as well as rehabilitation created. Standards were set in the NSF to cater the dignity of the older people when care is being provided. Standard 4 was set to ensure that acute hospital care is provided to the old people. Standard 2 was set up to stop age discrimination in the care provision. These standards also aim at providing dignity to all people especially the old when care services are being offered to them (DOH and OPD, 2006). Research done has shown that, there is adverse drug effect commonly in old people caused by polypharmacy. This has led to doing of risk assessments during the discharge plan and prior to discharge to reduce the risks of secondary morbidity, which lead to, readmission in hospitals. Recent NHS/ social care policy initiatives The NSF and NHS aim at providing the best health and social services without discrimination and reduce the rate of patient readmission in hospitals, in England. The NSF have eight standards, which ensure that, quality and nondiscriminatory care is provided; rooting out age disparity, person- centered care, intermediate care, general hospital care, strokes, falls, mental health in old persons, and promoting a healthy and active life. The NHS together with supporting councils ensures social and health services of high quality and to all people (Department of health, 2006). The National Service frameworks and NHS guidelines requires discharge and transfer planning to be done prior to the discharge and transfer, so as to provide all the patient needs. Discharge planning is also done to reduce the likely hood of readmission in hospitals. NHS has already taken the initiative of helping old people in England to remain healthy. This is by providing free influenza immunization for people aged 65 years and above (DOH, 2001). Guidelines and policies have been initiated to ensure oral health in older people, with provision to increased dentistry access. The deaths occurring, during winter, from cold are being prevented through the ‘keep warm, keep well’ campaigns. The National Service Framework resulted from extensive consultations with aged people, the professionals involved in old people care, and their carers. It also sets a program to address the issues and problems faced when providing and delivering quality services to old people. How patients perceive NHS depends on their experiences through the system. DH (2004), identified the discharge period as one period where a difference to the quality and speed of the patients journey can be made by multi-disciplinary teams. Impacts of NHS/Social care policies on Mr. Sharma The Social care policies have made it sure that Mr. Sharma’s discharge plan is made prior to his discharge, which is in ten days. Prevention measures for falls required in the National service frameworks have been looked at. The Occupational therapist has requested for rails to be placed in the shower, bathroom and bedroom before his discharge. NHS policies requires prior plan regarding discharge to be done, in order to avoid delaying the patient’s journey in hospitals (Henwood, 2006). Delay in discharge causes boredom, loss of confidence and independence, also the misuse of NHS resources (SPLG, 2010). Decisions on discharge are made after a senior assessment of the patient since admission, then the patients and the carers are told about the discharge date (DH, 2004). Mr. Sharma’s assessment has been made since admission, his progress monitored, and a discharge date set. His family and carers have also been informed, and the transport arrangements made prior to the discharge date. Patients and carers expectations should be managed by involving them in decision making. In Mr. Sharma’s case, the carers have been involved in decision making, whereby the Occupational therapist has gone ahead and requested for rails to be put in the bedroom before discharge. The family members will be the ones to pick him up from the hospital in their car, on discharge. The Health service providers are working jointly with the social service providers and the family members. Communication in the multi- agencies and cooperation is apparent in this case. His carer from the social service, his family, the Occupation therapist, and the community Matron all work jointly to assist Mr. Sharma after he is discharged from hospital (Henwood, 2006). The patient’s choice of going back to his own apartment is respected, and a carer provided for him (Roberts, 2003). He also has his family, who does the shopping and takes him out by his family, and he is comfortable with the arrangement made. An early discharge planning has been made ten days prior to discharge, and this will help in identifying if, the patient has a complex or a simple discharge plan. It will also ensure that the patient is discharged on time, and this will reduce misappropriation of NHS funds and facilities. References Age Concern. 2006. Hungry to be heard: The scandal of malnourished older people in hospital. London: Age Concern England. Bortwick, R., Newbrooner, L., and Stuttard, L., 2009. Out of hospital: a scoping study of carers of people being discharged from hospital. London: Blackwell publishing Ltd. Department of Health., 2006. Our Health, Our Care, Our Say: a new direction for community services. London: The Stationery Office DH., 2004. Achieving timely simple discharge from hospital- a toolkit for the multi- disciplinary team. London: DH publications. DOH, OPD., 2006. A new Ambition for old Age-next steps, in implementing. London: DH publications Orderline. DOH., 2001. National service framework for older people. London: DH publications. DOH., 2005. The national service framework for long-term conditions. London: DH publications Orderline. Henwood, M., 2006. Effective partnership working: a case study of hospital discharge. The author journal compilation. London: Blackwell Publishing Ltd. Katikireddi, S. V., Cloud, G. C., 2009. Planning a patient’s discharge from hospital.BMJ 338:b246 doi:10.1136/bmj.b246. Lindenberg, J., A., 2010. Medical safety in the elderly: Translating research into practice. Clinical Scholars review, 3(1). New York: Springer publishing company. Martens, K., H., 1998. An ethnographic study of the process of medication discharge education (MDE). Journal of advanced nursing, 27, pp.341-348. Ohio: Blackwell science Ltd. Roberts, K., 2002. Exploring participation: older people on discharge from hospital. Journal of advanced nursing, 40(4), pp.413- 420. London: Blackwell science Ltd. SPLG., 2010. Ready to go. London: DH publications. Wotton, K., Crannitch. K., and Munt, R., 2008. Prevalence risk factor and strategies to prevent dehydration in older adults. A journal for Australian nursing profession, 32(1), pp.44-56. Read More