650 Topic 15 DQ 1

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School

Grand Canyon University *

*We aren’t endorsed by this school

Course

650

Subject

Medicine

Date

Oct 30, 2023

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docx

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Uploaded by PresidentKouprey3370

Topic 15 DQ 1: Respond to one of the questions below and support your answer with a minimum of two APRN peer-reviewed resources. 1. Present a case from your practice in which there were barriers to discharge. What were these issues? Include financial considerations. How were they resolved? How could they have been prevented? Was the patient at risk of readmission and what measures did you take to prevent readmission? 2. What does the literature tell us about "safe" patient discharges and the financial implications of suboptimal discharge planning? What are the most common causes of adverse events after discharge? What can you as a nurse practitioner do to provide the safest discharge possible? 1. Present a case from your practice in which there were barriers to discharge. What were these issues? Include financial considerations. How were they resolved? How could they have been prevented? Was the patient at risk of readmission, and what measures did you take to prevent readmission? A 49-year-old female Hispanic was admitted for chest discomfort, headaches, nausea, and vomiting. She had a medical history of a brain tumor that she had surgically removed in August 2023, leaving her with left-sided weakness, facial droop, and slurred speech. Post-acute, she was discharged to a skilled nursing facility (SNF) for rehabilitation. Based on her understanding, her rehab sessions should be 3 to 4 hours daily for four weeks. She informed me that the physical therapy team did not work with her the first week until she started complaining, and then, they only worked 8 hours total for the whole week with her. She was on bed rest most of the time, got upset, and went home against medical advice (AMA). She was home for two weeks and then went to the emergency room for chest pain and SOB. She was diagnosed with pulmonary embolism in the lung and DVT in the left leg. Once stabilized, the provider discharged her to a different SNF and placed her on Coumadin. She said she liked this facility this time and did two weeks of rehab, then discharged home. She stated the therapists were great; she got stronger and could ambulate with a cane. On this admission, the head CT showed that she had a minor hemorrhage stroke. The neurologist was consulted, but no intervention was needed due to the repeat CT results that it is stable and no changes. She was cleared to resume Coumadin as prophylaxis for DVTs, and he is signing off her case. The patient asked me when she could be discharged home. I noticed that she was anxious and scared. Then she started to cry and informed me that she needed to be discharged home today or she would go AMA. Her husband had called earlier and told her he was planning on taking her to court for the custody of the kids due to her health status and inability to care for her two children. I related the patient’s situation and updated the hospitalist. The hospitalist assured me that the neurologist had cleared the

patient, so she would be discharging the patient home today. An hour later, the hospitalist messaged me that she could not discharge the patient home because the earliest home health visit for the Coumadin lab draw was Tuesday, which meant the patient had to spend two more nights in the hospital. I contacted the case manager by explaining the patient’s situation and asking for assistance. She responded immediately, and an hour later, she informed me that private home health could be scheduled for a patient visit as early as Monday. I got a discharge order, an arrangement for HH, discharge instructions, and education provided. The prescription was sent to her pharmacy, and transportation was arranged. The patient was so thankful and tears of joy as she was being discharged home to her children and family. Hospital discharge is a critically important care transition. Due to the complexity and potential for errors inherent in the discharge process, this care transition remains an area of focus for many patient safety organizations, regulatory agencies, and quality improvement initiatives. The discharge transition represents a vulnerable time for patients for several reasons (McKean et al., 2016) and can be very stressful for the patient, especially in this case scenario. As healthcare providers, we must listen to the patient’s needs and use our resources to accommodate the patient. Most importantly, remember that safety and quality are two of the central dimensions of health care (Kasper et al., 2018). Discharge planning should be initiated as soon as the patient is admitted. Additionally, effective communication is critical to a smooth discharge transition and involves other disciplinary teams collaborating for the best patient outcomes. References: Kasper, D. L., Fauci, A. S., Hauser, S. L., Longo, D. L., Jameson, J. L., & Loscalzo, J. (2018). Harrison's principles of internal medicine 20/e (vol.1 & vol.2) (ebook) (20th ed.). McGraw Hill LLC. McKean, S. C., Ross, J. J., Dressler, D. D., & Scheurer, D. (2016). Principles and practice of hospital medicine (2nd ed.). McGraw Hill LLC.

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