A Description And Defense Of The Change

Purpose: The focus of this assignment is identifying patient’s needs and analysis and synthesis of details within the written client record and planning an appropriate discharge plan with necessary patient teaching of the disease process.

Early identification of these patients helps to identify individual patient needs and problems so that coordinated efforts can be utilized to meet the patient’s needs. Failure to coordinate care, gaps in inpatient treatment and therapy along with lack of proper patient care follow up post discharge increases the chance of readmission for these patients (Chamberlain, Lau, Siracuse,

taught during residency). In particular, Dr. Chum noted that there was not a specific handbook or guideline that physicians were expected to follow in order to maintain quality of discharge among patients. It became clear that there was a lack of knowledge among various stakeholder parties on how the discharge process was managed for the patient. To address the issue, our project objective was to learn as much as possible about how current actors interacted to ensure a smooth discharge. Our method to meet this organizational goal is to conduct in-depth surveys about the various stakeholder parties associated with discharging patients. By interviewing key contributors to discharging patients, we can help Dr. Chum and Dr. Nieto better understand key actions being accomplished and possible pitfalls being overlooked.

Improve discharge process from hospital- improve communication and understanding of the discharge process with patient along with personnel dedicated to assisting through the transition

This program’s readmission rate has been evaluated, and due to the findings, a follow-up appointment spreadsheet was created. This allows the social worker the capability to retain discharge planning information on each client. As well as all any scheduled appointments with primary physicians, and outpatient psychiatrist and therapist.

The Department of Health guidelines suggest that preparation for discharge needs to involve health professionals, family members, social services, and the patient.4

When registering a patient, it is crucial that you get details of that patient’s demographics and the reason for seeing the doctor have it on record. Getting this info allows the patient to stay on schedule and helps figure out how much time is needed for their visit this will save time for the initial visit.

With the elimination of paper charts, patients information becomes available with a touch of a button. This information includes insurance verification, current medications, lab reports, and past visit summaries.

The recommendations of the RED guideline are easily identifiable, prominent, and specific to the overall purpose of reducing unplanned readmissions within 30 days after a patient has been discharged. Alternative actions to support these recommendations have been unfolded as well. For instance, the RED Toolkit states that where a patient does not understand the discharge plan, the caregivers should interview him or her further to see if there is any other person, such as a family member or friend, who could be informed about it on his or her behalf. There were some implementation issues that need to be addressed to make sure that the toolkit can be used in a variety of health care settings and patient populations.

• Keep all follow-up visits as told by your health care provider. This is important.

• Keep all follow-up visits as told by your health care provider. This is important.

Discharge planning begins at the patient’s initial assessment or within 24 hours of admission or initiation of a service (ACT, 2006). It requires the development and implementation of a documented discharge

Therefore, communication should be established between the nurse and the patient to ensure that effective communication takes place. Thus, the nurse can establish when the patient is ready to change the levels of care. The main objective of the nursing intervention in the process of discharge planning is to provide patients and families the essential knowledge, attitudes, and skills necessary to implement the discharge plan. The teaching related to continued care should not be done immediately before the discharge because the patient’s concentration ability and attention span will be hindered by the natural anxiety associated with the upcoming transition in care. Moreover, teachings done under the pressure of a deadline may not be effectively

In my externship, I split my time between the lab at the hospital and the office. A typical day for me began at 7 in the morning. I started at the lab drawing blood out of patients. Usually on Mondays, it was the busiest. An order would come in through the window, once the patient had registered. On this order, there was the patient’s hospital ID number and their demographics, which included: name, address, insurance information, and their primary care physician. If it was a recent order from the doctor, then it would have the script with the registration page. If it was a standing order, such as a Prothrombin Time, it would just have the registration page,

whether or not the patient would be hospitalised. If so, an ED nurse filled in a form