Discharge Plans and Policies

The overall process of discharging a patient from a hospital and the transition back home or to a care facility are critical advancements in the overall course of both acute and long-term care. It is important that the hospitals releasing these patients have ensured the proper overall course of care from beginning to end. The lack of consistency with both the discharge process and the quality of discharge planning has led to many avoidable readmissions. To reduce the amount of hospital readmissions, it is imperative that hospitals recognize the need for focused patient care and that programs are being implemented to assist in the care transition.

This week’s reflection paper focuses practice-based evidence and the operation of the theoretical framework of person-in-environment as each relates to discharge planning at UMPC Mercy Detoxification Unit (UPMC-MDU).

Ineffective discharge teaching often leads to unnecessary admissions to the hospital resulting in negative patient outcomes and decreased patient satisfaction. This negatively impacts the well-being of the patient and creates a financial burden on institutions. As a result, this universal practice issue requires a call to action on the part of the nursing profession. Nurses can proactively assist in assuring incidents of readmission do not occur. Nurses as educators play a critical role in the successful transition of patients from hospital to home. The overall goal of discharge education is to ensure there is an exchange of critical information between the patient and nurse in which plans of care are understood and followed. The research

Standard 16 of the American Nurses Association (ANA) Scope and Standards Practice, directs nurse leaders to advocate not only for patients but for all members of our healthcare community. As a discharge planner, I am in a unique position to advocate not only for patients but for caregivers as well. As part of my responsibilities, I participate in daily multi-disciplinary team rounds. The meetings take place so that all disciplines can openly discuss patient care needs. They provide the perfect opportunity for anyone to bring to light problems or concerns.

The office would need to establish a goal to accommodate all post-discharge patients. When appointments cannot be made then an escalation process to the office manager needs to occur. In order to foster communication with professional partners, an investigation of the system failures. How can the transition to home be improved? The workflow should include a validation step that would entail hand-off communication between hospital rounders and office schedulers. If missteps occur, then the office staff could catch the near misses and call the patient at home. Care coordination among providers on an outpatient basis could be supported by the electronic medical record and having verbal care conferences. Next strategy could involve the hospital completing a call back within twenty-four hours to all patients discharged. This intervention could potentially catch some of the missed opportunities. Another approach involves face to face reinforcement of the patient-centered partnership with H. H. According to Counsil et al. (2012), “patient-centered care plans for complex patients changed the relationships with the health team” (p. 190). The development of this patient directed plan of care and partnership is

Discharge planning is a routine feature of health in many countries. The aim of discharge planning is to reduce hospital length of stay and unplanned readmissions to hospital, to improve the co-ordination of services following discharge from hospital thereby bridging the gap between the hospital and community (S. Shapperd, 2008). The focus of this story is discharge planning that occurs while

My work placement is within the Organisation of Sense Scotland working in a respite care facility supporting adults with a variety of complex needs. Our service offers a warm welcoming environment to each individual who stays here and we strive to provide a service that meets their needs, our service is a chance for individuals requiring care and support to get away from it all and whatever the choices are of the individuals in our care staff will put a plan in place to meet their needs, it is important that anyone requiring our support feels that they are valued and respected at all times regardless of their disability, race, age, gender

Integrating an Advanced Practice Nurse into the discharge process to help guide proper understanding of discharge instructions to help decrease non-compliance, along with re-admission rates. The best types of research evidence will include clinical practice guidelines (CPG), Random Controlled Trials (RCT), Primary Research Studies. I included other types of studies but come up with small results. I used different variables when searching the literature. Some of these included, literacy level, different types of a disease process, use of pictograms, re-admission percentages, along with non-compliance.

The NMC Code (2008) charges nurses to protect confidential information, and to only use it for the purposes given – for their treatment. Therefore all patients and events mentioned in this essay are inspired by real patients and events, but names, locations, dates and other details have been altered or obscured to make identification impossible. Following the introduction of the knowledge and skills framework (DH 2004a) and emphasis on quality of health care and patient centred, interprofessional, health and social care (DH 2000; Leathard 2003; Thompson et al. 2002) health care professionals and students will need to be able to

Post-discharge follow-up visit remains a critical factor in ensuring that patients continue to do well after they leave the hospital. The success of the team was measured based on data collected after 6 months of revamping the discharge clinic and implementing a phone call system to patients. They had been given a choice of a phone call for discharge follow up or to come in within 7-14 days and be evaluated post discharge.

Transitioning patients from one care setting to another has to potential to cause chaos, confusion and even harm for the patient. Case management plays an integral role in reducing that potential

The following databases were reviewed for this systemic review: CINAHL Plus, MEDLINE, ERIC and Cochrance. The following journals were reviewed and information obtained for this systemic review: Nursing Times, Journal of Gerontological Nursing and The American Journal of Nursing. The following expert organizations were reviewed: World Health Organization (WHO) and Centers for Medicare and Medicaid Services (CMS). This systematic review was conducted by searching for “Effective discharge planning; does it decrease hospital readmission rates?”. The search was further limited by information that was published within the last five years and in the United States.

(2012) enrolled 256 staff nurses from general internal medicine units as participants to demonstrate that an education program related to discharge planning could improve nurses’ attitudes toward discharge planning and impact the culture of the unit. In the study the control group (n = 154) received no education and the intervention group (n = 102) attended an education program including study meetings, conferences, and home visits following discharge. Knowledge improved in the education group regarding the department of discharge planning (p = 0.007) and attitude improved as well (p = 0.045). The screening category of the discharge planning process improved slightly (p = 0.052) but the other four subscales and the total of all subscales showed no significant improvement. Knowledge of discharge planning and attitude toward discharge planning were improved in the education group as compared to the control group after the three-month

Using the seven key principles of the hospital discharge process devised by the Department of Health (DH, 2003), this case study will critically analyse the process of an elderly patient who was discharged from a local acute trust. It begins by providing a definition of discharge planning, before providing a brief biography of the patient, including a rationale of why this patient was selected, details of her past medical history, reason for current admission, any issues raised and details of any care provided. Throughout this case study, in accordance with the Nursing and Midwifery Council (NMC, 2008) and the Data Protection Act (1998), the patient shall be referred to as Mrs. Blue to maintain anonymity. Although the

Discharge Planning – Patients who require continuing care after release from the hospital are identified and the appropriate services are arranged through participating home care, medical equipment and other providers.