Discussion Board Evaluation Of Learning

Improving the quality of discharge planning in acute care include addressing the lack of appropriate staff and patient education about appropriate planning for discharge (4). This includes implementing proper discharge teaching regarding signs and symptoms to seek medical attention, management and care of medical equipment, and access to community resources (4, 5). Other challenges are patients with complex comorbidities too difficult to discharge as well as lack of community supports and equipment for newly discharge patients and lack of rehabilitation and nursing home beds (4). Consequently, acute care units are pressured to vacate hospital beds in response to the growing elderly population. Hospital professionals tend to focus discharge teaching and preparation on medical areas such as diet, activity, treatments, and medications (5). Community referrals to appropriate services at the time of hospital discharge does not often happen contributing to poorer patient outcomes and re-hospitalizations

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.

H, who had come into the emergency department two days prior for diabetic ketoacidosis (DKA) and was diagnosed with type 1 diabetes. The Mayo Clinic explains that diabetic ketoacidosis occurs when the body cannot produce insulin. Insulin is the key that allows glucose to enter cells, and provide the cells with energy. Without glucose for energy, the body begins to breakdown fats that produce harmful substances known as ketones. DKA is characterized by hyperglycemia, metabolic acidosis and ketones in the urine, (2017). That had since resolved, so for the most part of the day me and the secondary nurse were providing diabetic education. She was educated on the use of the glucometer, how to give insulin injections, and symptoms of hypoglycemia, I felt confident in this education and was surprised by how much I remembered from previous lectures. I did not have time to provide teaching on diet, exercise induced hypoglycemia, or patient specific teaching based upon her report, because we switched our roles. I can see how education can get swept under the rug in practice when you are so busy throughout the day. Instead of saving education until the end of the day, when I become a new nurse I will make sure I am taking advantage of every patient encounter as an opportunity to educate. Later in the simulation, when I had transitioned roles, Ms. H experienced a hypoglycemic episode after receiving a dose of insulin and not consuming any of her breakfast. According to Silvestri, hypoglycemia is often caused by the following, too much insulin, too little food, or excessive activity (2014, p. 653). In Dr. Johanson’s lectures I learned that carbohydrates are the main source of energy for the body and are metabolized to form glucose for the body to use. When there is no consumption of carbohydrates, there is no glucose and this results in low blood glucose known as hypoglycemia. A type 1 diabetic lacks the ability to make insulin, which is the key that

Low blood sugar also known as hypoglycemia quickly manifests in individuals who use insulin. Common symptoms come about when the blood sugar levels fall below 70 mg/dL. Symptoms include headache, hunger, nervousness, rapid heartbeat, shaking, sweating, and weakness. (Eckman 2011).

Readmission to a hospital creates strain and added expense for the patient and hospital; in 2011, hospital costs due to readmission were almost $41.3 billion (Hines, Barrett, Jiang, & Steiner, 2014; Rau, 2014). There are many aspects of healthcare associated with readmission, such as lack of discharge planning and education, which need to be addressed i to decrease the amount of preventable re-hospitalizations.

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

This model reimburses hospitals based on quality of care instead of the volume of patients. The quality of care is assessed by patient questionnaires and if hospitals are unsatisfactory penalties may be imposed (Edwoldt, 2012). The value-based system also affects Medicare and Medicaid. It was reported that Medicare readmissions within 30 days of discharge cost 17 billion dollars annually (Edwoldt, 2012). Due to the high costs of readmissions Medicare and Medicaid have implemented a Hospital Readmission Reduction program. A formula is utilized to evaluate readmission rates within 30 days of discharge for any medical reason related to their original admission such as heart failure and pneumonia. Upon review the hospital is potentially penalized. It is important that nurses strive to provide excellence in care despite their beliefs on the ACA. Nurses have the ability to provide a safe patient environment and reduce the risk of hospital associated infections by following hospital protocols such as hand washing.

The purpose of this study is to minimize the risk of hypoglycemia among the elderly. As people with diabetis age, the physiological changes affect the diabetic. The purpose of this study is to consider whether HbA1 goals can be attained without undue treatment burden and decrease the risk of severe hypoglycemia. Though client teaching and minimizing the risk factors of hypoglycemia can prevent further exacerbation of catastrophic events that could have potential lethal outcomes to an older patient with diabetes. The one patient’s case, Mr. J., an 86 year old man who has had type 2 diabetes for 15 years is a quantitative study that focuses on prevention of hypoglycemia in older adults. Interventions include diet, meal planning, medication, glucose

The main theme identified in this research focused on the Hospital readmission rate that has gained increasing attention because it reflects the effectiveness of healthcare system performance and the quality of patient care. The five articles studied all highlighted that an effective discharge planning is crucial to improve continuity of care between hospital and home/elderly home so as to improve patient’s health and reduce patient readmission. The themes that emerged described discharge planning in the hospital as pivotal in the continuing care of people who are in need of medical, social and rehabilitation care. Additionally as the needs of patients increase and become more complex, it is also important that an effective discharge planning system should have the capacity to discriminate and respond to different levels of need for coordination and post-discharge care (Central, 2012).

In 2013 an average of one out of eight Medicare patients are readmitted within a 30-day period which lead to the estimated costs of around $18 billion a year for Medicare patients alone. Hospitals will either be penalized or receive bonuses for their performance with readmissions. This program will encourage hospitals to concentrate on ways to improve coordinating transitions of care while improving the safety and quality of care provided. In order to

The second week of my preceptorship brought many new experiences for me, and I can honestly say that each day I spend with my preceptor is better than the last. This week I focused on time management of a full patient load with continued documentation practice as well as admission and discharge procedures. I’ve had brief experiences in my past rotations assisting with discharge teaching and admission assessments however I have never been able to fully take charge and complete the process from start to finish, so this was a great learning opportunity for me.

For years, healthcare costs have continued to increase in the United States and policymakers are constantly trying to find ways to reduce spending. According to reports, in 2011, about $900 billion out of the $2.6 trillion annual health care spending was wasteful spending. In the following year, there was a reported $690 billion wasted annually on healthcare. This wasteful spending is attributed to ineffective health care delivery, cost of adverse events, and poor care coordination that has led to avoidable readmissions (Lallemand, 2012). In the United States, readmissions are the highest amongst patients with chronic diseases accounting for about 90% of avoidable readmissions in 30 days after discharge, and costing the industry an estimated $17 billion. These readmissions are a result of inadequate discharge planning, lack of follow-up, and lack of education on disease management (Jayakody et al., 2016). Policymakers on the federal and state level have developed and implemented several programs, some varying state to state, to help reduce wasteful spending while improving quality of care.

Ongoing teaching is done throughout the patient’s hospital stay so that the patient is optimally prepared to eventually be discharged home or to a rehab facility.

The estimated time for the teaching session is approximately 3 hours. In the first hour I will give a brief overview of what diabetes is and how it can be controlled with insulin. First I will include a very simple explanation of the pathophysiology of the disease and the signs and symptoms that are common. Next, I will explain that when controlling diabetes, her blood sugar can become too high or too low. High blood sugar, or hyperglycemia is caused by eating too much food, eating sugary foods, or by not taking insulin as prescribed. Signs of high blood sugar include: dry mouth, thirsty, having to urinate often, blurry vision, feeling tired, and weight loss. If high blood sugar is not treated, it can cause you to go into a coma (Aldridge, 2005 p.36-37). When you have high blood sugar, drink water and take your insulin according to the sliding scale your doctor has provided. Low blood sugar, or hypoglycemia, can occur

When I was four years old, I was diagnosed with Juvenile Diabetes. Since this day, my constant need to monitor my blood sugar has not only negatively affected my health, but also other aspects of my life including my academic career. This may not seem like an academic responsibility, but to me it is just as important to keep up with my blood sugar as it is to keep up with my school work, because when my blood sugar isn’t near my target range, it is nearly impossible for me to focus and learn to the best of my ability. There are times when my blood sugar is low or high during school that I wish I could stop class, just long enough for my blood sugar to come back in range. But, wasting class time while by blood sugar corrects is impractical,