Summary: Improving Nurses Knowledge About Discharge Planning

Discharge planning is used to create a plan of care for a patient who is leaving a care setting. An evaluation is done to determine the patient’s continuing care needs once they have left the care facility. When patients are send back home or to a facility that does not require full time nursing care assistance, programs need to be put into place to ensure that the patient is receiving the proper continuation of care post discharge. Proper discharge planning can decrease the chances of a hospital readmit, help in recovery, ensure medications are prescribed and given correctly, and adequately prepare family or caregivers to assume proper post discharge care. According to the Family Caregiver Alliance, “It is important, not only for patients, but family

Throughout my time on the Mother Baby Care Unit, I have faced many instances in which I have been able to reflect on both my patients and the care that I was providing them. One situation in particular that I found myself critically reflecting upon involved a new mother who was feeling slightly stressed about being discharged as her newborn son would not be going home with her. For confidentiality reasons, this patient will be given the pseudonym of Kayla for the remainder of this reflection.

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).

With the prevalence of nursing shortages, more specialty units are now hiring new graduate nurses in positions that were once reserved for experienced nurses (Maiocco, G., 2003).

The hospital that I worked for while working as a case manager was not in network with Kaiser Permanente. It was also the time when the hospital started to hire hospitalists to manage patient care while they are a patient in the hospital. It actually worked out because it filled in the gap in patient care. The hospitalists were acting as the patient's primary care provider. Kaiser as with many other insurance have a case manager designated to ensure that the patient is meeting criteria not only for an inpatient hospital stay but for the level of care they are receiving as well such as ICU, Stepdown, or Med-Surg. I would have to give them an updated clinical information daily or every 3 days depending on the severity of illness. As a case manager, I was responsible for discharge planning and I preferred to transfer the patients to

In 2011, there were approximately 3.3 million readmissions to hospitals, raising healthcare costs and negatively impacting patient health. Two important contributors are discharge planning and education. Many patients do not receive enough of either, and are sent home misinformed about their diagnosis and medications. In order to decrease readmissions, hospitals should utilize interactive patient systems to educate patients while they are in the hospital. This will increase patient knowledge of their diagnosis, as well as make it easier for nurses to go over discharge teachings with the patient. This gives

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

Across the United States, hospitals are experiencing a nursing shortage. Yet, according to the American Association of Colleges of Nursing, 63,857 students graduated from nursing school in 2015 alone and enrollment is increasing. It seems like a lot of new nurses to fill those vacancies, does it not? Studies show, however, that within a year, about thirty percent of those new graduates have voluntarily left their job (Hillman). Further studies have attributed the high turnover rate to new nurses’ lack of competency to handle conflict, make critical decisions, and function autonomously (Bratt). Many of the new graduates are disappointed with the hospital’s orientation, or lack thereof. Lack of knowledgeable preceptors and lack of nursing staffing in general has led to new nurses being thrown into autonomous function more quickly. Without proper training, these nurses must make sound clinical judgements and provide competent care to patients, which anyone can imagine is stressful. Today, Nurse Residency Programs (NRPs) are being instituted in numerous hospitals as a way to improve new graduate nursing skill, but research shows many other benefits to these programs. NRPs also reduce hospital spending costs, increase patient safety, and most importantly increase new nurse retention rates.

Studies have found that improvements in hospital discharge planning can dramatically improve the outcome for patients as they move to the next level of care (Alliance, 2016). Moreover, Patients, family caregivers and healthcare providers all play roles in maintaining a patient's health after discharge. And although it's a significant part of the overall care plan, conversely there is a surprising lack of consistency in both the process and quality of discharge planning across the healthcare system (S. Shapperd,

The problem was discovered by Ashley Kilpatrick, NNP, Project Manager of this process improvement initiative. Ashley saw the opportunity to improve patient care by standardizing the care of the infants by decreasing the variation in care. I was made aware of the problem in weekly discharge rounds that occur every Tuesday in RNICU/CCN with the nurse managers, assistant nurse managers, social services, utilization management, UAB Police and the discharge coordinator to talk about any financial or social barriers to discharge. During discharge rounds, we discussed infants whose mother was addicted to drugs, whether prescription, illegal, or opioid substitutions. We also discuss whether the infants are having withdrawals and receiving Methadone. There would always be questions about weaning the Methadone, what day of weaning were the infants on so they could be discharged. There would be questions whether we were monitoring 3 -5-7 days off Methadone to send the infant home. This could ultimately be a safety and quality issue for the organization.

NICU Nurses are responsible for care of infants who may be diagnosed with diseases, delivery complications and, the one we see most, prematurity. They develop nursing care plans and assess, plan, implement, and evaluate the effectiveness of treatments in these plans. On

Participants reaffirmed that the guidance of the nursing team at the moment of discharge were specific to the care in relation to the drug therapy or to invasive devices, such as probes and tracheostomies, without a focus on the guidance about the general care related to the chronic health conditions and the importance of following-up the child after the hospital discharge. One can say that the factors associated with the readmission of children are related to the age group of infants, with respiratory problems associated with chronic conditions, besides the lack of effectiveness in the post-discharge follow-up. Accordingly, it is relevant to reflect about the role of the nursing team in the planning of interventions capable of providing the adaptation of children and their families over the period of admission, at the moment of discharge and in the post-discharge. The combination of guidance of verbal and written strategies can help us to understand the trajectory of illness and adaptation, thereby avoiding

Nursing care delivery is defined as the way task allocation, responsibility, and authority are organized to achieve patient care. Tiedeman and Lookinland (2004) suggested that systems of nursing care delivery are a reflection of social values, management ideology, and economic considerations. (Tiedeman&Lookinland, 2004) According to Fewer (2006), the quality of nursing care delivery systems affects continuity of care, the relationship between nurse and patient, morale, nurse job satisfaction and educational preparation.(Fewer, 2006) Nurses are essential human resources to provide medical services with professional knowledge and skills in the healthcare setting. However, the registered nurse turnover rate has increased in recent years resulting

Giving an accurate and detailed report to the nurse at the new facility is very important. Several times at night I have received phone calls from other facilities needing more information. Im usually unable to provide information because the shift nurse is usually gone. Events like that should never occur. It make my place of employment look bad and negative patient outcomes can occur if the new nurse doesn’t know what is going on with patient. During a monthly meeting my supervisor addressed the issue and stated a detailed report should be given to the nurse and the patient. All information including the discharge summary should be given to the patient and the new facility. Since the problem was addressed we haven’t had any

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