Discharge Planning - ANSWER"Discharge Planning begins
at the time of Admission!"
-Discharge Planning must begin when the patient is admitted. Some believe this to be financial because we are trying to save money and get patients discharged faster.
Discharge Planning (continued) - ANSWERThat i...
-Discharge Planning must begin when the patient is admitted. Some believe this to be financial
because we are trying to save money and get patients discharged faster.
Discharge Planning (continued) - ANSWERThat is one component but there has been a lot of research
that shows that patients that remain in the hospital too long are at increased risk for nosocomial
infections, developing pneumonia and DVTs, injuries such as falls....etc.
Purpose of Discharge Planning - ANSWER-To help patient transfer to next level of care continuity of
care and to avoid readmissions.
Planning for discharge with clear dates and times reduces:
-Patient's length of stay.
-Emergency readmissions.
-Pressure on hospital beds.
-Discharge planning for simple, 80%, or complex discharge needs.
Background - ANSWER-Greater 10 million discharges per year are Medicare patients.
-Quicker and sicker discharges of older and frailer patients.
-JCAHO, TJC, guidelines for multi-disciplinary discharge planning as component of high-quality care.
-Poor hospital reimbursement if patient no longer acute.
Patients at risk for complex discharge needs : - ANSWER-New or remaining functional alterations.
-Must follow restrictions or therapies.
-Requires referral to other disciplines.
Predictors of Poor Post-Discharge Outcomes - ANSWER-Age > 80.
-Multiple, active medical problems.
-Multiple hospitalizations last 6 months.
, -Hospitalized within last 30 days.
-History of depression.
-Moderate-to-severe functional impairment.
-Inadequate support system.
-"Fair" or "Poor" self-rating of health.
-History of non-compliance.
Admission - ANSWERThe initial nursing assessment:
-Identify risks.
-Identify changes in function.
-Identify patient and family concerns.
-Assess ability to perform ADL's.
-Identify number of active medical problems.
Past admissions - ANSWERIdentify past admissions
-How many times in last 3 months?
-Challenges?
-Deteriorating health?
-Increasing number of meds or treatments?
POSSIBLE DISCHARGE LOCATIONS - ANSWER-Home with family support.
-Home with HHC.
-SNF.
-Nursing home, ALF, custodial care.
-Acute rehab.
-LTAC.
-Hospice.
Discharge Planning is NOT: - ANSWER-Merely anticipating obstacles to discharge from hospital.
-Finished when patient has met goals for hospitalization.
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