Effective Patient Discharge Planning Guide
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ScribdTranslationsEffective Patient Discharge Planning Guide
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ScribdTranslationsSUSANA ROSALES/ BÁRBARA KOSSIER
DISCHARGE PLAN
WHAT IS IT?
It is the process of preparing a patient to leave a level of care. Normally, the
discharge planning refers to the patient leaving the hospital to return home; without
embargo; también se producen en otras situaciones medicas donde el paciente pasa de una
unit to another or from one service to another; for example: a patient with a stroke
can be transferred from a medical unit to another rehabilitation one, or a patient with
Polytrauma can be transferred from the emergency room to the intensive care unit.
Patients can also be transferred from a hospital to an assistance institution, etc.
Effective discharge planning includes:
a) Continuous assessment to obtain complete information about the needs
patient's progress.
b) Development of nursing diagnoses
c) Development of plans to ensure compliance with patient needs and
their caregivers.
WHEN DOES IT HAPPEN?
Both in discharge due to improvement and in voluntary discharge, a discharge plan is required.
consolidate your self-confidence and independence through stimulation to continue with the
necessary therapeutic measures and thus achieve an optimal state of health; control their
suffering; adapting one's lifestyle to the loss of health, anatomical structure or function; or
achieve an end in its life cycle with dignity and quality.
Each institution usually has its own rules and methods for admission. Many centers
they have discharge planners, a healthcare or social service professional who coordinates the
transition and act as a link between the center that grants the discharge and the one that receives the patient;
the nurse assumes this responsibility.
Since when has it been planned?
It must start from the patient's admission in a health institution; it must be developed with the
health team, with the patient and their family members, prior health or illness assessment,
educational, social, cultural, emotional or religious conditions; expectations regarding their
hospitalization and illness; human, physical, and economic resources available to the patient
and their families, as these will determine success or failure.
In some situations, planning requires meetings between the healthcare team and the family to
individualize patient care by discussing family-related topics concerning the patient.
ASPECTS TO CONSIDER...
The objectives of the patient's discharge plan for improvement or voluntary discharge are:
Offer continuity of home assistance.
Encourage the patient in self-care activities within their capabilities
functional.
Maintain optimal levels of physical and mental activity compatible with their abilities.
Minimize readmissions due to secondary complications.
It must contain: Prior information to family members or responsible parties of the patient
sobre posible fecha y horario de egreso, a fin de que estos adapten en el hogar los recursos
necessary according to the conditions of the patient.
Information about your health status or illness emphasizing on:
Assessment of functional capacity and ability.
Satisfaction of basic needs.
Attention to problems regarding your illness, or to situations that interfere or
increase their suffering.
Development of daily living activities (hygiene, dressing, nutrition, mobilization,
removal).
Ability to perform activities independently (medication management,
food preparation, household chores.
Guidance on safety precautions.
Adherence to therapeutic measures taught during their hospital stay that
prevent other diseases or complications regarding:
Pharmacotherapy: purposes, dosages, interactions, effects.
Dietotherapy: adaptation, supplementation, substitution or elimination of
food.
Physiotherapy: use and management of physical agents, motor exercises, transport,
management of support devices according to their age, mental state, and capacity
cognitive.
Occupational therapy
Speech therapy
Psychotherapy: socializing techniques and methods, relaxation, play therapy.
Surgery: physical and psychological preparation for surgical intervention, if applicable.
merit.
Inclusion of follow-up visits and evaluation methods.
Subsequent assistance to any service or institution, prior orientation on the importance that
this has for the continuity of your care.
Information about healthcare services or medical personnel that you can use in cases of
emergency.
PREPARATION OF PATIENTS TO RETURN HOME
Nursing must assess the following parameters of the patients:
Personal and health data
Age, sex, height and weight, beliefs and cultural practices, medical history, current health status,
forecast, surgical operations.
Skills to carry out daily activities (AC)
Ability to dress, eat, use the toilet, bathe, walk (with or without help, with a cane,
crutches, walker, wheelchair), move around, prepare meals, use transportation, carry out
purchases.
Disabilities/limitations
Sensory losses (auditory, visual), motor loss (paralysis, amputation), disorder of the
communication, mental confusion or depression, incontinence.
Responses/caregiver skills
Main relationship of the caregiver with the patient, thoughts and feelings about the discharge of the
patient, hopes for recovery, health and coping ability, comfort with the
carrying out the necessary care.
Economic resources
The economic resources and the needs (observe the equipment, supplies, medication,
special foods needed.
Community support
Family members, friends, neighbors and volunteers, nutrition services, nurses, day programs,
legal assistance, home care, respite care for the caregiver.
Assessment of hazards in the home
Safety precautions (stairs with or without handrails, light in rooms, hallways, bathtub,
well-fixed carpets, etc.), barriers for self-care, space for necessary equipment, etc.
Need for home assistance
Home delivery food service; need for a special diet, volunteers to reassure the
patient by phone, visits from friends, transportation, shopping, help to bathe, healing of
wounds, probes, medication, etc.
IN SUMMARY
One of the greatest responsibilities of the nursing professional is to ensure continuity of care.
the care, which consists of the coordination of services between centers and
healthcare professionals.
Continuity ensures the patient's health status. To provide assistance
continuously, nursing professionals need to achieve the following objectives:
Start the discharge planning for all patients upon their admission.
any healthcare center.
Achieve the participation of the patient and their family or support person in the process of
planning.
Collaborate with other healthcare professionals when necessary, to ensure
fulfillment of biopsychosocial, cultural, and spiritual needs.