Monday, June 3, 2019

Discharge Plan for Older Person

Discharge Plan for Older PersonIn this assignment the author will discuss a terminate broadcast with rule for an older person with a eagle-eyed term condition. Included will be potential and actual problems feeding from the patient profile on go over from an needlelike criminal maintenance setting. Reference to the Nursing and obstetrics Councils (NMC) professional commandment of conduct (2008) shall be made throughout the assignment along with a discussion of statute law in the latter part that is relevant to the plan of economic aid arranged. Moreover any copies of documentation used in the appendix will re important unknown maintaining confidentiality.The theoretical model used to formulate this plan of mission is Roper et al (1990) activities of daily invigoration which concentrates on twelve elements essential for daily documentation skills and the level of dependence solicitd for them. The elements of the theoretical model chosen will be those applicable to the p atients discharge give care for example, mobility and breathing.The patient profile put forwardred to is that of an elder valet de chambre in his late seventies admitted to hospital following weakness on waking to the left side of his body which had mainly abnormal his mobility. There overly appeared to be whatsoever facial drooping with dysarthria. For the purpose of this assignment when referring to the patient he will be named as Mr metalworker as to personalise the plan of care.Mr metalworker has a past medical history of chronic impeding pulmonary disease (COPD) and asthma for which he meets drug therapy of salbutamol and becotide inhalers. He is likewise the main carer for his wife whom suffers severe Alzheimers disease.Discharge planLiaise with the discharge co-ordinator as to the impending discharge of Mr Smith. This will ensure the continuity of his care on discharge.The discharge co-ordinator rears valuable assistance and is able to amplify the experience of a pa tients venture from hospital to the community Day et al (2009). They are highly skilled nurses in this specialiser area and mediate between the multidiscipliness involved in the care inevitably of Mr Smith.Mobility. enigma 1Possible varys to Mr Smiths movement, function and orientation.Method/outcome deal a falls attempt sound judgment using an identified tool and follow advisory notes on completion.With consent liaise with occupational therapy and physiotherapy departments for a discharge assessment and continued rehabilitation within the community.Make certain a floor visit with therapy teams has been undertaken before discharge.RationaleA falls risk assessment tool (FRAT) is a way to establish risk and manage falls prevention. Its use is advocated in the National institute for clinical excellence (NICE) guidelines in falls prevention document (2004).Following the use of FRAT (appendix 2) it is decided that Mr Smith is at moderate risk of falling and advices of therapy team i nput.Mr Smith requires an assessment by the occupational therapy team in his home environment prior to his discharge. This ensures his safety and well being for day to day living and maintains his independence. The visit presents an opportunity for the occupational therapist to evaluate the need for alteration in the home. For example it is recorded that Mr Smith has some difficulty in rising out of the privy he would therefore need modification in his bathroom to enable him to do this, promoting independence and maintaining his dignity.Mobility doesnt just include the physical aspect of movement it involves handsome motor activity, personal assertion, feeling and communicative function also. Having a stroke roll in the hay cause dysfunction, having a dramatic causatum on the persons life Barnet et al (2009). reservation adjustments in the home flush toilet be an upsetting experience.An assessment by the physiotherapist will maximise rehabilitation in physical movement and c ater focalizationing on the use of equipment that may be required in doing so, this ascertains safety and accuracy during use.Physiotherapists harbor superior kinetic knowledge and can pull in advice in falls prevention minimising the occurrence. NMC (2008) requires you as a nurse to refer to another practitioner when it is in the best interests of a persons care.Both therapists will be able to initiate communication with day hospitals for continued rehabilitation therapy sessions within the community.Maintain a safe environment and communication.Problem 2Mr Smith is to contend daily medication and understand the information provision.Method/outcomeEnsure the prescription with 7 days supply is provided and sent to pharmacy in judgment of conviction for discharge.Guarantee Mr Smith and his relatives receive relevant information regarding medication. Explain in an attackible manner.Arrange an out patients appointment. Present written and verbal information regarding the appoin tment. claim the GP of Mr Smith discharge.RationaleMr Smith has been convinced(p) aspirin 75mg following an ischaemic cerebral vascular accident (CVA). The aspirin is given prophylactically and inhibits platelet assembly which could otherwise issue in a thrombus formation British depicted object formulary (BNF) (2009).Eighty percent of strokes result from ischemia, caused by a thrombus blocking the cerebral circulation therefore, preventative medication such as aspirin reduces the risk of a reoccurrence Greenstein and Gould (2009a).It is important to provide Mr Smith with written and verbal information with regard to instruction on how and when to take his medication, along with the dosage and possible side-effects he may encounter.Educating Mr Smith on the need for medication and possible consequence of non compliance present him with an informed woof and reduces the risk of a drug induced re-admission. Reports notify that fifty percent of older people may not take medicines prescribed for them as they do not received valued information about the benefits and risks involved plane section of health ( do) (2001).The NMC (2008) says that you must share information about peoples health and regimes in a way they can understand. This facilitates informed choices and compliance.Nurses have a responsibility to continue assessment of their patients suitability for self-administration the NMCs standards for medicines management (2008) standard 9 require you to acknowledge changes to a patients condition and safety with regard to self-administration.Assessing Mr Smiths understanding and capability of remembering to take his medication is of great importance as if he is possible to encounter difficulty, provision for pre-dispensed medicine or help from a carer can be arranged Wade (2007). Indirect questioning will provide some indication as to how much Mr Smith understands and will not make him feel inadequate, maintaining his dignity and jimmy.An outpatients appointment with a neurologist will maintain lucid specialist monitor of Mr Smiths condition even though once discharged the GP is responsible for care in the community and continued prescribing. It is therefore alert that the GP has documentation on this hospital admission and any follow up appointments to be attended.Problem 3Change to Mr Smiths social and home environmental needs.Method/outcomeInform Mr Smith as to the importance of social serve participation and gain his consent.Liaise with social services for an assessment of needs completing the relevant documentation (sections 2 5) in acceptable time ready for Mr Smiths discharge.RationaleConsent must be given by Mr Smith prior to the involvement of social services, even though it is documented that they have had previous input with Mrs Smiths care. It is the individuals right to confidentiality and as a nurse you must mention this NMC (2008).Mr Smith has indicated that he has concerns with regard to coping and caring f or his wife whom has severe Alzheimers disease when he is discharged. Social services must assess the need for a care support package and provide financial advice for the services required as Mr Smith is a home owner. With Mr Smiths consent social services may even consider the possibility of Mrs Smith remaining in the nursing home until Mr Smith is more able bodied.The need fulfilment of the dependent can generate emotional stress in the carer and burden their physical well-being with the high level of physical exertion needed to provide endowed care Mackenzie and Lee (2006).When Mr Smith returns home it is the expectation that he will be allowing himself time to recover and not put his self under duress which could result in a relapse in his health. Anecdotally, caring for his wife at this stage would not be beneficial to his rehabilitation.Problem 4Transportation home on discharge from hospital.Method/outcomeLiaise with relatives regarding transport home and if necessary arrange hospital transportation.Verify Mr Smith has keys to his property, that someone will be there to receive him or that the key safe number is available.RationaleIt is of upmost importance that Mr Smith and his relatives are fully aware of the date of discharge and the preparations for his arrival. Where possible, Mr Smith and his relatives should contribute to the discharge plan. The expectation of you as a nurse is that you uphold peoples rights to be involved in decisions about their care NMC (2008).Working and playing.Problem 5Possible isolation and lack of social contact.Method/outcomeWith consent refer Mr Smith to the community stroke liaison services and bring about the relevant referral documentation. Provide the services contact details.RationaleThe community stroke liaison nurse is there to provide support with initial changes to Mr Smiths life. She is a specialist in stroke rehabilitation and can present him with coping strategies. These will help Mr Smith focus on problem s olving approaches and heighten his sense impression of control Carpenito-Moyet (2008a).The nurse specialist may also be able to provide Mr Smith with mini health checks and details of support groups, clubs and give advice regarding enrolling on an unspoiled patient programme if it is available within the local authority.The expert patient programme is a self management course for people with long term conditions. It was launched in 2002 as a pilot programme but is now national. The course is delivered over a six week period by a trained tutor who is either a volunteer or a previous programme attendee and is vastly beneficial. The service reduces isolation, promotes confidence and empowers those living with deficits or complex needs DOH (2001).Eating and drinking.Problem 6Nutritional support and secondary preventionMethod/outcomeWith consent refer Mr Smith to a community dietician completing the documentation.Highlight the importance of lifestyle and dietary changes with regard to his condition.Outline the need to attend to any emerging difficulty in swallowing or still dysarthria.RationaleFollowing his stroke Mr Smith may have a reduced appetite. Carpentino-Moyet (2008b) suggests this may be cod to fatigue, being less mobile or even because of some pain from limb limitation. Carpentino-Moyet (2008c) also discuss that during Illness or convalesce a bang-up nutritional consumption can reduce the risk of set ahead complications and aid faster recovery. Referring to the community dietician ensures that a diet plan optimal in calories and nutrition is received.Making certain that Mr Smith has some understanding about his condition will endeavour compliance with diet and life style changes. The reoccurrence of a CVA is much higher during the first year of rehabilitation, therefore regular checks and life style conversions need to be initiated DOH (2001).Mr Smiths awareness and detection of further difficulties with speech and swallowing is a desired outcome a s this could most definitely interfere with his nutritional intake in the future and would incorporate further change to his diet and lifestyle they would also warrant a referral to a speech and language therapist for a swallow assessment.BreathingProblem 7Mr Smith has COPD and asthma and requires respiratory maintenance and secondary prevention advice.Method/outcomeEnsure Mr Smith is aware of how to use his inhalers with the correct technique. Inform him of the importance to have regular visits to the GP or respiratory nurse in order to maintain adequate respiration.Provide cessation of smoking advice.RationaleBelamy and Booker (2000) suggest that the recommended maintenance appointment for patients with mild to moderate COPD should be annually within the primary care setting, they also indicate the monitoring session should involve a full assessment of the patients smoking status, symptom control, and medication efficiency with inhaler technique. Furthermore it allows the health c are professional to perform spirometry.It appears that Mr Smiths therapeutic intervention of becotide and salbutamol inhalers have symptomatic control of his COPD at present however, he is now also prescribed aspirin which could contraindicate his condition. Occasionally aspirin causes bronchospasm Greenstein and Gould (2009b) therefore close monitoring is essential.In set we can promote smoking cessation and provide advice to Mr Smith with regard to the health risks involved following his stroke and COPD. It is his individual choice as to whether he will participate.Many people given smoking cessation advice will continue smoking disregarding concern for their health. The NMC (2008) stipulates that as a nurse you must not discriminate against those in your care, treating people as individuals regardless of whether their choice exacerbates their illnesses.Key issues in older adults and long term conditions care provisionExtensive change has been underway with regard to the care sta ndards and expectations of health and social care services for older people.The force for change has happened due to demographic analysis, which indicates that people are living much longer with an increase in those above the age of 80. According to the DOH (2001) this figure is expected to have doubled between 1995 and 2025. Such longevity influences the amount of people living with long term conditions.Research and reports from extensive consultation with older people, their carers, healthcare professionals and from media coverage, discuss services declining to meet the needs of older people with age discrimination and depletion of dignity and respect being a major domination as clinical areas lacked test based practice DOH (2001).The introduction of clinical governance has helped develop effectiveness of evidence based practice assuring the quality of care is of a high standard.Zwanenberg and Edwards (2004) describe clinical governance as a system to advance the quality of ca re in which healthcare managers are responsible for constitution compliance. They explain that primary care trusts are accountable for providing evidence of their effectiveness and quality of clinical practice and further acknowledge the level of need for office since public interest in cases of malpractice.Care plans are aspects of clinical governance policies Lugon and Secker-Walker (1999) as is the essence of care document developed by the DOH in 2001.The essence of care document is a guidance tool specific in enabling healthcare professionals to deliver a structured and patient cerebrate practice within eight areas of care. Some of the areas include food and nutrition, self-care and privacy and dignity. The document also enables professionals to distinguish areas of poor practice allowing for remediation DOH (2001).The national institute of clinical excellence formulated guidelines for practice in assessment and prevention of falls, declaring that falls are a major cause of d isability or mortality in the elder population and impact on their quality of health and life NICE (2004). NICE (2004) also report that falling can have a devastating repercussion to an individual causing psychological distress, lack of confidence and poor self esteem, dependency and even pressure injury. The guidelines provide strategies for assessment (FRAT appendix 2) of those at risk of falling, including individuals following a stroke and suggest setting provision for interventions such as physical therapy, home adjustment and the revisal of visual deficit NICE (2004).The development of the national service framework (NSF) for older people by the DOH (2001) delivers policies as to the standard of healthcare that older people should receive. The NSF endeavoured to set strategies over a 10 year programme looking for improvements within specific areas of health promoting independence and providing treatment with respect and dignity. The document lists the quality of care that is r equired on the best available evidence and provides one standard for all, achieving consistency within healthcare DOH (2001).The focus of the NSF for older people was to abolish age discrimination and provide a patient centred approach to care DOH (2001). The document defines stroke and falls prevention, publicity of health and introduces standards of care for hospital and intermediate settings and for mental health illness in older people.The DOH in connection with the NSF for older people also developed the NSF for long term conditions in 2005. The document expresses the need for the promotion of quality of life with autonomy based around the individuals specific need for their condition. carrying into action of this policy includes provision of support for housing, benefits, education and pension schemes helping those suffering with long term conditions to live as independently as possible with access to services as required DOH (2005).A stroke (CVA) is classified as a long term condition and the DOH (2007) stroke schema document identifies the need for health promotion and management of risk. The plan of action firstly focuses on awareness and prevention, treatment and services available for those whose lives have been affected by stroke. Secondly, it identifies that all needs, health and social of the individual, should be contemplated in a plan of care not just medical ones DOH (2007).The stroke dodging guidelines allow for individuals following a minor event to be given an MRI scan within 24 hours, as evidence suggest eighty percent will follow on to have a severe stroke DOH (2007). clinical areas can therefore reduce deaths in practice if they adhere to this policy. Promotion of healthy weight, physical exercise and smoking cessation along with regular blood pressure checks and advice on alcohol consumption further reduce risks DOH (2007).The stroke strategy also expresses the need for a multidisciplinary approach, all health and social care workers collaborating together cultivating a stroke care community that will provide the best possible service for those affected returning home DOH (2007).Continued assessment by the multidisciplines following a hospital admission is essential to ensure an individuals suitability for discharge. The DOH (2004) suggests that consideration be made for the individuals physiological, functional and psycho-social wellbeing during the assessments. Being fit for discharge means that receiving care in an acute setting is no longer needed and continued care can be provided between the GP, community services and outpatients appointments DOH (2004).One professional included in the multidiscipline approach within the community is a pharmacist with initiatives developed to increase their involvement in care, such as repeat dispensing, medication reviews and independent prescribing especially for those with long term illness DOH (2005). The pharmacists involvement within the multidisciplinary team is v ery beneficial to patient care as it decreases medication errors, discovering discrepancies and many contra-indications before the medication reaches the patient.All legislation and government policies have influence on the way healthcare professionals practice. They provide guidelines as to accommodate continuity of healthcare in general. They set standards for quality of care that service users can expect when accessing healthcare provision and project how they will receive this provision.Legislation is an important aspect of healthcare and individuals have the right to life without discrimination, being treated equally with dignity and respect regardless of their condition, disability or age.The writer concludes that Mr Smith is awaiting discharge from hospital following a stroke. Evident from the patient profile he has achieved a satisfactory level of independence and he appears to be making good progress. The discharge plan documented for Mr Smith incorporates many of the NHS a nd social care policy initiatives to deliver continuity of care from hospital to home using elements from the Roper et al (1990) theoretical nursing model.The discharge plan supports the inclusion of multidisciplines, health promotion, prevention strategies and patient participation. It also up holds the NMC code of professional conduct (2008) whilst focusing on independence and maintenance of ones dignity, providing community support and rehabilitation.ReferencesBarret, D. Wilson, B. Woollands, A. (2009) Care planning a guide for nurses, Essex Pearson Education Limited.Belamy, D. Booker, R. (2000) Chronic obstructive pulmonary disease in primary care, all you need to know to manage COPD in your practice 3rd ed. London Class Publishing.BNF 57 (2009) British national formulary. London BMJ Group/RPS publishing.Carpenito-Moyet, L.J. (2008) Nursing care plans documentation, nursing diagnoses and collaborative problems 5th ed. Hong Kong Lippincott Williams Wilkins.Day, M.R. McCarthy,G. Coffey, A. (2009) Discharge planning the role of the discharge co-ordinator, Nursing Older People, 21, (1), pp. 26-31.Department of Health (2001) Medicines and older people implementing medicine-related aspects of the NSF for older people, The Department of Health. online. ready(prenominal) from http//www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4008020 accessed 18/03/2010.Department of Health (2001) The essence of care patient-focused benchmarking for healthcare practitioners, The Department of Health. online. Available from http//www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/dh/en/documents/digitalasset/dh_4127915.pdf accessed 12/02/10.Department of Health (2001) The national service framework for older people, The Department of Health. online. Available from http//www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/dh/en/documents/digitalasset/dh_4071283.pdf accessed 14/02/2010.Department of Health (2002) The expert patient prog ram, a new approach to chronic disease management for the 21st century, The Department of Health. online. Available from http//www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/dh/en/documents/digitalasset/dh_4018578.pdf accessed 30/03/2010.Department of Health (2004) Achieving incidentally simple discharge from hospital, a toolkit for the multi-disciplinary team, The Department of Health. online. Available from http//www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/dh/en/documents/digitalasset/dh_4088367.pdf Accessed 26/03/2010.Department of Health (2005) The national service framework for long-term conditions, London The stationary Office.Department of Health (2007) National stroke strategy, Department of Health. online. Available from http//www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_081059.pdf accessed 25/03/2010.Greenstein, B. Gould, D. (2009) Trounces clinical pharmacology for nurses 18th ed. London Churchill Livingstone Elsevier.Lugon, M . Secker-Walker, J. (1999) Clinical governance, making it happen. London royal stag Society of Medicine Press.Mackenzie, A. Lee, D.T.F. (2006) Carers and lay caring, In Nursing older people Redfern, S.J. Ross, F.M. (eds.) Nursing older people. 4th ed. London Elsevier.National Institute of Clinical honesty (2004) Clinical practice guidelines for assessment and prevention of falls in older people. CG21. London Royal College of Nursing.Nursing and Midwifery Council (2008) Professional code of conduct, London.Nursing and Midwifery Council (2008) Standards for medicine management, London.Roper, N. Logan, W. Tierney, A.J. (1990) The elements of nursing, based on activities of daily living. New York Churchill Livingstone.Wade, S. (2007) Refusing discharge or transfer of care, in Nurse facilitated hospital discharge Lees, L. (ed.) Nurse facilitated hospital discharge. Keswick MK Publishing.Zwannenberg, T.V. Edwards, C. (2004) Clinical governance in primary care, in Clinical governance in p rimary care Zwannenberg, T.V. Harrison, J. (eds.) Clinical governance in primary care. 2nd ed. Oxon Radcliffe medical Press Ltd.

No comments:

Post a Comment

Note: Only a member of this blog may post a comment.