Discharge Planning

The main aim of the health fraternity is to improve a deteriorating condition of sick persons. Health institutions have established structures that will enhance better healthcare service delivery and boost th9iuyt45e condition of their patients. Chronic heart failure patients have registered high admissions in hospitals. Mr. Brown suffers from chronic heart failure condition. It is a long term condition that requires a special, long, continuous and individualized care throughout his life. Though the medical staff can provide this sort of care for Mr. Brown in the hospital, they cannot underestimate outpatient care services that have been found to quickly improve recovery process of patients. To ensure that Mr. Brown receives the required care services as he prepares to go home in the next few days, a discharge plan has to be formed. In this paper, I will design a discharge plan for Mr. Brown and explain factors to be considered when planning a discharge. The paper will also discuss strategies that will empower and support Mr. Brown in his recovery and their significance to him and to others.

Mr. Brown suffers from chronic heart failure. This is a clinical heart condition in which Mr. Brown’s heart is not able to pump enough amount of blood as required by the body to meet the demands of tissue metabolism (Andrietta, Moreira & de Barros, 2011). Coronary artery disease is considered as United Kingdom’s most common cause of heart failure (NICE, 2010). The arteries to the heart of Mr. Brown have been narrowed as a result of a plaque buildup. The plaque is composed of an accumulation of cholesterol and other substance. By building up within the artery passage, it decreases the volume of blood that can flow to the heart hence increasing the risk of developing coronary heart disease (Tidy, 2014). The heart gets less oxygen at a time.         Petersen, Rayner and Wolstenholme (2002) report that people suffering from this condition are more likely to have had a myocardial infarction. Mr. Brown positive diagnosis of this heart failure was expected and it will worsen when you consider that he is aging (now at 67 years old), suffered from ischemia heart disease and went through several treatments for heart failure (Owan, Hodge, Herges et al., 2006) such as coronary artery bypass 10 years ago. He was also suffering from hypertension which also increased the risk of developing a chronic heart failure.

Some symptoms of the condition exhibited by Mr. Brown before he sought some medical assistance included depression that made him distance himself from family members when he had two sons who lived nearby, loss of interest in playing golf as a hobby, loss of appetite and a decrease in weight. Later, he experienced shortness of breath, chest pains and feeling very fatigued.

At the onset of admission into the hospital, a discharge plan for him had to be made. The symptoms and degree of the condition that Mr. Brown has, means that he would need to be put under a complex discharge plan. Bell, Ervin & Lesperance (2005) recommends an individualized discharge plan which will take into account depression and social isolation of Mr. Brown (Cockburn, Davison & Newton, 2008). The plan must be focused, comprehensive, and involve all the multidisciplinary organs within and outside the hospitals. The plan must involve assessment and evaluation, monitoring and constant supervision, inclusion of the patient and his family in decision making and administration of care, models of communication, nursing care services, summary care and health education of Mr. Brown’s condition.

Discharge planning is a continuous process that usually starts when a patient is admitted in a hospital. The discharge plan is aimed at improving health conditions of patients and preventing re-hospitalization (Griffith, Kwok, Lee, Lee & Woo, 2008). There are some factors that you must consider before making the plan so that you are able to successfully facilitate a smooth transition of inpatient care services to outpatient care services. Condition of the patient is very important when designing a discharge plan. Mr. Brown’s heart failure condition is chronic and long term. He would need regular assessment to monitor his blood pressure, breathing and lung function. This will in turn help in organizing a proper medical intervention.  A complex condition like that one of Mr. Brown requires a complex and effective care plan.

Multidisciplinary teams (MDT) within this hospital have to be factored in the discharge plan process. The team members have been responsible in carrying out medical assignments to Mr. Brown. These professional men and women are the closest people that interacted with him and understand his condition. The MDT has a responsibility to ensure the continual well-being of Mr. Brown. They are the best recommended medical personnel that should be recruited in resuming home care services to Mr. Brown. Better health outcomes have been reported on patients who receive multidisciplinary health care (Hauptman , Rich, Heidenreich et al., 2008; National Heart Foundation of Australia & the Cardiac Society of Australia and New Zealand , 2006). The MDT is comprised of dieticians, physiotherapist, doctors, general practitioners (GP), discharge nurse, social workers, cardiologists, and exercise physiologists, general physicians, nurses with cardiology training, palliative care nurses formally accredited heart failure nurse, specialist nurses and practice nurses, community nurses, occupational therapists, palliative care physicians, hospital pharmacists, community pharmacists, accredited pharmacists and psychologists (Heart Foundation, 2010).

Another factor that needs to be considered in planning discharge is time and communication. Through time the discharge process will look organized because each activity will be carried at its scheduled time. Assessment and the period in which Mr. Brown is expected to stay in the hospital will help every person involved with the patient prepare for his discharge while carrying out other health care responsibilities. Communication involves how and when to pass an information. Through communication different views from different people can be gathered together to formulate a clear and easy to understand discharge plan. Some concepts and technical aspects in the condition will be clearly explained. Through communication, health care education and nursing care activities can be shared among the MDT. Communication will reduce misunderstanding and in turn it will ensure that the type of care given to Mr. Brown is well coordinated.

The family and the patient play an important role when they are involved in discharge planning.  Mr. Brown and his family will be informed about his condition and the medical principles on which he will be discharged from the hospital. The family will provide information about the patient and his medical history plus their opinions which will influence the type of discharge plan for him. In relation to this, the family’s financial and psychosocial needs (McCoy, 2006) must be taken into account when planning the discharge. This will help in advising them in applying for assistance to help with home care, purchasing resources that will enhance care delivery or referrals that they should seek. Family involvement and their psychosocial and financial needs will help Mr. Brown and his family members make adequate preparation towards taking full responsibilities of his care.

Mr. Brown’s condition requires constant and continuous care plan. The hospital is the most trusted institution that is capable of offering the necessary care for him when you consider that heart failure patients’ condition can worsen at any time and they might need some urgent medical attention. Involving the family of Mr. Brown will ensure successful transition of the care given in the hospitals. During discharge planning, the family will be educated about the chronic heart failure condition that Mr. Brown is suffering from, “material containing information concerning medication, diet, exercise and weight control” (Paul, 2008). Some concepts and type of medications will be taught through ‘teach back’ method to familiarize them with the family.

Involving the parents in the discharge plan will enable them to prepare for transport of Mr. Brown during discharge; the new environment that he will occupy and planning their schedules to allow themselves provide some home-based care to him. The process is very important especially when done early because it will provide an opportunity for the family to make frequent visits to the hospitals and spend maximum time with their loved ones with a purpose of embracing and learning some basic nursing care that they can offer to Mr. Brown. His conditions involve administration of complicated medication at different times and of specific dosages for example prescribing aspirin (75-150 mg once daily) to the patient (NHSScotland, 2012; 2003), use of diuretics routinely, offering beta-blockers or performing blood test and other assessments.

Taking care of Mr. Brown is not going to be easy. The condition that he has requires a combination of different care services that must be understood by the family that would take the care responsibilities. Involving them in the discharge planning process will give them an opportunity for them to ask questions about the condition and the mode of care that Mr. Brown will require. They will also get information concerning any kind of help or assistance that they might get in enhancing Mr. Brown’s heart failure condition. Involving them will also increase his satisfaction (Bauer, Fitzgerald, Haesler et al., 2009) and interaction when they start taking care of him.

Summary care and medical report for Mr. Brown will also be explained during the discharge process. Hence, the presence of or working with the families in planning a discharge will give them first hand information on the patient’s life during his stay in the hospital. The medication, date and time of its administration is included in the summary. In addition, it summarizes some side effects and behavioral characters of the patient during his stay and how they were managed. All these information in the summary care will assist the family in taking care of Mr. Brown and managing his heart failure condition without any cause of alarm when shows abnormal characters and response.

Most people suffering from chronic heart failure have been reported to seek re-hospitalization after discharge. Some have been readmitted as early as 6 months after discharge. Though Mr. Brown’s condition is not different from them, the discharge plan must involve his family who will learn basic caring methods for their patient and will be given some efficient and effective ways of communicating with them in urgent matters. Instead of taking Mr. Brown back to the hospital, the health institution will facilitate transfer of health care professionals who worked with the patient’s MDT to offer any special type of care. This type of involvement will reduce unplanned readmissions (Shepperd, McClaran, Phillips , et al., 2010) or eliminate any form of re-hospitalization unless his condition becomes very serious, facilitate follow-up and improve his outcome.

Communication is important when planning discharge. Activities during and after discharge that are aimed at improving the health of Mr. Brown will be well coordinated in executed. Summary of care will be well understood and its transition will be successful when it is understood by the family and the MDT. The patient and the family will have to be updated and honestly informed about his condition regularly so that he feels important and secured. Good communication will involve a lot of listening which will play a role of devising a customized discharge plan that will easily be complied by Mr. Brown and family.

Mr. Brown’s chronic heart failure condition is a long term condition that requires a special, long, continuous and individualized care throughout life. His heart is unable to pump enough amount of blood to the tissue metabolic demands. Due to experiencing shortness of breath, chest pains and fatigue he is in need of a discharge plan. The plan must be focused, comprehensive, and involve all the multidisciplinary organs. The plan will cover assessment and evaluation, monitoring and constant supervision, inclusion of the patient and his family in decision making and administration of care, models of communication, nursing care services, summary care and health education of Mr. Brown’s condition.

Factors that I must consider before making the plan so that I am able to successfully facilitate a smooth transition of inpatient care services to outpatient care services will include the family and the patient, time and communication, condition of the patient and multidisciplinary teams (MDT) within the hospital. The family should be involved in the discharge plan to enable easy transition and improve recovery of the patient. On the other hand communication will enable coordination and implementation of the discharge and care plan for Mr. Brown’s best interest.

 

Appendix

Discharge Plan

Name:………………………………………………………………………….………

Date of Admission:……………….Expected date of Discharge…………………..

Health condition Diagnosed:………………………………………………………….

Date Time Health Care Services/ Medication
Day 1-3 Morning Light exercise e.g. walking/running Breakfast

 

Taking medication as assigned by the doctor
  Noon Lunch

resting

Medication
  Afternoon

3 – 5.00 pm

Snack/tea/porridge

Exercise-walking

Therapy session

 
  Evening

6 – 7 pm

  Medication
Day 4 Morning Light exercise e.g. walking/running Taking medication as assigned by the doctor
  Noon resting Medication
  Afternoon

3 – 5.00 pm

Assessment and Evaluation

Snack/tea/porridge

Therapy session

 
  Evening

6 – 7 pm

  Medication
Day 5-7 Morning Light exercise e.g. walking/running Breakfast

 

Taking medication as assigned by the doctor
  Noon Lunch

resting

Medication
  Afternoon

3 – 5.00 pm

Snack/tea/porridge

Exercise-walking

Therapy session

 
  Evening

6 – 7 pm

  Medication
Day 4 Morning Light exercise e.g. walking/running Taking medication as assigned by the doctor
  Noon resting Medication
  Afternoon

3 – 5.00 pm

Assessment and Evaluation

Snack/tea/porridge

Therapy session

Review of medication

 
*      

*Schedule will follow the same cycle until his condition reaches stability levels that can be managed at home

Medication will include:

Medication Application and action
Angiuotensin-converting enzyme (ACE) Inhibitors At lower dose increasing it by the day
Beta-blockers Unblock artery pathways
Hydralazine in combination with nitrate Introduce in a ‘start low, go slow’ manner and assess heart rate, blood pressure after each titration
aldosterone antagonist  Monitor potassium and creatine levels after introduction of the medication to prevent hyperkalaemia and renal function deterioration
Diuretics Relieves congestive symptoms and fluid retention. It is titrated up and down
Aspirin To relieve chest pain caused by coronary heart disease

 

Care services

Type Design
Exercises Either individual or group based: reduces risk of the condition developing
Nutrition Strictly follow the dietician instruction,

Diet low in fat, sodium and sugar, complex carbohydrates, fruit and vegetables.

Socialization Reduces work stress, depression, anxiety and hostile personality which increases development of heart failure condition

 

 

Assessment/monitoring of:

·         Functional capacity

·         Blood test to check amount of serum urea, Creatinine and electrolytes

·         Fluid status

·         Thyroid and liver function test

·         Cardiac rhythm

·         serum potassium because he will taking aldosterone antagonist

·         Cognitive status

·         Nutritious status

 

MDT that will assist in provision of the healthcare services and Medication

·         dieticians

·         physiotherapist

·         doctors

·         discharge nurse

·         cardiologists

·         exercise physiologists

·         nurses with cardiology training

·         palliative care physicians

·         psychologists

 

Discharge policy requirement

·         Patient being able to perform self care  services

·         Low risk levels of disease worsening

·         Ability of the family to provide home care

·         Reduction of symptoms of chronic heart failure

 

References

Andrietta, M., Moreira, R. &  de Barros, A. (2011). “Hospital discharge plan for patients with congestive heart failure.” Vol.19 Issue 6, pp.1445-52

Bauer M, Fitzgerald L, Haesler E, et al. (2009). “Hospital discharge planning for frail older people and their family. Are we delivering best practice? A review of the evidence.” Journal of Clinical Nursing. Vol. 18 Issue 18, pp. 2539–46.

Bell, S. Ervin, N. & Lesperance M. (2006). “Heart Failure and weight gain monitoring.” Lippincotts Case Management. Vol. 10 Issue, pp. 287-93.

Cockburn J, Davison, PM, Newton PJ. (2008). “Unmet Needs Following Hospitalization with Heart Failure.” Journal of Cardiovascular Nursing. Vol. 23 Issue 6, pp. 541-6.

Griffith, S., Kwok, T., Lee, D., Lee, J. & Woo, J. (2008). “A randomized controlled trial of a community nurse-supported hospital discharge programme in older patients with chronic heart failure.” Journal of Clinical Nursing. Vol. 17 Issue 1, pp. 109-17.

Hauptman PJ, Rich MW, Heidenreich PA,et al. (2008). “The heart failure clinic: a consensus statement of the Heart Failure Society of America.” J Card Fail. Vol. 14, pp. 801–15.

Heart Foundation (2010). Multidisciplinary care for people with chronic heart failure Principles and recommendations for best practice. National Heart Foundation of Australia

MCcoy ML. (2006). “Care of the Congestive Heart Failure Patient: The Care, Cure and Core Model.” J Pract Nurse. Vol. 56 Issue 1, pp. 5-6

National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand (Chronic Heart Failure Guidelines Expert Writing Panel) (2006). Guidelines for the prevention, detection and management of chronic heart failure in Australia. Melbourne: National Heart Foundation of Australia

NHSScotland (2012). Heart Disease. Edinburgh: Scottish Intercollegiate Guidelines Network

NICE (2010). Chronic heart failure: Management of chronic heart failure in adults in primary and secondary care. Manchester: National Institute for Health and Clinical Excellence

Owan TE, Hodge DO, Herges RM et al. (2006). “Trends in prevalence and outcome of heart failure with preserved ejection fraction.” New England Journal of Medicine 355: 251–9

Paul S. (2008). “Hospital Discharge Education for Patients with Heart Failure: What Really Works and What Is the Evidence?” Crit Care Nurse. Vol. 28 Issue 2, pp. 66-82.

Petersen S, Rayner M, Wolstenholme J (2002). Coronary heart disease statistics: heart failure supplement. London: British Heart Foundation

Shepperd, S., McClaran, J., Phillips C., et al. (2010). “Discharge planning from hospital to home.” Cochrane Database Syst Review. Vol.20 Issue 1

Tidy, C. (2014). “Epidemiology of coronary Heart disease.” PatientPlus. Vol. 22. Document ID 2102. Retrieved January 14, 2015 from Patient.co.uk