Implementation of a patient progress diary for stoma patients living with dementia

2021 ◽  
Vol 30 (22) ◽  
pp. S34-S38
Author(s):  
Lorraine Coston ◽  
Judy Pullen
Keyword(s):  
Positive Feedback ◽  
Discharge Planning ◽  
Ageing Population ◽  
Ward Staff ◽  
Traffic Light ◽  
National Guidelines ◽  
Effective Discharge ◽  
Dementia Patients ◽  
Patient Advice ◽  
Stoma Care

With an ageing population and an increase in the prevalence of dementia, stoma care nurses (SCNs) are experiencing greater challenges in their role supporting this group of patients with their stoma care. Following concerns raised in our department by relatives about the care and teaching provided in this area, with patients occasionally denying having even seen an SCN, the need for a visual tool to enable timely interventions and increase knowledge for family, carers and ward staff became apparent. There is a comprehensive list of local and national guidelines underlining the need to provide more support and an increased comprehensive teaching plan specially tailored to dementia patients’ needs. The development of a patient progress diary, with a traffic light system showing each stage that the patient has reached, has provided a visual, up-to-date guide to the patient’s stoma management and highlights the need for further input to enable the patient to be discharged home safely and in a timely manner. The diary was formulated by the SCNs and printed by Coloplast, culminating in an easy-to-read booklet with a pictorial step-by-step guide to be inserted into patients’ washbags. The diary was reviewed by Great Western Hospitals Patient Advice and Liaison Service (PALS) and the Carers Committee, who provided positive feedback and subsequently supported the development of this patient-focused tool. Since introducing the diary, our team has decided to implement it with all patients, with positive feedback from patients, relatives, carers and ward staff. This has assisted in safe, timely and effective discharge planning.

scholarly journals Use of the Flugelman index for identifying patients who are difficult to discharge from the hospital

2013 ◽  
pp. 103-108
Author(s):  
Chiara Bozzano ◽  
Ilario Lancini ◽  
Elena Mei ◽  
Maida Lucarini ◽  
Roberta Mastriforti ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Hospital Stay ◽  
Discharge Planning ◽  
District General Hospital ◽  
Feeding Problems ◽  
Care Needs ◽  
Socioeconomic Condition ◽  
Factors Affecting ◽  
Effective Discharge ◽  
Medical Wards

Introduction: To evaluate the use of multidimensional assessment based on the Fluegelman Index (FI) to identify internal medicine patients who are likely to be difficult to discharge from the hospital. Materials and methods: Have been evaluated all patients admitted to the medical wards of the District General Hospital of Arezzo from September 1 to October 31, 2007. We collected data on age, sex, socioeconomic condition, cause of admission, comorbidity score preadmission functional status (Barthel Index), incontinence, feeding problems, length of hospitalization, condition at discharge, and type of discharge. The FI cut off for difficult discharge was > 17. Results: Of the 413 patients (mean age 80 + 11.37 years; percentage of women, 56.1%) included in the study, 109 (26.39%) had Flugelman Index > 17. These patients were significantly older than the patients with lower FIs (85 + 9.35 vs 78 + 11.58 years, p < 0.001), more likely to be admitted for pneumonia (22% vs. 4.9% of those with lower FIs; p < 0,001). They also had more comorbidity, loss of autonomy, cognitive impairment, social frailty, and nursing care needs. The subgroup with FIs>17 had significantly higher in-hospital mortality (30.28% vs 6.25%, p < 0.001), longer hospital stay (13 vs. 10 days, p < 0.05), and higher rates of discharge to nursing homes. Conclusions: Evaluation of internal medicine patients with the Flugelman Index may be helpful for identifying more critical patients likely to require longer hospitalization and to detect factors affecting the hospital stay. This information can be useful for more effective discharge planning.

Discharge from hospital and early supported discharge

2020 ◽  
pp. 345-352
Author(s):  
Catherine Gaynor
Keyword(s):  
Discharge Planning ◽  
Models Of Care ◽  
Effective Discharge ◽  
The United Kingdom ◽  
Early Supported Discharge ◽  
Hospital To Home ◽  
Discharge From Hospital ◽  
Applied Health Research

‘Discharge from hospital and early supported discharge’ provides some useful guidance and outlines the issues that we encounter in facilitating effective discharge from hospital following a stroke. Hospital discharge is an important milestone in a stroke patient’s journey. It marks the end of the acute hospital episode, and the start of a new life living with and adjusting to their stroke and its sequelae. It can be a stressful time for patients and their carers, but careful and thorough discharge planning can help to ease the transition from hospital to home. The chapter explores the timing of discharge, models of care after discharge, early supported discharge, the evidence from SSNAP (Sentinel Stroke National Audit Programme) in the United Kingdom, the initiative of CLAHRC (Collaborative for Leadership in Applied Health Research and Care), guidance from the National Institute for Health and Care Excellence (NICE), institutionalization, role of capacity, role of IMCA (independent mental capacity advocate), communication with primary care, and follow-up after discharge from hospital.

Effective Discharge Planning And The Neurosurgical Nurse

1984 ◽  
Vol 16 (2) ◽  
pp. 101-106
Author(s):  
Joanne V. Hickey ◽  
Janice E. McKenna
Keyword(s):  
Discharge Planning ◽  
Effective Discharge

Effective discharge planning - timely assignment of an estimated date of discharge

2011 ◽  
Vol 35 (3) ◽  
pp. 357 ◽  
Author(s):  
Lixin Ou ◽  
Jack Chen ◽  
Lis Young ◽  
Nancy Santiano ◽  
La-Stacey Baramy ◽  
...  
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Older Patients ◽  
Discharge Planning ◽  
Index Score ◽  
Charlson Index ◽  
Effective Discharge ◽  
Delayed Discharge ◽  
Chronic Morbidity ◽  
English Speaking

Objective. To examine the implementation of estimated date of discharge (EDD) for planned admissions and admissions via the emergency department, to assess the variance between EDD and the actual date of discharge (ADD), and to explore the determinants of delayed discharge in a tertiary referral centre, Sydney, Australia. Methods. Primary data from a convenience sample of 1958 admissions for allocation of EDDs were linked with administrative data. The window for assigning EDDs for planned admissions was 24 h, for admissions via the emergency department it was 48 h. Logistic regression models were used to examine the key factors associated with an EDD being assigned within 24 h or 48 h of an admission. An ordinal logistic regression model was used to explore the determinants of delayed discharge. Results. Only 13.4% of planned admissions and 27.5% of admissions via the emergency department were allocated a timely EDD. Older patients, patients with significant burdens of chronic morbidity (OR = 0.903; P = 0.011); and patients from a non-English-speaking background (OR = 0.711; P = 0.059) were less likely to be assigned a timely EDD. The current Charlson Index score was a significant predictor of a positive variance between EDD and ADD. Conclusions. The prevalence of the timely assignment of an EDD was low and was lowest for planned admissions. The current Charlson Index score is an effective tool for identifying patients who are more likely to experience delayed discharge. What is known about the topic? Failure to assign an EDD is one of the major barriers to implementing effective discharge. Establishing an EDD for a patient within 24 h of an admission is thought to be a measure of efficient and high quality discharge planning. What does this paper add? Older patients, patients with significant burdens of chronic morbidity, and patients from a non-English-speaking background were less likely to be assigned a timely EDD. The current Charlson Index score was a significant predictor of a positive variance between EDD and ADD. What are the implications for practitioners? A significant gap existed between policy and the implementation of assigning EDD in a large sample of discharges. Effective discharge planning may be obstructed by failure to assign an EDD at the time of admission.

scholarly journals The Role Of The Pediatric Nurse In Discharge Planning; Identifying Gaps In Sri Lanka

2021 ◽  
Vol 5 (1) ◽  
pp. 36-50
Author(s):  
Kalpana Jeewanthi Subasinghe ◽  
A.M. Shyama Deepanie Pathiranage
Keyword(s):  
Sri Lanka ◽  
Planning Process ◽  
Transitional Care ◽  
Discharge Planning ◽  
Pediatric Population ◽  
Discharge Process ◽  
Sri Lankan ◽  
Care Coordinator ◽  
Pediatric Nurse ◽  
Effective Discharge

Background: Pediatric discharge planning is a complex process, and that nurses need lengthy preparations. Role confusion among nurses will disrupt the smooth planning of the discharge. In Sri Lanka, although there is a possibility of reducing health costs through effective discharge planning led by pediatric nurses, it is questionable whether Sri Lankan nurses have clarified their role in this process.Method: This systematic review was conducted to map the different roles of nurses in the pediatric discharge planning process. Electronic databases of PubMed and CINAHL were searched for peer-reviewed journal articles among the pediatric population from 2005-2019, using the keywords such as discharge planning, pediatric nurse, care transitions, transitional care, and Sri Lankan nurse.Results: Articles that resulted in the word combination ‘Discharge planning and pediatric nursing (n=329) were used for screening. Two hundred and forty articles out of the nursing scope and sixty articles that do not describe an apparent nursing involvement in the discharge process were excluded, based on abstract review and full-text review, respectively. Sixteen studies were included in the final review. Few literature was found on the topic among Sri Lankan pediatric population. Four main categories of nurses’ roles were identified with the thematic analysis: discharge educator, discharge collaborator, post-discharge care coordinator, and family counselor. Conclusion: In Sri Lanka, no such defined roles of a nurse have been established yet in the discharge planning of pediatric patients. These roles may help nurses carry out discharge planning effectively, and future studies are needed on this topic in Sri Lanka.

Improving patient care after a suicide attempt

2018 ◽  
Vol 26 (2) ◽  
pp. 145-148 ◽  
Author(s):  
Fiona Shand ◽  
Laura Vogl ◽  
Jo Robinson
Keyword(s):  
Suicide Attempt ◽  
Discharge Planning ◽  
Psychosocial Assessment ◽  
Coordinated Care ◽  
Effective Discharge ◽  
Effective Care ◽  
Increased Risk ◽  
Discharge From Hospital ◽  
Improving Patient Care ◽  
Risky Patients

Objectives: Improving the care that patients receive after a suicide attempt will reduce the risk of a subsequent suicide attempt. We described how care for these patients can be improved and identified the available guidelines. Methods: We reviewed the literature on crisis and aftercare, psychosocial assessment, risk assessment, brief contact interventions, and brief interventions. Results: People who have made a suicide attempt are at increased risk of suicide, and the period immediately after discharge from hospital is particularly risky. Patients require an empathic response at their first point of contact, comprehensive psychosocial assessment, effective discharge planning, rapid and assertive follow-up, and coordinated care in the subsequent months. Conclusions: Empathic and effective care that begins in the emergency department and extends through to community care is imperative. Enough is known about the risks of inadequate care and the key ingredients of effective care to proceed with changes to Australia’s healthcare response to a suicide attempt.

62 Geriatric Surgical Liaison Staff Perspectives of Geriatric Care Before and After Introduction of An Embedded Service

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i18-i20
Author(s):  
K Shah ◽  
R Kyzy ◽  
H Pittaway
Keyword(s):  
Older Patients ◽  
Discharge Planning ◽  
Adverse Outcomes ◽  
Ageing Population ◽  
Emergency Setting ◽  
Complication Rates ◽  
Before And After ◽  
Key Indicators ◽  
The Impact ◽  
Multi Disciplinary Team

Abstract Introduction National evidence demonstrates that older people having surgery, both in the elective and emergency setting, have more adverse outcomes postoperatively when compared with their younger counterparts (1). National reports have recommended daily input from a geriatric team for older patients having surgery (2). At our hospital we have introduced a geriatric surgical liaison consultant as a formal post to ensure daily geriatric input or review for patients over the age of 70 or comorbid younger patients as requested. The aim of this study was to review perspectives across the multi-disciplinary team on care provided to these patients before and after introduction of the surgical liaison team. Methods We created a 10 part questionnaire, which was distributed amongst all members of the multi-disciplinary team, asking them to rate confidence out of 10 in management of comorbidity, polypharmacy, discharge planning, pain assessments and nutrition. These data were then analysed to produce median scores for each category before and after the introduction of the service. We compared the change in scores between the foundation year 1 (FY1) doctors and the remainder of the respondents. Results The below table demonstrates the median scores across all 36 respondents in their confidence with the assessment and management of the 10 key domains before and after the liaison service was introduced: Conclusions Universally within our survey, staff reported improvement in all 10 key indicators of care of older patients on surgery with the introduction of a geriatric surgical liaison team. Greatest benefit was seen within the FY1 group. References 1. McVeigh TP, Al-Azawi D, O'Donoghue GT, Kerin MJ. Assessing the impact of an ageing population on complication rates and in-patient length of stay, Int J Surg, 2013, vol. 11 (pg. 872–5). 2. Wilkinson K. An age old Problem: A Review of the Care Received by Elderly Patients Undergoing Surgery: A Report by the National Confidential Enquiry Into Patient Outcome and Death. London, 2010.

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