Assessment and Requirements for Discharge

Main objective of this essay is to elaborate discharge planning for Angelo with focus on medical history, health status and social life. This essay will include aspects like planning, roles and responsibilities of each member of multidisciplinary team, incorporation of family members of patient and social worker in discharge planning and importance of effective communication. In this essay, potential and actual situations will be discussed for the discharge of Angelo. Holistic assessment of patient’s needs and preferences should be arranged for Angelo to return to his home and back to independence with minimal assistance. Nursing and Midwifery Council’s (NMC) professional code of conduct (2015) will be followed throughout the discharge planning. According to Data Protection Act (1998) and the Nursing and Midwifery Council (NMC 2015) all the information related to the patient will be kept confidential. Usually discharge planning is initiated from admission of the patient and there is a possibility of alteration depending on the outcome of patient’s recovery during his stay in the hospital. It is important that Family and friends is incorporated in discharge planning. Family members of the patient should be educated about the health status of the patient, diagnostic results, dose and frequency of medication administration, adherence to medication administration and diet. Family members need to be educated about the changes to care plan ato aid smooth transition back to the community. Views and wishes of the patient and family members need to be considered while designing discharge planning. The multidisciplinary team involved should make sure that patient is medically fit, and all the facilities are available for his discharge. Arrangements should be made for continuity of care after discharge and carers will be involved to help Mr Davies with his activity of daily living (ADL) should also twice a day. In the case of Mr Davies as he lives in a sheltered accommodation, the security should also be involved for him to increase his frequency of checking on Mr Davies. Therefore, in the case of Mr Davis, his Discharge planning is complex and should patient and family centred (Heath et al., 2015; Orlu-Gul et al., 2014).

Complexity of Discharge Planning for Lewy Body Disease

Discharge plan helps to ensure smooth and safe move of patient from hospital to home. Discharge plan is an ongoing procedure for safe movement of the patient without any complication from the hospital facility to the home or society.  In psychiatric patient like Angelo, there should be symptoms change for movement from hospital to society. Psychiatric patients might develop stigma of rejection from the society, hence this stigma should be addressed before discharge form the hospital. Assessment of the discharge should be based on the requirements and needs of the patient after discharge. Based on these requirements and needs of the patient, few patients need simple and other need complex discharge process. Angelo require complex discharge process because he needs to receive care from district nurses, general practitioner (GP), district nurses, and specialist nurse, community psychiatrist, occupational therapist, physio therapist, social worker and carers (see table 1) after discharge from the hospital.  MDT for the discharge of Angelo should comprise of nurse, doctor, care manager, occupational therapist, psychotherapist and discharge co-coordinators (Day et al., 2009). The nurse in charge of the discharge must be able to liaise with the social worker so that vital necessities and arrangements for Mr Angelo’s needs will be communicated effectively to eradicate fail discharge (Tochimoto et al., 2015). ( I edited this part and you can see how it makes sence) Angelo is awaiting discharge from the hospital following Lewy body dementia.  Lewy body dementia is the deposition of alpha-synuclein proteins in the brain which are termed as Lewy bodies. It results in problems in thinking, movement, behaviour, and mood. Lewy body dementia worsens condition of the patient gradually. Hence, long term care need to be provided to John. Lewy body dementia can affect patient both physically and mentally. It is evident in case of John also because he is being experiencing fall and hallucination. Fall and hallucination indicates both physical and mental impairment in John respectively.    (Kosaka, 2016). From the reports and profile of Angelo, it is evident that he received all the necessary care, attained satisfactory independence and he is exhibiting good progress. There can be burden on the caregiver for the management of LBD due to its complex nature. Hence, there should be incorporation of professionals from diverse fields like medical, nursing, pharmacy and social (Heenan and Birrell, 2017). (whats the relevance its repitition)

Incorporating Professionals from Diverse Fields

NMC Code of Professional Conduct (2015) was incorporated for independence, empowerment and maintenance of Angelo. Angelo’s dignity should be considered and community and social support should be provided to him after his discharge (see table 1) (Burnard et al., 2004). (grammar is bad still you fail to read the guildlines and follow the step no references to the table in the appendix)

Most of the patients with LBD are not responsive to antipsychotic medications, hence discharge planners need to consider this before making discharge plan. Hence, neurologist should be consulted and his input incorporated and follow up appointments need to be arranged  before Mr angelo is discharged (see table 1) Evidence based information related to unresponsiveness of antipsychotic drugs for LBD patients should be shared with healthcare providers (Boot et al., 2013) (what evidence please state and add reference). This information should be provided to the family members and they should be educated about it (see table 1). LBD patients like Angelo might experience sudden decline in the functioning and unacceptable behaviour. Hence, this type of emergency can be tackled effectively by providing this information to the family and carers that will be involved in his care while his at home, Caregiver should control emotions while making discharge plan for LBD patient like Angelo because there can be mixed emotions like loving, rewarding, anger and impatience while providing care to the LBD patient. Caregiver might have changed perception about Angelo due to his unacceptable behaviour due to LBD. Caregiver should only focus on health issue of Angelo keeping aside feelings about Angelo (please elaborate I don’t understand)(Cross et al., 2015).

There should be effective communication among members of MDT (multi-disciplinary team) to ensure smooth transition and safe discharge to the society. A meeting should be arranged involving the members of  MDT team, family members and social worker to facilitate a smooth discharge planning and implementation before Angelo is discharged from the  hospital. Effective communication can be helpful in making proper decisions for providing care with the available resources. Angelo and family members need to communicate to the MDT and influence decision making and proper person centered care that will meet all Angelo’s needs (see table 1) (Pethybridge, 2004).

Considerations for Medication Management

Angelo should be educated about the confusion and hallucination. MDT team should convince him that there is no existence of genomes (what is the relevance). He is also associated with conditions like Hypertension and Hyperlipidaemia. For these conditions, he need to consume medicines on the regular basis. However, due to diseased condition, he might forget to take medicines. Discharge co-ordinator should make all the arrangements to monitor his medication consumption on regular basis. Since, he was staying alone at home and falls occasionally, there should be arrangement for staying with him. Hence, there is incorporation of occupational therapist.  (good point but make it clear and use proper grammar in this case say that’s why the occupational therapist will be involved to make sure the house is safe for angelo to return back to by visiting his home and making sure all equipments , wires, and harful stuff that will cause mr Davies harm will be removed, key safe put in place , pendant alarm provided, just incase he falls so that help will come in time, carers will come in 3 times a day to give him food and make sure he takes his medication and also assist him with wash, shopping and cleaning the house, and helpwith his activity of daily living)

Patient participation in the hospital discharge can be helpful in establishing safe care. It can be helpful in improving patient satisfaction and reducing risk of hospital readmissions. Effective patient and family members participation can be achieved by integrated and co-ordinated care provide by MDT. Angelo should receive continued care after discharge, his social needs to be identified and holistic care needs to be provided to Angelo. Holistic care will include is social well-being, psychological, (list the holistic care) to Angelo should be provided for giving not only medical care but also to improve well being of Angelo (see table 2) (Dyrstad et al., 2015).

Long-term care (LTC) is necessary for Angelo because providing care to the patients like Angelo by social workers and carers for the longer duration would be difficult (a sheer contast you said its necessary , so give rational). Long-term care can provide care based on the individuals needs. Physical, mental and social well being of the patient like Angelo can be achieved through long-term care. Long term care not only consider therapeutic care but also other aspects like activities of daily living (ADL). ADL include bathing, toilet use, dressing and grooming, moving about and eating. LTC is necessary for Angelo to keep him healthy, to maintain his wellbeing and to protect him from injury. LTC can also be helpful for Angelo for improving access to care. Social support groups and family members should play significant role in improving access to care for Angelo because Angelo could be more accessible to these groups after discharge to provide LTC (this is repition but if it must be used in this contest then explain why clearly). It is evident that LBD patients face problems in terms of ADL and access to care. Challenges in care also need to be considered while providing LTC to Angelo. LBD is complicated with multiple symptoms. Hence, physician should consider only prominent symptoms which are more disturbing to Angelo (McKeith et al., 2009). There might be disagreement between caregiver and Angelo. Angelo might experience hallucination, however caregiver might not be agreed with him on his hallucinating state. Hallucination might be more disturbing to Angelo, however; caregiver might not consider as a serious issue for Angelo. On the other side, caregiver might be more concerned about the fluctuating memory of Angelo due to his confused state. In LTC, open discussion should occur between Angelo and caregiver because in LBD, medications useful for one symptom can exaggerate another symptom. LTC is not feasible for LBD patients in the hospital premises because hospital management try to avoid hospitalisation of LBD patients for longer duration. Due to consumption of neuroleptics, there might be behavioural manifestations in LBD patients and it can lead to adverse effects. Hence, effective discharge plan should be implemented for Angelo for timely discharge and arrangements should be made for LTC at home. Accessibility of Angelo for the outpatient physicians should be improved to avoid unnecessary hospitalisation (Blanc et al., 2017).   

Importance of Effective Communication

Coordination is most important aspect in the discharge process. Nurse need to play both shift discharge coordinator and full time discharge coordinator for Angelo. Discharge coordinators should perform the tasks of communication, functioning of MDT and assessment. Expected date of discharge for Angelo should be decided within 48 hours of admission to the hospital. However, it is difficult to implement strictly based on the needs of the patient. Hospital policy also need to be considered while deciding discharge date for Angelo (Lin et al., 2014). Making decision on the date of discharge as early as possible would be helpful in the preparation of discharge plan and its smooth implementation. However, date can be amended based on the reassessment of the patient condition and progress with respect to clinical management plan. Making decision on the date of discharge is based on the overall hospital capacity, progress of clinical outcomes and patient’s expectations. For effective discharge planning clinical management plan of Angelo should be reviewed on daily basis. Clinical management plan can be reviewed by implementing review, action, progress (RAP). Timely update of clinical management plan to MDT and Angelo is important aspect in discharge planning (see table 2) (Mortenson and Bishop, 2016).

In discharge planning, attention should be given to prevent readmission of Angelo to the hospital. Readmissions can be prevented by ensuring discharge checklist is completed, ensuring Angelo or his family members understands about diagnosis, medication consumption and side effects of medications, ensuring Angelo can visit GP after discharge from the hospital and ensuring Angelo is satisfied with the discharge process. Empowerment of Angelo and his family members in the discharge process is important aspect in discharge process. Patient expectations, complexities and challenges need to be considered for the empowerment of the patient. Medical and social care partners play significant role in the empowerment of the patient (Russell et al., 2014). Clinical referrals are important for the empowerment of patient. Empowerment can be achieved by providing support services like intermediate care and dementia care to Angelo. Involvement of patient in the discharge plan requires experience and patience. There should be operative discussion among patient, family members, MDT, discharge co-ordinator and social workers for the empowerment of the patient in the discharge process (Shepperd et al., 2013). Discharge checklist should be ready 48 hours prior to discharge. However, in most of the cases it is difficult to maintain same checklist at the time of actual discharge. Primary and social care involvement is required for preparing discharge checklist. Planning stage, pre-discharge and vital aspects of discharge should not be missed from the checklist (see appendix 3) (Soong et al., 2013).  

Educating the Patient and Family

Conclusion:

Discharge planning can be a tough job in case of patients with complex discharge. Discharge planning in case of Angelo is also a complex process. Effective discharge for Angelo can be achieved by incorporation of different professionals of MDT. LTC should be considered in the discharge process of Angelo. Planned discharge process proved to be useful in reducing unnecessary readmissions. Effective communication among MDT, Angelo and family members can provide person centred care to Angelo and also it can empower Angelo. Effective discharge planning is necessary to ensure timely discharge and continuity of care.  Please review again and refer to the table, one which will explain with definition of  the role of the multidisciplinary team which will be involved, table two will be for discharge planning, which will show assessment, goal, intervention and the rational. Please!!!!!!! I need to pass that’s why I am paying for it.

Reference:

Blanc, F., Mahmoudi, R., Jonveaux, T., et al. (2017). Long-term cognitive outcome of Alzheimer’s disease and dementia with Lewy bodies: dual disease is worse. Alzheimer’s Research & Therapy, 9(1):47. doi: 10.1186/s13195-017-0272-8.

Boot, B. P,  McDade, E. M., McGinnis, S. M.,  and Boeve, B. F. (2013). Treatment of Dementia with Lewy Bodies. Current Treatment Options in Neurology, 15(6), 738–764.

Burnard, P., Christine, M. C., and Susan, S. (2004). Professional and Ethical Issues in Nursing. Baillière Tindall.

Cross, N., Terpening, Z., Rogers, N.L., Naism et al. (2015). Napping in older people ‘at risk’ of dementia: relationships with depression, cognition, medical burden and sleep quality. Journal of Sleep Research, 24(5), pp. 494-502.

Day, M.R., McCarthy,G., and Coffey, A. (2009) Discharge planning: the role of the discharge co-ordinator. Nursing Older People, 21, (1), pp. 26-31

Dyrstad, D.N., Laugaland, K.A., and Storm, M. (2015). An observational study of older patients’ participation in hospital admission and discharge–exploring patient and next of kin perspectives. Journal of Clinical Nursing, 24(11-12), pp. 1693-706.

Greenhalgh, T. (2013).  Primary Health Care: Theory and Practice. John Wiley & Sons.

Heenan, D., and Birrell, D. (2017). The Integration of Health and Social Care in the UK: Policy and Practice. Macmillan International Higher Education.

Heath, H., Sturdy, D. and Cheesly, A. (2010) Discharge planning: A summary of the Department of Health’s guidance Ready to go. Planning the discharge and the transfer of patients from hospital and intermediate care. Harrow: RCN Publishing Company Ltd.

Housley, W. (2017). Interaction in Multidisciplinary Teams. Routledge.

Kosaka, K. (2016). Dementia with Lewy Bodies: Clinical and Biological Aspects. Springer.

Lin, R., Gallagher, R., Spinaze, M., et al. (2014). Effect of a patient-directed discharge letter on patient understanding of their hospitalisation. Journal of Internal Medicine, 44(9), pp. 851-7.

McKeith, I. (2009). Top cited papers in International Psychogeriatrics: 1. Long-term use of rivastigmine in patients with dementia with Lewy bodies: an open-label trial. International Psychogeriatrics,  21(1), pp.  5-6.

Mortenson, W.B., and Bishop, A.M. (2016). Discharge Criteria and Follow-Up Support for Dementia Care Units. Journal of Applied Gerontology, 35(3), pp. 321-30.

Orlu-Gul, M., Raimi-Abraham, B., Jamieson, E., Wei, L., Murray, M., Stawarz, K., Stegemann, S., Tuleu, C. and Smith, F.J. (2014) Public engagement workshop: How to improve medicines for older people?. International journal of pharmaceutics, 459(1), pp.65-69.

Pethybridge, J. How team working influences discharge planning from hospital: a study of four multi-disciplinary teams in an acute hospital in England. Journal of Interprofessional Care, 18(1), pp. 29-41.

Russell, P., Hewage, U., and Thompson, C. (2014). Method for improving the quality of discharge summaries written by a general medical team. Internal Medicine Journal, 44(3), pp.298-301.

Shepperd, S., Lannin, N.A., Clemson, L.M., et al. (2013). Discharge planning from hospital to home. Cochrane Database of Systematic Reviews,  31, (1):CD000313. doi: 10.1002/14651858.CD000313.

Soong, C., Daub, S., Lee, J., et al. (2013). Development of a checklist of safe discharge practices for hospital patients. Journal of Hospital Medicine, 8(8), 444-9.

Tochimoto, S., Kitamura, M., Hino, S., and Kitamura, T. (2015). Predictors of home discharge among patients hospitalized for behavioural and psychological symptoms of dementia. Psychogeriatrics, 15(4), pp. 248-54.

Whitworth, H.B., and  Whitworth, J. (2010). A Caregiver’s Guide to Lewy Body Dementia. Demos Medical Publishing.

Zun, L.S. (2013). Behavioral Emergencies for the Emergency Physician. Cambridge University Press.