Prepared By REENA YADAV

LECTURERPUSHPANJALI SCHOOL OF NURSING , AGRA

DISCHARGE OF THE PATIENT

DISCHARGEDischarge from the hospital means the departure from the hospital.

It can be formal discharge of the patient by attending doctor, when the patient treatment is over, Left Against Medical Advice (LAMA) due to personal reasons, the patient may abscond i.e leave the hospital without any prior information or the patient may expire during hospitalization.

 

systematic process for preparing the client to leave the health care agency and for continuity of care.

The key to successful discharge planning is an exchange of information among the client, present care givers and those responsible for care after release.

DISCHARGE PLANNING

PURPOSE OF DISCHARGE PLANNING:-

1. patient has the information on his or her condition, follow up schedule.

2. provide for a safe and efficient return of the patient clothing’s and other valuables

check that all the hospital equipments back to hospital.

3. avoid any misunderstanding or difficulty for the patient or hospital in relation to patient’s release; medicines, bills, dues or referrals etc.

PURPOSE OF DISCHARGE PLANNING

4. help the patient by making the safest arrangement possible for patient at the time of discharge.

5. assist the patient to manage successfully the change from hospital environment to home environment.

6. To provide continuity of care.

Exchange of information among-

The client

Patient care giver

Those responsible after discharge

KEYS TO SUCCESSFUL DISCHARGE PLANNING

DISCHARGE PLANNING MUST BE

Co-ordinate-Carefully planned Initiated as early as possible

Involving the client, family or significant care taker

KEYS TO SUCCESSFUL DISCHARGE PLANNING

TYPES OF DISCHARGE

STEPS OF DISCHARGE PROCESS

ASSESSMENT

DIAGNOSIS

PLANNINGIMPLEMENTATION

EVALUATION

ASSESSMENT:- l. HEALTH DATA ll. PERSONAL DATA lll. ENVIRONMENT lv. CLIENT OR FAMILY KNOWLEDGE

STEPS OF DISCHARGE PROCESS

ASSESSMENT:- l. HEALTH DATA- Clients’ age, sex, height, weight, diagnosis, past medical history, current health problems, surgery, functional limitation such as amputations, wheel chair or walker.

STEPS OF DISCHARGE PROCESS

ASSESSMENT:- ll. PERSONAL DATA- Ascertain how the client feels about discharge(as he anxious ?),

expectations for recovery –are they realistic ?

what has been their coping ability in the past- effective or ineffective?

What are their attitude and beliefs about health and illness.

STEPS OF DISCHARGE PROCESS

lll. ENVIRONMENT Includes both home and community.

Are there any structural barrier that would inhibit function – narrow stairs for a wheel chair –bound elderly client or caregivers;

Assistive device in bathroom,

Hot water, heat, available space.

iv. CLIENT OR FAMILY KNOWLEDGE

Assess the understanding of treatment plan and care regimen –

medication, side effects, client diagnosis, prognosis, emergency measures, complications and symptoms of impending problems

Anxiety related to inability of self care -Deficient knowledge regarding home care

-Ineffective family coping related to financial or personal support system.

-Self care deficit {e.g.-feeding, toileting, grooming, bathing etc) related to inability to use right hand.

NURSING DIAGNOSIS

-Impaired home maintaining management related to limited ability to shop for food and clean the house secondary to chronic respiratory illness.

NURSING DIAGNOSIS

By METHOD approach we should plan for care- M: MEDICATION The client will know•Drug name •What dosage to take and when to take.•Purpose of drug •Effect the drug should have •Symptoms of possible adverse effect and which ones to report.

PLANNING

E: ENVIRONMENTThe client will be assured of:

Adequate instruction in necessary homemaking skills.

Adequate emotional support.

Investigation of sources of economic support.

PLANNING

T: TREATMENT

The client and family will able to

Know the purpose of any treatment to be continued at home.

Be able to demonstrate correct performance of the treatment.

PLANNING

H: HEALTH TEACHING

The client will oDescribe how his or her disease condition affects body function

oDescribe the means necessary to maintain present level of health or achieve a higher level of health.

PLANNING

O: OUTPATIENT REFERRALThe client will able :

•Know when and where to keep clinical appointments.

•Know where and whom to call for medical help.

•Take home written discharge instructions.

PLANNING

D: DIET

The client will be able to

•Describe the purpose of his or her prescribed diet.

•Plan several typical menus using the prescribed diet.

PLANNING

IMPLEMENTATION

Before Day of Discharge

1. Suggest ways to change physical arrangement of home.2. information about community health care resources. 3. Gives opportunity to practice new readiness to learn, 4. conduct teaching session with client

Day of Discharge;-1. Let the client and family ask question or discuss issue-Allow for final clarification of related to home health care. 2. Check physician’s order for prescription,-Make sure that client receive all medicines and know how to take.3. Determine whether client or family has arranged transportation.-Prevent loss of personal items.

Day of Discharge;-- If patient has financial problem for arranging transport.- Offer assistance4. If patient has financial problem for arranging transport at the time of discharge, social worker may be contacted to arrange financial assistance.5. Offer assistance as a client dresses and packs -Prevent loss of personal items.personal belongings. Provide privacy as needed.

Day of Discharge6. Check all closets and drawers for belongings. Obtain client’s sign verifies receipt of items - copy of valuable list signed by client.7.Make sure that all the hospital charges are cleared i.e hospital bill, pharmacy bill etc and bill receipt handed over to client or family members.-Any missing of the articles is belonging are returned back to hospital before handing responsibility of nurse attended the over the discharge slip patient.

Day of Discharge8. Explain detail about the diet, medication and importance of follow up.9. If patient is unable to walk, wheelchair or trolley to carry him up to the transport.10. As a courtesy, wish him early recovery and good gives a sense of wellbeing.11. After the discharge of patient, the bed has to be to keep the unit ready for next use.12. Collect the patient records and complete it and enter it into dispatch book. -Complete the records.

E. EVALUATION:

1. Ask client or family member to describe nature of illness treatment regimen andphysical sign or symptom to be reported to a physician.

2. Have client or family member perform any treatment to be continued at home. 

WRITE DATE AND TIME OF DISCHARGE ON THE FOLLOWING

RECORD• Nurse’s record.

•Admission and Discharge register.

•Treatment book.

•Report book.

VARIOUS HOSPITAL PROCEDURES FOR DICHARGE:

PRIVATE SECTOR: care taker is informed to clear the medical bills and on producing the bill receipt the discharge slip.GOVT SECTOR: discharge slip is handed over to the patient\care giver as soon as discharge summary is prepared. Special Cases: In case of MLC, the hospital security is informed and the local police are informed about the discharge.

ELEMENTS OF WRITTEN DISCHARGE SUMMARY

FORM

FUMIGATION •Total surface exposure to formaldehyde gas under the condition of controlled humidity temperature and time exposure will destroy all vegetative forms of bacteria, viruses, and most of the spores.

•The best result can be obtained with highconcentration of gas , humidity above 60 and temperature of not less than 18 degree centigrade.

• The exposure time varies from 1 to 16 hours.• The agent commonly used for the fumigation are formalin tablets, ethylene oxide liquids etc.

BIBLIOGRAPHY1. Potter and Perry, CLINICAL NURSING SKILLS TECHNIQUE, Mosby, 5th edition, USA, Page no: 14-15.2. Cole Grace, BASIC NURSING SKILLS AND CONCEPTS, Mosby, Missouri, 1991, Page no: 36-37.3. Sorensen and Luckmann’s, BASIC NURSING, Library of congress cataloging, 3 rd edition, USA, 1994, Page no: 395-396.4. Christensen Barbara.L, Kochrow Elaine oden, FOUNDATION OF NURSING, Mosby, 2003, Missouri, Page no: 199-201.5. TNAI, FUNDAMENTALS OF NURSING, Secretary General on behalf of TNAI, 1 st edition, 2005, Page no: 134-136.

BIBLIOGRAPHY6. Lindeman Carol A, Meathie Marylov, FUNDAMENTALS OF CONTEMPORARY NURSING PRACTICE, W. B. Saunders, 1999, Philadelphia, page no: 255.7. Harkness Hood and Dincher, TOTAL PATIENT CARE-FOUNDATION AND PRACTICE OF ADULT HEALTH NURSING , Mosby, 8th edition, Page no. 127.8. Craven Ruth F, Hirnk Constance J , FUNDAMENTALS OF NURSING- HUMAN HEALTH AND FUNCTION, Lippincot 2000.9. Sr. Nancy, PRICIPLES AND PRACTISE OF NURSING, N.R Publication House, 1999, Page no344- 347.10. White lois, BASIC NURSING: FOUNDATIONS OF SKILLS AND CONCEPTS, Delmar, 2002, Page no. 152-154.11. WWW.Wikipedia.com.