Drowning: Discharge Planning (Nursing)

00:00 You as a nurse will play a critically important role in discharge planning.

00:04 You're the one who knows that patient better than anyone else.

00:08 So you want to make sure that you know what to look for, and how to ensure your patient is safe and ready for discharge.

00:15 So in this video we're going to talk about discharge planning.

00:17 Now, this is necessary for any diagnosis.

00:20 But in this case we're going to look at an example of a patient who experienced drowning. Now every patient has discharge criteria, right? These are the decisions that have to be thought through, to know that the patient will be safe wherever they're being discharged to, because there's more than one option for where someone can be discharged.

00:38 Most of us want to go home.

00:40 Everybody wants to go home.

00:42 But let's look at all the discharge options.

00:45 Now the patient can be discharged home with or without services like home health or home PT or other outside community resources.

00:53 They could be discharged to inpatient rehab.

00:57 This is someone who we think can be discharged to a lower level of care, but they're going to have to go to rehab first and see if they can make progress.

01:05 Now, if they go to a long term acute care, that is what it says.

01:10 This is going to be a longer stay than like an inpatient rehab.

01:14 And this is someone who needs extra care, but they wouldn't be able to tolerate or make the progress necessary in inpatient rehab.

01:22 They might go to a skilled nursing facility.

01:25 Sometimes these are housed in hospitals.

01:27 It's just another unit in the hospital.

01:29 Sometimes they're housed in nursing homes.

01:31 So there is a difference between skilled nursing facility and long term acute care. But each place varies.

01:38 So you're going to need to be familiar with the agencies in your area.

01:42 The social worker in the case manager can be really helpful in helping outline that.

01:47 Now, the last one is probably the saddest one because if you have a pediatric patient, you might need to consider a specialized pediatric care facility.

01:57 Okay. So there's the options when you as a nurse are coordinating the discharge planning. Those are some examples of possible discharge destination options. Now for the sake of this example we're just using drowning.

02:10 But we're really focusing on what you do as a nurse in discharge planning what you want to make sure the patient is stable: hemodynamically, neurologically respiratory, all of it.

02:20 We want to make sure the patient isn't deteriorating, but they're stable. So we want to make sure let's start at the top.

02:26 Neuro wise, they're appropriate for whichever discharge setting you're sending them to. Respiratory wise, do they need oxygen and do they not need oxygen? You want to make sure that whether they're going home or being discharged on oxygen, is it enough to support their saturations with walking or doing activity? Hemodynamic stability means their blood pressure is going to be where you need it to be. Not too low, not too high, and you want to make sure they that they don't have any episodes of orthostatic hypotension.

03:00 Now, adequate nutrition and hydration is always an issue the patient may have. They may not feel like eating.

03:07 They may have difficulty eating.

03:08 So you want to make sure that is covered.

03:10 These are the things that you'll be thinking through. Wherever we're discharging them, will they be able to get adequate food and nutrition and will they stay hydrated? What about pain? Is this patient having any pain? You want to make sure that that pain is controlled.

03:25 And there's a plan for managing that.

03:27 And next, appropriate follow up depending on where they're being discharged. Do we already have lined up what the appropriate follow up is? And do they have all the information they need to make that appointment.

03:41 Now, if they're going home, we really need to do some type of assessment of their home for safety.

03:46 If it was a drowning patient, we'd want to know what the plan was for water safety. If that happened at home, we want to make sure if they need equipment or modifications, we make that available to them.

03:56 They may have stairs in their house that they're not able to climb or ascend.

04:00 So, you want to make sure that they have the equipment they need.

04:04 There's a bathroom that's accessible to them that they can get to if they need to get into the bathroom with a walker.

04:10 They're able to do that.

04:11 These are questions that family may not think about when they're middle and when they're in the middle of this experience.

04:17 So you need to be the one to ask these questions, or involve your OT and your PT to make sure you have some type of home assessment. Also, can they care for themselves safely or do they need to have some type of caregiver and is it available? Is there a caregiver available to them and are they capable to help.

04:37 It's really difficult to send an older client in their 90s home, if the only one that can care for them is their spouse, who's close to 100. You want to make sure that the caregiver willing is great, but they have to be physically and mentally able to provide that care.

04:55 Now you want to set them up for success in follow up care when you as the nurse or coordinating discharge planning.

05:00 So you want to make sure if they need a follow up for any system head, heart, lungs, GI, whatever it is, those follow up appointments are made and the patient has access numbers on how to follow up with that.

05:13 They're also likely going to need to see their primary care provider.

05:16 If they need outpatient therapy, that should be in there or home health services. This is your role as a nurse to make sure that all these specialties are in one place.

05:27 So the patient has the information and their caregiver has the information so they know all the things they need to do to safely follow up for their loved one.

05:36 Now, when it comes to equipment and supply needs, there can be a million things that they need. Oxygen therapy is a big one.

05:43 Suction equipment may be something they need that might.

05:46 Assistive devices consist of anything from a spoon with a big handle, so that someone who can't close their hand or grip can use that to feed themselves. They might need supplements.

05:58 They might need difficulty with medication access.

06:01 I know from my mom when we discharged her home, we have a medication machine on her counter that dispenses the correct medications at the correct time and alarms to remind her to take them.

06:12 So you want to make sure for each particular patient, you know what their needs are, what their abilities are, and make sure they have enough equipment and supplies to be safe at home.

06:22 Now, the caregivers might need training.

06:24 They might need training in respiratory care techniques or how to give the medications.

06:28 Maybe there's a complicated timing for the medications that have to be given.

06:32 I have I've written out many a medication plan so that patients clearly understand what should be given, when and what to do if they miss a dose. So you want to make sure they have some type of system in place that they can keep track of, whether they've taken their medications or if they've missed a medication, and what to do.

06:51 In both cases, you want them to have an emergency response plan.

06:54 You want to make sure the caregiver knows how to take care of the equipment.

06:57 And most important, make sure the caregiver knows what to look for. That would be signs that indicate the client is deteriorating.

07:07 So when you're training the caregiver, go slow and steady and don't overwhelm them.

07:14 The worst possible time to do caregiver training is when they've stayed in the hospital as an admin patient, and at the end, as they're wanting to get out the door, you should be giving them little bits of training and education as you go along so they can absorb it.