In this essay, discharge planning of Angelo will be discussed. In planning and practicing discharge for Angelo, different aspects like his medical and social history, also current medical condition will be considered. Multidisciplinary team (MDT) will be incorporated in his discharge planning and Angelo and his family members will be encouraged to actively participate in the discharge planning. Coordination among all the stakeholders can be effectively maintained through communication. Exact condition of the Angelo will be considered and also possible complications also will be considered while designing discharge plan. Smooth transition of Angelo to the society can be achieved by providing holistic care by incorporating interventions for physical, physiological, pathological and psychological condition of Angelo. Requirements of Angelo and his family members will be considered and preference will be given to fulfil these requirements. Family members of Angelo should be informed about all the aspects of Angelo. These aspects include, medical condition of Angelo, diagnosis, schedule of medication administration, adherence to medication and nutritional requirements of Angelo. Discharge planning for Angelo will be planned and executed according to Nursing and Midwifery Council’s (NMC) professional code of conduct (2015). All the information related to Angelo will be kept confidential according to guidelines of Data Protection Act (1998). Discharge planning foe Angelo should be initiated since he got admitted to the hospital. Based on the, health status of Angelo discharge planning can be changed to provide effective discharge to Angelo. Family members should be educated about the care to be taken at the home. Prior to discharge, it should be sure that Angelo is with improved medical condition and all the requirements for the discharge are fulfilled. Continued care after discharge should be arranged for Angelo after discharge from the hospital. Prepared discharge plan for Angelo should be person centred (Heath et al., 2015; Orlu-Gul et al., 2014).
During preparation of discharge plan, patient should be assessed based on the current health status and potential complications. Based on the assessment, some of the patients require simple discharge plan. On the other hand, few patients require complex discharge plan. Angelo requires complex discharge plan because he is associated with multiple health issues like hypertension, hyperlipidaemia and Lewy body dementia. LBD patients are associated with symptoms like visual hallucination, movement disorder, poor regulation of body functions, cognitive problems, sleep difficulties and depression. Hence, Angelo should be provided with care from multiple professionals like doctors, nurses, occupational therapist, dietician and social worker. (Tochimoto et al., 2015). Anxiety in the Angelo can be reduced by minimizing sensory stimulation. Angelo is going to be discharged from the hospital after diagnosis of Lewy body dementia. Lewy body dementia is a pathological condition in which there is deposition of alpha-synuclein proteins in the brain which are called as Lewy bodies. It leads to problems in thinking, movement, behaviour, and mood. Lewy body dementia patients exhibits progressive decline in the physical and mental abilities. These patients also exhibit mental disturbance like hallucination, alteration in alertness and attention. (Kosaka, 2016). Angelo received all the necessary care, exhibiting acceptable discharge and exhibiting satisfactory progress (Heenan and Birrell, 2017).
NMC Code of Professional Conduct (2015) 2.3 was followed for the enabling independence and empowerment of Angelo. Due to this Angelo can participate in decision making for treatment and care. Social support should be provided for Angelo to maintain his dignity and to improve his morale (see table 1) (Burnard et al., 2004). Discharge planner should make an account that antipsychotic drugs are not going to be helpful for LBD patients and should make discharge planning accordingly after consultation with neurologist. Healthcare providers should follow evidence-based information for care of Angelo and this information should be shared with his family members. Evidence based information related to unresponsiveness of antipsychotic drugs for LBD patients need to be provided to family members (Boot et al., 2013). This information can be helpful in educating Angelo’s family members. It is evident that, LBD patients can experience emergency situations like drastic decrease in functioning and unfavourable behaviour. Hence, Angelo and his family members should be educated with education use, food and medicine allergies and health insurance. Even though caregiver and discharge planner need to provide person centred care to Angelo, they need to be professional while providing care and preparing discharge plan. They need to leave behind emotions while preparing discharge plan for Angelo. In LBD patients there might be unacceptable behaviour and due to this behaviour care provider might have changed perception about Angelo. Care provider should not take into account this emotional change about Angelo while providing care to him (see table 2) (Raymond et al., 2014).
Assessment of mental condition is an important aspect in the patients with LBD patients. Assessment can be performed by performing objective test. This can be useful in assessing different tasks. MDT comprising of nurse, doctor, care manager, occupational therapist, psychotherapist and discharge co-coordinators should work in coordination for effective discharge of Angelo (see table 1) (Day et al., 2009). Discharge planning incorporates multiple stakeholders and effective communication among all the stakeholders is very important. Effective communication among different stakeholders can be helpful for smooth and safe discharge of Angelo. Effective communication among different stakeholders of MDT team can be helpful in precise decision making. MDT should communicate with Angelo and family members and enforce them to participate in the decision making (Pethybridge, 2004). There can be impairment of communication in patients with dementia. Hence, special tools need to be developed and implemented for communication in LOB patients. Communication can be also be helpful in the educating Angelo and his family members about his health condition. Angelo is claiming that he is experiencing presence of genomes. However, care providers and psychiatrics should educate him that it is only hallucination due to his confused state. As such, there would not be existence of such genomes. Other than Lewy body dementia, Angelo is also suffering through hypertension and hyperlipidaemia. For these health issues, he need to consume medicine consistently for the longer duration. Discharge planner should make sure that he would consume medicines regularly by arranging stay of nurse at his home (see table 2).
Patient participation is an important aspect in discharge planning because it can be helpful in safe transition to society, improving patient fulfilment and lessening risk of readmissions. Discharge planner should co-ordinate with Angelo and his family to improve their participation in the discharge planning (Pearce, 2016). For providing holistic care for Angelo in the regular basis his medical and social needs to be identified. By providing holistic care to Angelo, his well-being can be effectively improved.
Long-term care (LTC) should be considered for Angelo because he is associated with multiple conditions like hypertension, hyperlipidaemia and Lewy body dementia. LTC care for patients usually decided based on the medical and social requirements of the individual patients. Medical and social care to Angelo can be effectively provided by LTC. Activities of daily living (ADL) should be incorporated in LTC of Angelo. Support for ADL to dress, toilet use bath, to groom and to eat should be extended to Angelo. LTC in the form of ADL can be helpful for Angelo to remain healthy, to improve wellbeing and to protect from injuries because Angelo is being prone to fall (see table 2). LBD can produce slowed reflexes, impaired reasoning and heightened risk-taking ability. These are the reasons responsible for fall and injury in LBD patients. Access to care in case of Angelo can be improved by LTC. Access to care can be improved with the help of community groups and family members (Holland et al., 2013). LBD patients are usually isolated from the society and unable to perform their own tasks. Hence, LTC should be incorporated in the care of LBD patients to help them in ADL and to improve access to care. Provision of care to LBD patients is associated with multiple factors, hence these patients face problems in receiving care for the longer duration. Providing intervention to LBD patient can be more complicated due to its manifold symptoms. Healthcare professionals should focus on the symptoms which can disturb Angelo prominently (McKeith et al., 2009).
There can be disagreement between healthcare provider and Angelo for the potential or actual symptoms of LBD (Popejoy et al., 2012). Hallucination experience of Angelo might not be acceptable for healthcare provider as the prominent symptom for Angelo. At the same time, Angelo might get ore disturbed due to his hallucination. Conversely, healthcare provider might be considering loss of memory and confusion as the prominent symptoms for Angelo. In LTC, exaggerating symptoms in the LBD patients might change over the period of time. Hence, there should be open and healthy discussion between Angelo and healthcare provider to focus on the particular symptom. It is evident that in psychiatric conditions including LBD, treatment of one symptom can exaggerate another symptom. LBD patients need to consume neuroleptics. Due to consumption of neuroleptics, there might be behavioural changes on the LBD patients. These behavioural changes might be unacceptable to other people. Hence, it is advisable not to provide LTC to the LBD patients in the hospital facility. Hence, Hospital authorities try to avoid hospitalisation of LBD patients for the longer duration. Hospital authorities need to make arrangements for LTC at home for Angelo and approachability of outside healthcare professionals should be improved for Angelo to avoid unnecessary hospitalisation (Kramberger et al., 2017).
Outcome of the discharge planning can be effectively improved by effective coordination among the stakeholders engaged in the discharge planning. Nurse need to coordinate both at the shift change and at the time of discharge from the hospital. Discharge coordinators can perform their duties by effective communication among all the members of MDT. Potential date of discharge should be declared on or before hours of admission of Angelo to the hospital. Though, it is not feasible always to declare date before 48 hours of admission because patient’s health status and requirements need to be considered while deciding discharge date. For each patient, there might be different condition. Discharge date is also depending on the hospital authorities and hospital policy. (Zurlo and Zuliani, 2018). Early decision on discharge planning can be helpful in preparing effective discharge plan and its operative implementation. There are varied aspects responsible influencing date of discharge. These include hospital capability, progress of clinical intervention and patient’s requirements. Clinical progress of Angelo should be reviewed on daily basis by implementing review, action, progress (RAP). Clinical progress should be updated on daily basis to MDT and Angelo and his family members (Mortenson and Bishop, 2016).
Discharge checklist can be used as effective tool to assess effective implementation of discharge planning. Success in discharge panning reflects in reduced hospital readmissions. Checklist reflects excellence of discharge planning. Hospital readmissions can be prevented by providing information related to diagnosis and medication consumption to the Angelo and his family members. Discharge co-ordinator should ensure that Angelo is approachable to GP post discharge and gratified with the discharge process. Discharge co-ordinator should also ensure that Angelo and his family members are empowered to participate in decision making in discharge planning. Patient empowerment is necessary to fulfil patient’s expectations and to resolve their challenges. Patient empowerment in the discharge planning can be improved by incorporation of both social and medical stakeholders (Russell et al., 2014). Discharge coordinator should be bringing effective communication among Angelo. MDT and social workers to improve Angelo’s empowerment in the discharge planning. Clinical referrals should be made for Angelo, so that he can independently visit these healthcare facilities and avoid hospital readmissions (see table 2) (Shepperd et al., 2013).
Approximately 48 hours before discharge, discharge checklist should be ready for Angelo. However, it is not always feasible to prepare checklist before 48 hours discharge due to varied conditions for different patients. Discharge checklist should comprise of all the medical, social and personal needs of Angelo. All the aspects related to planning stage, pre-discharge and important facets of actual discharge should be incorporated in the discharge checklist (Soong et al., 2013).
Conclusion:
In case of complex discharge process, discharge planning requires more attention. In case of Angelo, discharge planning is a complex process due to his multiple disease condition. Appropriate discharge for Angelo can be achieved by incorporation of MDT which comprises of stakeholders from both medical and social filed. Since, he is associated with multiple disease for the longer duration, LTC should be considered for him. Coordination and communication among different stakeholders can be helpful in reducing readmissions to the hospital. Appropriate discharge planning is necessary for empowerment of Angelo and permanency of care.
Reference:
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