Western Governors University
Discharge Planning Task 724.2.4-01-07
Successful discharge planning is not something that should be initiated when the patient is ready to go home, but should be discussed prior to the surgery being performed if possible. The total hip replacement that Mr. Trosack is recovering from was not a planned surgery so case management should have begun working on this once he was admitted to the floor postoperatively. Healthcare Issues and Their Importance
There are numerous healthcare issues that must be considered in discharge planning for Mr. Trosack to ensure that medical, social and functional issues related to his recovery have been evaluated. Safety is a very important healthcare issue that must be addressed prior to discharge. As with most patients over the age of 65, Mr. Trosack is at high risk for a fall for various reasons. 33% of this age group experience one fall per year and commonly involve falling down stairs or steps (Heasley, Buckley, Scally, Twigg, & Elliott, 2005). He lives on the second floor of an apartment building that has no elevator so he must maneuver a long flight of steps to enter or leave his apartment. In addition to this, he has a small apartment that is cluttered with WWII .memorabilia and furniture which increase his chances of tripping and falling. Mr. Trosack has recently been diagnosed with hypertension and noninsulin dependent diabetes which will present another healthcare issue and result in a lifestyle change for him. Previously, he was not taking any prescription medications and expressed displeasure about having to take the Lopressor and Glucophage now. Although he was educated and demonstrated competency in the hospital on use of a glucometer, this will necessitate a change in his daily routine and be a difficult adjustment. This may also present some challenges for him due to his vision problems. In addition to these medications, these new diagnoses will require a change in his diet to reduce his weight and the sodium and sugar he ingests. Mr. Trosack verbalized that he eats most of his meals at the bakery he owns which may present an issue with these new dietary restrictions. The addition of Lopressor also has challenges for Mr. Trosack. Lopressor may affect the blood sugar, cause blurred vision and dizziness. These side effects could exacerbate his risks for falls. Another healthcare issue to consider prior to discharging Mr. Trosack is the support system that he has. There are numerous lifestyle changes that are required due to his recent hip surgery and diagnosis of hypertension and diabetes. Changes to lifelong patterns can be difficult for the elderly to comprehend and retain and often require ongoing reinforcement. There appears to be some tension between Mr. Trosack and his son and they do not have contact on a frequent basis. Other than one brother, Mr. Trosack does not have any other support people emotionally or functionally. He currently lives alone in an upstairs apartment with no access except using stairs. Without a well established support group, activities such as cleaning, shopping, cooking and transportation will present challenges. The home assessment revealed that he keeps little food in his apartment and admitted to eating most of his meals at the bakery. This food does not support a well balanced meal which is needed to promote healing and compliance for his new dietary restrictions. His new medication regimen and use of a glucometer may be confusing and he would benefit from ongoing instructional support and reinforcement. Interdisciplinary Team Members and Their Roles
An interdisciplinary discharge planning team is vital to the success of appropriate placement for a patient. The case manager, dietician, occupational therapist, physical therapist and nurse contribute vital input from various aspects. The nurse educates the patient on the new...