Using the seven key principles of the hospital discharge process devised by the Department of Health (DH, 2003), this case study will critically analyse the process of an elderly patient who was discharged from a local acute trust. It begins by providing a definition of discharge planning, before providing a brief biography of the patient, including a rationale of why this patient was selected, details of her past medical history, reason for current admission, any issues raised and details of any care provided. Throughout this case study, in accordance with the Nursing and Midwifery Council (NMC, 2008) and the Data Protection Act (1998), the patient shall be referred to as Mrs. Blue to maintain anonymity. Although the case study will largely focus on how the discharge affected and impacted on Mrs. Blues outcomes, it will also include some of the issues highlighted in the current literature surrounding the discharge process. Included will be a summary and any additional points will be raised. Finally it will draw closure to the case study by concluding the main themes and finishing with a final suggestion to achieve optimal results when discharging patients. Definition
According to Wats & Gardner (2005) discharge planning is defined as ‘an on-going process that facilitates the discharge of the patient to the appropriate level of care. It involves a multidisciplinary assessment of patient/family needs and co-ordination of care, services and referrals’ (pg. 176).
The rationale for selecting Mrs. Blue was to highlight how easily it is for patients to experience a delay in hospital discharge. Mrs. Blue was an elderly lady who presented into a local medical assessment unit having sustained a recent fall whilst at home. She lived alone in a bungalow with the support of carers four times a day. She did have a friend who visited daily, but had no other family or friends. Her medical history comprised of short-term memory loss, extrinsic asthma and she currently presented with low grade pyrexia, hypotension and dehydration. Upon admission, assessments were conducted to formulate a plan of care. Whilst conducting the initial assessments, it was identified that Mrs. Blue had a possible urinary tract infection. Additionally, intravenous sodium chloride was administered to achieve euvolaemia. After the first three days, Mrs. Blue showed signs of improvement and the team began to focus on reinstating her care package and discharging her back home. However, whilst these plans were conducted Mrs. Blues friend approached a student nurse and informed her that she was concerned for Mrs. Blue’s safety as on numerous occasions she had visited her friend and found her on the floor and/or incontinent of urine. She felt that she had become increasingly unstable on her feet and this prevented her from mobilizing around the bungalow and to the toilet. Principle 1
Providing patient-centred care across the whole of the UK has been a government objective for many years and the DH informs us that when providing a ‘whole systems approach’ a range of health professionals will be involved in patients care (DH 2003). According to Glasby & Martin et al (2008) tackling delayed hospital discharges and preventing unnecessary admissions (O’Brian 2012) has been a vital government focus since the introduction of the NHS plan. Guidance published by the DH (2000), discusses that it envisions health communities work in partnership to plan and deliver health improvement and services for the benefit of the community as a whole. Miers & Polland (2009) indicate that identifying patients’ needs promptly and utilising the appropriate services will achieve optimum results. Whilst, Underwood & Burnett (2012) discusses that the admission of elderly patients aged over 75 costs the NHS hundreds of millions of pounds each year in hospital admissions. Upon admission, the nurse conducted an initial triage assessment with the...
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