Discharge Plan and Legislation Issues - Essay Example

Discharge Plan and Legislation Aging and Managing Health Part A – A Discharge Plan The discharge process is a set ofactions which needs to be taken to ensure a smooth transition for a patient who is to be discharged from hospital to home. The patients discharge is to be arranged in such a way that his continuing need for primary health care and social services are properly dealt with. According to Medicare (), effective discharge planning identifies the patient’s post-hospital needs as early as possible to ensure discharge to a safe environment with the appropriate level of services required for adequate recovery and rehabilitation. A typical scenario involves the screening of hospital records for Mr. Sharma within 24 hours of admission to identify if he is a high risk patient who requires discharge planning. A typical high risk criteria might include factors like being age 65 and older and living alone with no immediate social supports. Prior to being admitted to the hospital Mr. Sharma had a care giver who visited morning and evening. This is expected to continue after discharge. However, there are additional complications that will require the need for additional assistance. Mr. Sharma is now recovering from a stroke and is undergoing therapy to help in the process. Additionally, Mr. Sharma has a wound which he acquired on getting the stroke. This wound is slow to heal. Further, Mr. Sharma has mild osteo-arthritis which appears stable but may later cause pains and therefore curtain his movements significantly. This discharge plan relates to 87 year old Mr. Sharma who has a history of minor strokes, Type 2 diabetes which is diet controlled; and a past history of hypertension which has been well controlled with the use of the medication, bendrofluumethiazide. Mr. Sharma also has mild osteo-arthritis which appears stable. In his recent bout of stroke Mr. Sharma stumbled and fell resulting in a wound to his leg. The wound became infected and has been slow to heal. Additionally, on his admission to hospital Mr. Sharma’s blood sugar level was raised to 10mmol g per litre. Mr Sharma has been in hospital for the past ten days and based on the results of tests has made a good recovery. He is very keen on going back home and so it is important that a proper discharge plan be done. This plan should include health care officials at the hospital, social services, his caregiver, Mr. Sharma and his family. During discharge from hospital the Caregiver for Mr. Sharma should be consulted. The caregiver’s comments should be taken into consideration and both Mr. Sharma and his caregiver should receive a copy of the discharge plan for Mr. Sharma detailing the care that is required. According to the British Geriatrics Society (2006), older people who have been discharged from hospital and are living in a community have higher levels of dependency as well as more complex health and social care needs than other patient groups. Mr Sharma is 87 and falls in this group. He has complex problems which include hypertension, Type 2 diabetes and a wound to his leg which he obtained when he stumbled after suffering a recent stroke. This infection has been slow to heal. There is no present sign of infection but it will require special care on discharge. There are a number of problems that 87 year old Mr. Sharma is likely to face on discharge, some of which should be dealt with before discharge. They include management of diet, exercise, wound care to prevent re-infection, and proper use of medication. It has been suggested that Mr. Sharma starts to attend a local Expert Patient Programme in his community which will be organised by the community matron. This will have an impact on planning. Discharge arrangements are dependent on social services, health authorities, NHS trusts and primary care groups/trusts BGS (2006). Mr. Sharma should be involved early in the assessment process and care plans should offer them real choice. Carers are also entitled by law to receive if they require an assessment of their ability to continue caring. A multi-layered approach to assessment is recommended. The first step is that a member of the health team who possess the necessary skills and knowledge is required to screen Mr. Sharma. Since Mr. Sharma has multiple complications and so will need proper care. Both Mr. Sharma and his caregiver need to be involved early in the assessment process and the plan should offer both of them a real choice. The accident and Emergency Departments and Medical admission units should have access to a discharge planning team which is ideally coordinated by a discharge liaison nurse or social worker so that they can refer and discharge appropriately. Arrangements for dealing with Mr. Sharma outside of normal hours should be in place. Problems The patient or care giver should be advised on when to check the diabetes ABCs – A1C (blood glucose), Blood pressure, and Cholesterol. It is important that they are kept under control in order to prevent another stroke as well as to facilitate a speedy healing of the wound (NEDP n.d.). Interventions to Control Blood Glucose According to Ferry (n.d), diabetes mellitus is one of several persistent conditions that can lead to high blood sugar levels. High blood pressure is also called hyperglycemia and has many possible causes. They include eating foods containing too much carbohydrate, and the body (pancreas) being unable to produce sufficient insulin action. When food, exercise and insulin are not balanced, blood glucose level rises. Stress caused by various emotional problems also has a role to play in the elevation of blood sugar levels. The opposite condition is called low blood glucose or hypoglycaemia. Mr. Sharma’s has a history of type 2 diabetes which is diet controlled. It therefore means that he needs to be placed on a diet which will keep the blood sugar levels at normal levels. On admission it was found that his blood sugar level was a little raised at 10mmolg per litre. It therefore means that a proper diet which includes fruits and vegetables, low-fat and high in fibre should be enforced. His blood sugar levels should be closely monitored to ensure that it does not rise beyond levels that cannot be controlled using his diet and that will require going to the hospital for treatment or for medicinal prescription. Rationale Mr. Sharma does not currently depend on medication and so maintaining a proper diet is very important. Additionally, Mr. Sharma now has a wound which is hard to heal. The wounds of diabetic patients are normally slow to heal and therefore it is best for Mr. Sharma to keep his diet in check. This diet should take into account the fact that he has a wound which depends on the maintenance of normal blood glucose level for quick healing. Blood sugar levels should be checked regularly and Mr. Sharma should be made aware of the signs and symptoms because high blood sugar fluctuations occur daily in people with diabetes. When blood sugar levels remain high for long periods a number of serious complications as well as dehydration can develop (Ferry n.d.). Interventions to Control Hypertension According to Feldman et al (2009) hypertension is a chronic condition which requires adherence to prescribed medication as well as dietary and behavioural regimes. These can yield positive results in terms of improved blood pressure levels. Interventions that have been effective over the long term have been multifaceted and no single strategy has been found to show a clear advantage. Promoting self management in Mr. Sharma’s case is therefore very important and so Mr. Sharma will need to be told what medication is prescribed for the condition and when to take the medication. This information should be written on paper and given to Mr. Sharma and his caregiver as patients sometimes find it very difficult to retain this kind of information. Mr. Sharma should also continue on therapy as this is important in reducing the risk of both stroke and heart failure in the short term. This however is not the only focus as Mr. Sharma has other complications which can result in complex problems if they are not dealt with simultaneously. Mr. Sharma should continue taking the prescription drugs as prescribed by his Physician. Regular blood pressure tests should also be taken. This should be done when Mr. Sharma is rested and relaxed. It should not be taken after exercising or if Mr. Sharma is stressed. He should also avoid foods that are high in sodium and cholesterol. Rationale Adequate control of blood pressure can reduce the risk of both macro-vascular and micro-vascular complications (Whalen and Stewart (2008). A blood pressure reading of less than 130/80mm Hg should be the goal for Mr. Sharma. Whalen and Stewart (2008) also referred to study done by The UK Prospective Diabetes Study (UKPDS) 38 which shows that tight control blood pressure is related to major reductions in the risk of stroke, macro-vascular complications, and diabetes related mortality. According to Whalen and Stewart (2008), controlling hypertension is key factor in reducing cardiovascular risk in patients with diabetes. Mr. Sharma has already suffered a number of minor strokes and there is an increased possibility that he will get another if his blood pressure is not kept at normal levels. There is increased risk of a repeat if blood pressure checks are not done regularly. His blood pressure has been normalised and so healthy changes in lifestyle as well as taking prescribed medication regularly should keep it within normal levels. Healthy changes in lifestyle involve changes in diet and a daily exercise regimen. Mr. Sharma currently has frozen meals which are cooked in a microwave oven for lunch. The ingredients of these meals need to be checked for sodium and fat content as well as other nutritional content. Fresh fruits and vegetables as well as high fibre foods should be included in all meals. Continued Medicinal Intervention Mr. Sharma is currently using three (3) of the top five drugs (NHS, 2010) used to treat cardiovascular disease in the UK. This indicates that his blood pressure was very high and so three medications had to be used. The doctors should ensure that on discharge Mr. Sharma’s blood pressure level is not above the level on admission and that he is given the necessary medication or a prescription to take to the pharmacy so that he will not run out. It has been stated that his blood pressure levels has been well controlled by bendrofluumethiazide and therefore it is of extreme importance that he be not allowed to run out of this drug. Mr. Sharma’s family and Caregiver should ensure that Mr. Sharma has adequate medication in place at all times and that they are administered in the right dosage at all times. The timing and use of these medications is also very important to prevent his blood pressure levels from both rising above or falling below normal levels. Medicines should be taken as prescribed and the full dose and course should be given to prevent complications. It is also advised that Mr. Sharma not be given over-the counter drugs or any vitamins herbs or food supplements without the caregiver’s knowledge. Use of these may result in further complications and therefore should only be recommended by a Physician.. Rationale It is important that Mr. Sharma sticks to his medical regimen as any change may lead to further health complications. He suffers from comorbidity and both diabetes and hypertension are linked in many ways. Rationale for Regular Blood Glucose Tests Already the healing of the wound received during the bout of stroke has not healed and this may get worst if the blood sugar levels are not held in check. Mr. Sharma should also be informed of how and when to test blood pressure. It is important that this be done so as to avoid the his experiencing extremely high blood pressure levels. Mr. Sharma should be advised of the signs and symptoms of above normal blood pressure levels and how to deal with it before he gets to the hospital or he is seen by a physician. The blood pressure readings should be written down on each occasion that it is checked. Mr. Sharma should also be informed of when and how often to perform these tests. Intervention for strokes and fall Dietary intervention is very important in almost all forms of illness. According to Moser (2005), low-sodium intake, weight loss and exercise are the cornerstones of recommendations for lifestyle related interventions. This is normally used as initial therapy in all hypertension patients. This is considered to be less expensive and free of adverse effects that sometimes result from the use of medication. It is also important that meals that contain a variety of healthy, low-fat, high-fibre foods that includes fruits and vegetables should be had regularly each day. Rationale Mr. Sharma requires further rehabilitation for the strokes he received. a proper dietary regime and exercise, along with therapy are key to his recovery. This should help to maintain blood pressure levels at normal levels so as to prevent further strokes from occurring. Physical activity is very important. Research has shown that Tai Chi exercises should be taken to reduce falls which can lead to wounds, fractures and death. Diabetics should try to prevent falls as this could result in fractures and wounds. Intervention for wound care Proper care should be given to the feet in general and to the wound in particular. In order to prevent cuts and abrasions to the feet Mr. Sharma should wear socks and shoes around the house. This will help to prevent further complications relating to the healing of wounds. Part B – Influence of Recent Health Service Legislation The problems with health care service provision in the past are that patients and caregivers were not allowed to take part in the planning process involving discharge from hospital. Patients were abused by caregivers and other persons involved in the management of their care plan and they were not allowed to make choices. The government has now instituted legislation relating to standards of health care for older people and those with whom they work. These legislations are important for health professionals, primary care groups, NHS managers, general practitioners and agencies that provide voluntary assistance as well as geriatricians, old age psychiatrists and specialists registrars (BGS 2007). These legislations cover the rehabilitation of older people which is very important for their continued wellbeing. They also cover acute medical care for older people including strokes and pulmonary diseases. Older people were not being accorded the dignified and respectful service they deserved. In a study carried out by the joint committee it was revealed that some people received excellent services there were some who were treated poorly, neglected, abused and discriminated against and granted ill-considered discharge. An entire change in the way things were done in these health institutions were clearly in order and so legislation and a role for the new Commission for Equality and Human Rights was recommended. A recommendation was therefore made for the adoption of human rights principles in order to transform health and social care services. They sought to make the Human Rights Act integral to the policy making process and social care across the Department. Health professionals are now required to be trained in human rights principles and this is included in their qualifications. A patient is therefore not allowed to be discharged until a proper care plan which is agreed to by the caregiver, the patient and all stakeholders in the process. Some of the problems encountered by patients in the past included: Malnutrition and dehydration; Abuse and rough treatment Lack of privacy on mixed sex wards Lack of dignity and especially for personal care needs; Insufficient attention paid to confidentiality; Neglect, Carelessness and poor hygiene; Inappropriate medication and use of physical restraint; Inadequate assessment of a person’s needs Too hasty discharge from hospital; Bullying, patronising; and infantilising attitudes towards older people; Discriminatory treatment of patients and care home residents on grounds of age, disability and race; Communication difficulties, particularly for people with dementia or people who cannot speak English; Fear among older people of making complaints; Eviction from care homes. Additionally, persons were being discharge without an address being identified for them that would ensure proper recovery and rehabilitation. This meant that requirements for equipment and other services were not in place for the efficient and effective facilitation of the recovery process. Problems like these do not augur well for healthy recovery and rehabilitation of patients and therefore had to be dealt with as a matter of urgency. It is unreasonable to have older people treated in such a manner by persons who are being paid from the public purse and so having them undergo training which involves dealing with older patients are in order. Recent NHS/Social Care policy initiatives have been geared towards dealing with the problems faced by older persons like Mr. Sharma in health care facilities. The Department of Health (2001) published a national service framework for older people. This framework seeks to root out age discrimination which has been a common problem up to the time that the joint committees published their report in 2007. Additional standards relate to person-centred care; intermediate care; general hospital care, stroke, falls, mental health in older people; and the promotion of health and active life in older age. The aim of the framework was to improve standards of care; extend access to services; ensure fairer funding of long term care; develop services which support independence which would help avoid unnecessary admission to hospital as well as assist in speedy recovery and rehabilitation. The framework also served to present a programme of action that would help to recommend changes that would address the problems faced by older people as well as to deliver a higher quality services in order to meet their needs. This included the use of more consultants, nurses and therapists to work with patients. Patients would also now have better and increased access to high tech surgery and community equipment (DOH 2001). These changes have impacted positively on the discharge of Mr. Sharma. He has made a good recovery and is now keen to return home. He has not been forced by anyone under whose care he has been placed for early discharge. His caregiver and he were very much engaged in the integrated care plan and both were able to make choices. The hospital worked jointly with social services to ensure that proper preparations were made at Mr. Sharma’s home. These included changes to the flat and requests been made for hand rails to be placed in the shower, bedroom and bathroom prior to his discharge. He has an Occupational Therapist who visits occasionally to offer therapy and to assist in a speedy rehabilitation from his stroke. Mr. Sharma has also been referred to the medical diabetic team for a follow up appointment and there are also suggestions for his attendance at a local Expert Patient Programme which is to be organised by the community matron. This speaks volumes of the services that are available to Mr. Sharma and how well his care plan has been organised References American Diabetes Association. (2004). Hypertension Management in Adults With Diabetes. Diabetes Care: 27(1). p.65-67 Blood pressure Association (2008) The Facts about Blood Pressure. Retrieved: http://www.bpassoc.org.uk/microsites/u40/Home/facts/Whatisnormal. Last accessed 24th May 2011 British Geriatrics Society. (2006). The discharge or transfer of care of frail older people for community health and social support: Best Practice Guide. Retrieved: http://www.bgs.org.uk/Publications/Compendium/compend_3-3.htm. Last accessed 24th May 2011 Department of Health (2001) National Service Framework for Older People. 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(2005) Are Lifestyle Interventions in Management of Hypertension Effective? How Long Should You Wait Before Starting Specific Medical Therapy? An Ongoing Debate. (2005). The Journal of Clinical Hypertension: 7(6) NEDP (n.d.) A guide for People With Diabetes: Take Care of Your Feet For a Lifetime: Retrieved: http://www.ndep.nih.gov/media/Feet_broch_Eng.pdf Patient. Co.UK (2010) 'Tai Chi 'prevents falls in the elderly'' - NHS Analysis. Retrieved: http://news.patient.co.uk/newspaper.asp?ss=15&id=14295. Last accessed 23rd May 2011 Whalen, K.L. and Stewart, R.D. (2008) Pharmacologic Management of Hypertension in Patients with Diabetes. American Family Physician: 78(11). p. 1277-1282 Read More