Planning Care Delivery - Essay Example

PLANNING CARE DELIVERY Planning Care Delivery Introduction Care planning process in the MedihilR Hospitalthat I operate is based on the multi-professional approach developed in the declaration of Alma-Ata in USSR. This model requires practitioners to focus not only on disability and illness, but also on the strengths of the individual and their environment. Adoption of the model enables the facility avoid duplication of care processes and also improve communication between different services offered by the hospital. The care planning process adopted by the hospital comprises of five vital pieces of documentation that dictate how the medical staffs interacts with patients’ from when they are referred to their exit from the hospital (Rai and Mulley, 2007, p. 25). Initial assessment of the patient is the first step in the care planning process; basic information about the patient is gathered and include; contact details, relative and doctor details, previous medications taken and if they have any known allergies. The processs second step is the biopsychosocial assessment that aims at collecting detailed information about the patient. Third step involves assessing risks associated with the patient through identifying their needs and prioritising them. The fourth step involves developing a care plan for the patient based on the SMART (specific, measurable, achievable, realistic and timely) approach. Plans to address the needs of the patient are developed during this stage. The final stage involves developing a record sheet on which all activities about the patient are recorded and later used as evidence during the evaluation stage (Lees, 2012, p. 34). Process of Referral to and Exit from Our Medical Service The hospital implements the care plan cycle in five steps that are easily manageable so as to meet the Public Health Agency (PHA) directives on patient matters. The package care offered by the hospital comprises of an admission/ pre-admission, a multidisciplinary team review, the estimated date of discharge (EDD), referrals and liaison and transfer of care from the hospital after the patient is discharged. Our modified care plan cycle focuses on the person centred approach that focuses on attending to a patient’s psychological, spiritual, biological and sociological needs (Rogne and McCun, 2013, p. 45). A patient may be referred to the hospital through a phone call from family members, ambulatory services or the patient, through fax, online on the hospital website or after the patient fills the referral form at the hospital facility as required by Health and Social Care Trusts. Pre-admission/ admission step marks the first step of contact of a patient with the hospital after their referral. A Transfer of Care Risk Assessment’ (TCRA) form is completed by the clinician. The form aims at identifying a patient who may need further assessment and to be followed up before they are transferred to an ongoing care or at home. The form’s importance is to inform on how the patient has been managed. Key areas addressed by the form are: if the patient lives alone, if they have self-care issues, if they bear the responsibility to care for others and if they have used community services previously (Walsh, 2009, p. 191). Multi disciplinary team reviews are performed to ensure that patients experience favourable outcomes. Multidisciplinary rounds occur twice weekly to ensure that short stay patients have their needs met as recommended by Patient and Client Council (PCC) body. The multidisciplinary team can agree on a treatment plan for every patient, set the Estimated Date of Discharge (EDD) and also slot in the transfer of care risks into the care plan of the patient. The whole meetings of this team or part of them are normally carried out at the bedside to make the patient aware of their treatment plan. Depending on the patients needs, more meetings are organised (Emslie and Hancock, 2008, p. 4). Estimated Date of Discharge (EDD) is the most likely date for the patient to be transferred back to their community. The British Social Care Council requires that this date be set to enable everyone involved in caring for the patient to have a projected date upon which they can coordinate the requirements of the patient. Discussions with the caregivers and the patients are set early for the care planning to be effective. Staffs involved with the patient do record any changes in the EDD and informs the family or caregivers of the alterations and on the patient’s progress. The EDD is always kept visible near the patient’s bed, and the multidisciplinary team uses it to synchronise referrals (OECD, 2011, p. 264). Referrals and liaison stage involve planning for the patients transfer back to the community setting. The hospital liaises with the patient’s general practitioner and any other care provider. The GP’s name and address should always be displayed together with the EDD on the patient’s bedside. The hospital also identifies services and equipments that the patient may need during the critical phase of providing care and makes them available. Lastly, the patient is transferred home and the hospital staff utilises the Transfer Care Checklist to make sure and confirm that the needs and wants for patients are met before they leave the hospital (McCarthy, Schafermeyer and Plake, 2011, p. 87). How a Patient Is Referred To the Hospital and Delivery of Package of Care The care planning process adopted by the hospital focuses on four basic stages of the care planning cycle model. The four steps are; assessing the needs of the patient, care planning, implementation of the care plan and lastly evaluating the care plan. The hospital recognises the importance of a person centred approach in managing patient during recovery. Every patient is unique as they possess different abilities, ways and skills that can be applied and used to accelerate their recovery. We encourage the patients, or those sick and their families to make decisions on their recovery programs. As recognised by the Mental Capacity Act 2005, patients or those sick also have the right and willto choose the wrong decisions. This has led and contributed to the abandonment of the traditional practice of placing patient in different categories as it led to many people being left out as they never fitted in a particular category (Votroubek, 2010, p. 584). We have developed individualized care for the patients based on the five principles of the Mental Capacity Act 2005. These are: each adult is entitled to make their decisions unless proven otherwise, before being treated as if they can not make own decisions, any adult must be given practicable help; any adult must not be treated as not having the capacity to make a decision just because they made what may seem to be an unwise decision, any decision that is made on behalf of an individual lacking the capacity, must be made at the best of their interest and anything that is done on behalf of an individual lacking the capacity to do so, must not infringe their basic rights and freedoms (Geisler, Krabbendam and Schuring, 2003, p. 567). The hospital also recognises that for the empowerment theory (illustrated in figure 1)to function as intended, all the patients must be empowered so as to feel that they are in control of their destination as opposed to decisions being imposed on them. People always feel weak when taken from their familiar environment such as home. Hence, the hospital has put measures in place that encourage patients to be treated in their home or in a familiar environment that are comfortable. Practitioners and other care givers in the hospitals have also been profiled in order to establish their skills. Matching individual skills with care giving has proved to offer optimal results in a person centred model. Though it is difficult to fulfil all the individual needs of the patients, the hospital continues to address the issues as they arise (Lawrence, 2010, p. 56). A patient is referred to the hospital through phone, fax, online, through family members and filling out the referral sheet in the hospital. The assessment step of the care planning cycle is a right for the patients and their carers. Assessment tools such as assessment forms are used to enable the hospital learn in depth about the needs of the patient. The hospital staffs have been trained in order to be keener in observing psychological, social and physical changes in patients. Planning as a step in the care planning cycle, comprise of the hospital identifying goals to achieve with the patient’s condition. Approaches are laid down to enable the hospital achieve both long term and short term goals in time. The patient is consulted in order to ensure their full participation in the planning process of the cycle. Recovery plans are normally carried closest to the home of the patient to accelerate the healing process since they are already familiar and comfortable with the settings (Deber and Mah, 2014, p. 58). The implementation stage of the cycle requires the hospital to achieve the already set goals in the planning step. The step is crucial in building good relationship with patients and their families as it cements or breaks the credibility of the facility. It also demonstrates the effectiveness of the social and health care measures provided to the patients to facilitate their recovery. Outcomes of this step should be inclined in fulfilling the patients’ needs. Evaluation step of the cycle provides the opportunity whereby the care plan is reviewed by the team that has contributed to delivering health care in the hospital. The step is crucial in ensuring that the patients’ needs are continuously assessed in regular intervals (Langabeer, 2008, p. 34). The evaluation stage enables the hospital staff to determine whether the care plan is still effective and if any changes are necessary for its operations. Failure to evaluate the process regularly would lead to overlooking of minor changes that my indicate recovery or deterioration of a patient’s condition. The evaluation step also provides the hospital staff with time to discuss the care plan with an aim to identify blind spots in the plan and finding other ways of supporting the patient (Ellershaw and Wilkinson, 2011, p. 175). Bibliography Deber, R. & Mah, C. 2014. Case Studies in Canadian Health Policy and Management, Second Edition. Toronto: University Of Toronto. Ellershaw, ‎J. & Wilkinson, S. 2011. Care of the Dying: A Pathway to Excellence. London: Oxford University Press. Emslie, ‎S. & Hancock, C. 2008. Issues in Healthcare Risk Management. London: Lulu.com. Geisler, E., Krabbendam, K. & Schuring, R. 2003. Technology, Health Care and Management in the Hospital of the Future. New York: Greenwood publishing group. Green, A. 2007. An Introduction to Health Planning for Developing Health Systems. New York: Oxford University Press. Langabeer, J. 2008. Health Care Operations Management. New York: Jones & Bartlett Learning. Lawrence, W. 2010. Health Care Administration: Managing Organized Delivery Systems. New York: Jones & Bartlett. Lees. L. 2012. Timely Discharge from Hospital. New York: M&K Update Publishing. May, A. 2011. Organisational Innovation in Health Services: Lessons from NHS Treatment. London: Policy Press. McCarthy, R., Schafermeyer, K. & Plake, K. 2011. Introduction to Health Care Delivery. New York: Jones & Bartlett publishers. OECD. 2011. Health at a Glance. OECD Indicators: OECD Indicators Health at a Glance. New York: OECD Publishing. Rai, ‎G. & Mulley, G. 2007. Elderly Medicine: A Training Guide. New York: Elsevier Health Sciences. Rogne, L. & McCun, S. 2013. Advance Care Planning: Communicating About Matters of Life and death. New York: Springer Publishing Company. Votroubek, W. 2010. Pediatric Home Care for Nurses: A Family-Centered Approach. New York: Jones & Bratlett Publishers. Walsh, L. 2009. Depression Care across the Lifespan. New York: John Wiley & Sons. Appendix Figure 1. Showing the Empowerment theory adopted by the hospital Figure 2. Flow chart of the process of care planning within the hospital Read More