Managing Discharge Process For Congestive Heart Failure Patients

This paper focuses on an a patient who is admitted to the medical unit for an exacerbation of congestive heart failure (CHF), and to discusses the nurses’ involvement in achieving an effective outcomes at the time of discharge from the hospital (Riley, 2015). The paper also discusses ensuring that a patient with CHF receives the appropriate discharge instruction to prevent rehospitalization and to achieve positive patient outcomes (Riley, 2015). The process of implementing a flowchart regarding the discharge of a patient with CHF, will guide hospital staff in ensuring the patient has the proper resources including medication, diet, self-management techniques, and follow-up appointments The patient will be able to fully utilize the resources that would help to improve self-care management of CHF after discharge from the hospital (Riley, 2015).

Analysis

CHF is the most common indication for hospitalization, re-hospitalization, and readmission, among adults age 65 years and older (Rabbat et al. , 2012). CHF is the second leading cause of hospitalization in the United States with over one million people being admitted to a healthcare facility (Centrella-Nigro, 2016). There is also a 25 % readmission rate within 30 days of being discharged from the hospital. Patient-centered factors that affect re-hospitalization include poor compliance with monitoring daily weights, adhering to the prescribed diet and monitor fluid restrictions; reduce sodium intake, a lack of full understanding of the medication regimen, and exercise program (O’Brien et al. , 2015). It is noted that patients with CHF adhered to only 50 % to 60 % of the prescribed medication regimen (O’Brien et al. , 2015). Physical exercise was not performed by 41% to 58 % of the CHF population, and compliance with the sodium restricted diet varied from 50 % to 88 % of the patients (O’Brien et al. , 2015). The hospitalization process has three main stages: an admission, an inpatient period and a final stage with the discharge process (Ortiga et al. , 2012).

Inefficient bed management in any of the three stages of the hospitalization can cause a mismatch between demand and capacity (Ortiga et al. , 2012). It has been proven that when bed demand exceeds capacity, patient admissions and scheduled surgical procedures can be delayed or canceled. Traditionally, it has been assumed that the variability in the demand comes from the emergency patient. Interventions focused primarily on emergency departments have had limited success (Ortiga et al. , 2012). Studies have shown that elective admissions are often the major cause of variation as they are more unpredictable than the emergency admissions (Ortiga et al. , 2012).

In addition, the greatest variation is typically in the number of discharges and, therefore, efforts to reduce variation 24 should start with the discharge process and not in the admission process (Ortiga et al. , 2012). According to Ortiga et al. , (2012) by having 24 hours prior information regarding discharges would allow a higher planning and an optimal bed assignment. The discharge process should begin during the admission process in order to follow a pathway to a proper and prepared discharge process (Ortiga et al. , 2012).

Discharge planning allows for a better and quicker bed assignment in hospitals and the development of nurses and other staff working in discharge coordinator roles (Ortiga et al. , 2012). The multidisciplinary team that is involved in the patient’s care can continue to deliver health services and patient care. All admissions and discharges of the hospital should have a central intake processing center that would manage and plan the admission to discharge path in order to prevent single-department solutions creating or worsening bottlenecks in other areas (Ortiga et al. , 2012). Improving patient flow by standardizing the admission and discharge processes can improve patient outcomes (Ortiga et al. , 2012). During the hospitalization process, patient flow is a strategic plan for the healthcare enterprise.

Ortiga et al. suggest that in an effort to redesign patient flow for maximum efficiency and clinical outcomes healthcare facilities can combine process management with information technology (2012). Information services are an essential factor in the foundation of all patient flow initiatives (Ortiga et al. , 2012). Patient flow is built by integrating and sharing information with staff from other departments in an interoperable manner (Ortiga et al. , 2012). Close monitoring requires an environment where caregivers have an adequate amount of time to identify and respond to changes in physiological data in a responsible manner (Ortiga et al. , 2012).

The association between the competence of nurses and the quality of care has long been recognized and the association between nurse staffing, nurse expertise and patient outcome has been confirmed (Riley, 2015). how the healthcare information system/exchange is currently being used in practice. The exchange of health information can improve healthcare quality by allowing better access to providers regarding patient information from various sources at the point of care (Kierkegaard, Kaushal & Vest, 2014). A better access to patient information from various point of care can also improve comprehensive patient information which can support optimal decision making, have quick access to recent diagnostic tests and test results and decrease any duplicative testing, provide a better medication information system, improve patient safety and can save cost recognized the evidence that indicates a multidisciplinary approach in CHF management is effective in reducing readmissions and re-hospitalizations. A team of multidisciplinary health professional’s work together to deliver comprehensive care to inpatients (Health and Social Policy, 2014). Stakeholders that are involved in ensuring the CHF discharge process is successful for all patients includes nurses, dietician, pharmacist, physician, nurses, social worker, and physical therapists (Health and Social Policy, 2014A multidisciplinary and well-coordinated inpatient care including the discharge planning process is an important area where the clinical pharmacists can contribute to optimal management and care of patients with admitted with CHF (McNeely, 2017).

Clinical pharmacists play a very important role in improving the care of hospitalized by providing education to patients, family members, and healthcare personnel regarding proper dosing strategies and considerations for improving adherence to the medication regimen (McNeely, 2017). Pharmacists in the clinical setting can also help with monitoring and tracking medication prescriptions and refills to ensure that patients are taking prescribed medications appropriately (McNeely, 2017). The pharmacist treatment plan for patients with CHF includes medication regimes that are consistent with current guidelines (Stacy, 2016). The social worker can provide social support and adjust of health visits related to patient symptoms (Stacy, 2016). Dietary can educate patient and family in ways to promote dietary modifications, and physical therapy can provide the patient with exercise programs (Stacy, 2016). Nurses should educate patients and family members on recognizing early signs and symptoms of CHF which includes changes in weight, diet restrictions, medication adherence, and activity level (Amakali, 2015).

The patient must verbalize understanding of the discharge instructions. Shaw et al. (2014), states that patient understanding of self-managing CHF is necessary to bring changes in health behavior which should be the primary target for interventions. Key Roles for the Nurses in Managing Inpatient CHF The nurses’ responsibilities include an appropriate environment for the safe clinical care medical unit, objective monitoring for a change in symptoms suggestive of a response to treatment, and to quickly identify and address relevant changes in status (Riley, 2015). The nurse is also responsible for the discharge planning and referral to the multidisciplinary team for a collaborative effort in administering care (Riley, 2015). The nurse must also ensure that effective and consistent communication between the patient and family and multi-disciplinary team are carefully orchestrated (Riley, 2015).

Discharge Process

The process of discharging patients from the healthcare facility is a complex one that is stressed with challenges that involves more than 35 million discharges each year in the United States (Alper et al. , 2017).

According to Alper et al. (2017), preventing readmissions that are avoidable has the potential to improve the quality of life for patients and the financial wellbeing of health care systems. Discharges that are done prematurely to an environment that is incapable of meeting the medical needs of the patient may result in rehospitalization (Alper et al. , 2017). An early hospital discharge could result in the need for the utilization of a more intense health, including emergency room visits, and other nursing facility visits (Alper et al. , 2017). When it is decided that a patient is ready to be discharged, the most appropriate setting for ongoing care must be determined by the healthcare team (Alper et al. , 2017). In deciding the appropriate site for post discharge care includes medical, functional, and social aspects of the patient's disease process (Alper et al. , 2017). It is imperative that the nurse gather input from multidisciplinary sources to determine the most suitable discharge plan (Alper et al. , 2017).

The discharge process will include the patient, family members, medical social worker, case manager, nurse, physician, physical and occupational therapist, and pharmacist (Alper et al. , 2017). Considerations for discharge to home should include safety and readiness, rehabilitative environment, the patients cognitive status, activity level, home suitability, companionship, availability of medical supplies, transportation to and from hospital, and community service (Alper et al. , 2017). Discharge planning The discharge planning phase includes developing an individualized discharge plan that occurs before the patient leaves the hospital to ensure adequate discharge instructions, and post discharge services (Alper et al. , 2017). Many hospitals have mandatory discharge planning incorporated in the hospital accreditation (Alper et al. , 2017). Many healthcare institutions have discharge checklists to ensure that appropriate communications including the discharge summary, involvement of the patient and family members, and multidisciplinary groups input (Alper et al. , 2017). Prior to discharge, patients should be provided with discharge education that would enable self-management at home (Amakali, 2015). The discharge education should include self-management, change in lifestyle; medication; diet; physical activities, and follow-up appointments (Amakali, 2015).

System Improvement

By following a road map developed by a major hospital in the United States, a rural community hospital in south central Kentucky adopted a system that would help to control the flow of patients from admission to the medical unit, until the patient is discharged from the hospital. A software based program named the “Patient Tracker” was utilized to assist in the flow of patients. An interdisciplinary team of healthcare professionals including software engineers, experts in system improvement process improvement to examine the problems of patients bed patient flow from admission to discharge (Maloney et al. , 2007). The new software application was also designed to establish an efficient bed management process improve coordination and communication between departments (Maloney et al. , 2007). One of the implementation to help the discharge process include notifying the patients two days prior to the discharge. The discharge process comprised seven criteria to ensure a smooth flow of information and outcome. The discharge criteria included the discharge including the discharge criteria list, a daily communication with the primary caregiver, regular discharge assessments, morning discharge rounds, bed control measures, discharge plan notes, and ongoing communication (Maloney et al. , 2007).

The discharge process would begin at the time of admission, then when quantifiable medical conditions are met, a discharge prompt would be triggered, the physician would be notified, the patient may learn about the pending discharge, the physician will then approve the discharge and the medical team will immediately begin the paper work, a discharge summary will follow, then arrangements for home equipment, medical supplies, and follow up appointments (Maloney et al. , 2007).

Conclusion

In conclusion, the admission and discharge process including the length of stay are mostly under the control of the staff nurses (Amakali, 2015). There are opportunities to improve patient flow to create a better bed management and hospital throughput, which would ultimately improve quality and safe patient care (Amakali, 2015). Discharge instructions are oftentimes inadequate and has limited information regarding education (Regalbuto et al. , 2014). Patients who has English as a second language are more likely to difficulty understanding discharge instructions and higher rates of rehospitalization within 30 days from discharge (Regalbuto et al. , 2014).