Prepare Patients for Early Discharge
Preparing non-priority home health patients for early discharge should be the primary objective of home health agencies right now. Since accessibility to routine healthcare is currently suspended, home health agencies should prepare patients and caregivers to assume responsibility of monitoring their own medical conditions and practicing preventive care sooner rather than later.
Under these challenging circumstances, preparing patients for early discharge process requires enlisting the patient/caregiver to actively participate in monitoring her/his symptoms and reporting unstable symptoms to the physician. Additionally, the patient/caregiver should be provided written instructions for diagnosis-specific preventive care to be practiced for managing symptoms.
Priority patients include those who do NOT have a teachable caregiver and the patient is NOT teachable, or those who have medications or procedures that can only be performed by a skilled professional.
Priority 1: Provide a written list of diagnosis-specific signs and symptoms to be monitored.
Provide a list of signs and symptoms that require a call to the doctor.
A list of the top 3-5 symptoms for each diagnosis - that indicate the physician's orders are not working - should be provided to the patient/caregiver. In both challenging and normal times (just 4 weeks ago!), a teachable patient or caregiver is capable of notifying the physician when s/he is experiencing unstable symptoms. A list of signs and symptoms might look like the following:
Congestive Heart Failure: Call the doctor if you have weight gain, shortness of breath, unusual fatigue, increased swelling of legs, ankles and feet, palpitations, persistent cough or wheezing
Pressure Ulcer: Call the doctor if you have increased wound drainage, increase in pain, foul wound smell, increased temperature
Neurogenic bladder: Call the doctor if you have urinary incontinence, decreased volume or dribbling when urinating, urinary frequency and/or urgency
Priority 2: Provide description of preventive care to be practiced.
Provide a list of the preventive care to be performed. An example:
- Follow your cardiac diet.
- Take your blood pressure every day and report abnormalities to the physician.
- Get 7-9 hours of enough sleep every night.
- Get 30 minutes of exercise a day
Priority 3: Provide written instructions for procedures.
Patients requiring wound care, catheter or ostomy care or any type of procedure should have WRITTEN, printed instructions. The teaching plan should have step-by-step instructions for preparing and performing the procedure. The patient/caregiver should be able to DEMONSTRATE the step-by-step instructions before discharge.
Perform medication teaching.
Patients are often on 15, 20 – even 30 or more medications. Often patients don’t remember medication information and/or find it hard to retain. Medication teaching might need to wait until a later time.
Provide a list the medications the patient is taking for each diagnosis.