Ischarge planning of a patient using a patient profile

Patients Profile:

r. Mr Sharma is an 87 year old man
He has been admitted to an elderly care ward after a history of minor strokes and a history of Type Two diabetes which is diet controlled. He has had raised blood pressure in the past but this is well controlled by the bendrofluumethiazide. (130/70 on admission.) He has mild osteo-arthritis but this seems stable.
Medication. He takes:
Simvastatin 20 mg nocte
Aspirin 75mg od
Bendroflumethiazide 2.5 mg od.
Paracetemol 500mg QDS prn

1 Mr Sharma lives in a flat. He is mainly house-bound but is taken out most weeks by her family. He is content with these arrangements. His family does the shopping.
2 He has a carer from social services who comes in to help him wash and dress in the morning and evenings.
3 He has a history of hypertension. This has been well controlled on bendrofluumethiazide (bendrofuazide) 2.5mg in the morning. He is normatensive.
4 Mr Sharma has frozen meals for lunch which he cooks in a microwave oven. He manages other meals with help from the carer or his family.
5 On admission it was found that Mr Sharmaas blood sugar was a little raised 10mmol g per litre. It is decided to continue with only diet control for this but he has been referred to the medical diabetic team for a follow up appointment in six weeksa time and it has been suggested that he starts to attend a local Expert Patient Programme to help him in the community. This will be organised by the community matron.
6 Mr Sharma has a wound on his leg when he stumbled after suffering his recent stroke which became infected and is slow to heal. His shin remains unhealed and will require regular dressing on discharge although there is no present sign of infection.
8 He has been on a home visit with the Occupational Therapist. She has made some changes in the flat and put in a request for rails to be placed in the shower, bedroom and bathroom prior to discharge.

Mr Sharma has made a good recovery and is keen to go home. The doctors agree to a discharge after ten days. Apart from the wound and the Expert Patient programme referral, there are no planned changes to his care. His family have agreed to come to pick Mr Sharma up in their car.
This is an academic essay.
Write in third person.
Use Harvard Reference system

Part 1.

A discharge plan. You have been given the Patient Profile.

You must read through the profile and plan the discharge. There are no a?tricksa? or special problems to identify beyond those any case might create. Do not be tempted to look for obscure issues or complicated a?possiblea? problems. Concentrate on the key issues in the patient profile.

We are looking for a safe, comprehensive discharge plan. However, because this is also an academic assignment, we are looking for the student to explain the rationale behind the decisions she or he has made in far greater detail than would be written in a care plan. It is vital that you use recent health service guidelines or research papers in order to justify the reasons for the intervention. A key part of the assignment will be a good referencing technique.

We suggest the following format for your work.

Firstly identify the potential or actual problems on discharge and then describe your intervention (for the discharge) to manage this problem. Some of these might be issues on the ward before the patient is discharged to ensure the discharge goes smoothly. Some will be interventions to start once the patient has been discharged.

But all of your interventions must be discharge focussed;
Health advice for when the patient gets home is acceptable. An exercise programme while he/she is still an inpatient is not.

This can be set out in a table format (1) or simply in headings down the page (2). But make ensure that the problem/intervention/rationale is clearly linked so the marker can follow your thinking. Start a new section for each problem/intervention.

Problem Goal intervention Rationale

Or.

Problem Goal Intervention Rationale

The rationale section will consist of your explanation of the key issues in each particular intervention.
For example (this is very brief; only the barest outline given here):

Problem Goal Intervention Rationale
Patient is taking four medicines For patient to take medication safely following prescription in order to get the maximum benefit from medication and to reduce risk of complications. 1 Order medication from Pharmacy prior to discharge
2 Ensure correct medication is dispensed
3 Explain importance of medication, timing of dose, completion of course A discussion here about the importance of medication with some referenced details about the incidence of (re)-admissions due to poor compliance. This needs to be fully referenced at the end of the assignment. You might draw on the National Service Frameworks for Older People (medicines management) (DOH 2001) and research about the importance of patient concordance with medication regimes.
Or:

Problem Patient is taking four medicines

Outcome For patient to take medication safely following prescription in order to get the maximum benefit from medication and to reduce risk of complications.

Intervention1 Order medication from Pharmacy
2 Explain importance of medication, timing of dose, completion of course

For patient to take medication safely following prescription in order to get the maximum benefit from medication and to reduce risk of complications.

Rationale
A discussion here about the importance of medication with some referenced details about the incidence of (re)-admissions due to poor compliance. This needs to be fully referenced at the end of the assignment. You might draw on the National Service Frameworks for Older People (medicines management) (DOH 2001) and research about the importance of patient concordance with medication regimes.

Try to develop appropriate interventions for each of the patient problems. But this is not an exercise in trying to come up with large numbers of obscure interventions. Concentrate on what is important to make the discharge safe. We are probably looking at 4-8 interventions.

Not all interventions will need a long or even a short rationale. For example the problem might be access to the house/home and the intervention might be to ensure patient has keys. This would not need a rationale. But it is an important consideration.

The word limit is 2000 words.

Part 2
The second section will be a discussion of the influence recent health service legislation/innovations has made to their care plan.

It is only 1000 words. This is very short and you must be very precise in your answer. A good plan is vital.

It might be helpful to organise your answer in the following way (but if you prefer another way, thatas fine).

A Forces for change: demography, public interest/pressure, research. Problems in service provision in the past.

B Description of recent NHS/Social Care policy initiatives:
National Service Frameworks, NHS guidelines etc.
Use both legislation and guidelines.
Look at both issues of care for older people and issues around discharge.

C How these have impacted on the patient in question: Describe how all these interventions have impacted on the discharge of the patient under discussion. You will need to summarise the major themes running through recent legislation (For example a?patient choicea?, a?joint working with Social Servicesa?, a?early discharge planninga? etc.

Again make reference to the main policy documents/legislation throughout.
Try not to copy out sections. Limit lengths of quotes.
The articles:DOH Discharge planing;Ready to go home;Polypharmacy and older people;NSF Older people;NSF Medicines;NSF long term conditions;Medicatio safety and elderly;Malnutrition and older;Hungry to be heard,august 2006;DOH Discharge planning;Discharge partnership working;Discharge medications;Discharge and carers;Dehydration and older adult;Covert drug administration;BMJ discharge;Anaemia and older people;A New Ambition for old Age;
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