Discharge Planning VeHU Class

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Discharge PlanningVeHU Class 321

• Hi-Ho, Hi-Ho, Its Out the Door You Go!

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Presenters

• Nancy H. Prewitt, RN
• Nurse Manager
• Lexington VAMC
• Kathleen Wolner, MD
• CBOC Section Chief
• Dayton VAMC
• Kay Willis, R.Ph
• Chief, Pharmacy / SPD
• North Chicago VAMC

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HOUSE KEEPING

• Welcome
• This is a 1.5 hour class
• Please silence your cell phones and pagers.
• If you must answer a call, please leave the
  room.
• Thank you.

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• Please,
• Hold your questions during the presentation.
• Questions written on the 3X5 cards provided will
  be answered at the conclusion of the
  presentation.
• For questions not answered,
• the question and the answer will be available on
  the web.

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Objectives

• -To enable participants to explore the
  utilization of electronic media to expedite the
  Discharge Process
• -To expose multidisciplinary team members to
  alternative methods for improving access and
  coordination of care.
• -To highlight key processes along the way
• Transportation
• Placement
• Medication Reconciliation
• Outpatient Appointments
• Hand Off Communication
• -To discuss methods to improve the transition of
  care from the Inpatient to the Outpatient Provider

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And last, but not least

• -To get it all planned and completed the day
  prior to the planned discharge date!

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Facility Complexities

• University Affiliation
• Residency Program
• Teaching Hospital

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Challenges

• -Continuity
• -Coordination
• -Potential for errors

• -Rapid Inpatient Turnover
• -Reduction in Patient Bed Days
• -Frequent Turnover of Resident Physicians

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Importance of Discharge Planning

• Benefits to Patient / Family
• -Outcomes
• -Safety
• -Satisfaction
• Benefit to Facility
• -Efficiency, Safety, Satisfaction
• -Utilization
• -Cost

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Link to National Patient Safety Goals

• Hand-off Communication
• Medication Reconciliation

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Managing and Meeting the Challenge

• It Takes a Village
• Interdisciplinary Teamwork is necessary for
  successful discharge planning

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Interdisciplinary Team

• Physician
• Nurse
• Social Worker
• Dietician
• Pharm D.

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Other Roles

• -Discharge Planner ( RN, MSW, other )
• -Utilization Case Manager
• -Specialty Specific Case Manager
• -Community Health Coordinator
• -Primary Care Case Manager
• -Inpatient Medical Team Administrator
• -You name it, you create it!

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Discharge Planning Starts When?!

• Discharge Planning Begins on Admission or does
  it?
• In many instances, discharge planning begins
  PRIOR to admission.

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Tools to Assist in Successful Discharge Planning

• Impact of the Electronic Age
• Communication
• Documentation
• Tracking

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Sample Tools and Methods to Improve Discharge
Planning Processes Initial RN Assessment
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Learning Readiness AssessmentClinical Reminder
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Collaborative Care Note
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Day of Discharge Note

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Day of Discharge Note
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Discharge Appointment
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Expanded Entry Discharge Appt.
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CPRS Cover Sheet View Discharge Day Appointment
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Discharge Instruction Note Cont
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Discharge Instruction Note
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Outpatient Medication List
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Tools

• Extended Care Consults
• Skilled Home Health
• Homemaker / Home Health Aide
• Respite
• Hospice
• Rehabilitation
• Long Term Care

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So, to Summarize

• -Many avenues to enhancing discharge planning
  processes
• -Electronic Medical Record lends itself well to
  improvements in the process
• -The possibilities are endless!

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If you have a process which needs improvement (
and who doesnt?)

• Implement an interdisciplinary team to work on
  solutions
• -ACA Team (Advanced Clinic Access)
• -Goal Sharing Team

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The Pay-off for Your Work

• -Decrease Bed Days of Care
• -Decrease Nosocomial Infection Rate
• -Decrease Potential for Errors
• -Decrease in Recidivism
• -Decrease Call Volume back to Telephone Care
  Program from Recently Discharged Patients
• -Decrease Staff and Patient Frustration

• -Improve Utilization of Resources
• -Improve Staff and Patient Satisfaction
• -Reduce Cost of Care
• -Improve Third Party Payment / Cost Recovery
• -Meet Performance Measures

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So,

• Hi-Ho, Hi-Ho,
• Were All Discharge Planners
• You Know!

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Formulary on Toolbar

• Kathleen Wolner, MD

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Formulary on Toolbar
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Medication Reconciliation Clinical Reminder
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How to Add a Drug to the Drug File
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Resident Patient Information Handoff
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Dayton Discharge Note
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• Pharmacy,
• The Last Stop before Out the Door

Kay Willis
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Get Started Early

• Pharmacist involvement in discharge planning
  should begin on admission and should include
• Allergy Assessment
• Complete medication history, including NON-VA
  meds and Herbal/OTCs
• Medication Reconciliation

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Have a Discharge Plan

• Many ideas to improve discharge system
• FIX (Flow Inpatient Improvement Initiative
• Discharge appointment

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Special Issues

• Specialized medications might require more
  intense education
• Home IV therapy
• New Patient Administered Medications like
  Enoxaparin
• Scriptalk (for vision impaired patients)
• Tube Feeding
• Warfarin

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Be Proactive

• As soon as specialized medications are identified
  as going home with patient
• Obtain list of drugs and supplies
• Educate patient and family multiple time
• Education should include return demonstration

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Roadblocks

• Stability of medications may be too short to
  support home infusion
• Patient unable to self-administer medications
• Short notice discharge announcement
• Medication Reconciliation

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Speaking of Medication Reconciliation

• VA struggles to meet the intent of National
  Patient Safety Goals for an complete and accurate
  medication profile
• Recommend you consider attending 212
  Medication Reconciliation (The Good, The Bad, and
  The Ugly) Thursday, August 23, 20071000 AM 
  -103000 AM (EST)

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Hines Class III Medication Reconciliation Tool
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DISCHARGE PLANNING

• Know your medical centers policy on discharge
  planning
• Understand that special need medications may need
  to be ordered
• Plan Ahead

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Actual Discharge RX Process

• Provider determines medications to go home with
  patient after conducting medication
  reconciliation
• Provider enters outpatient prescriptions in CPRS
  for medications and supplies to go home

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Pharmacy Actions

• Pharmacist reviews medication orders
• Seeks clarification concerning any problems
• Prepares medications to go home
• Medication teaching by pharmacist/nurse with
  actual prescriptions in hand
• Documentation of discharge medication teaching

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Components of Medication Teaching Documentation

• A complete list of medications is provided to the
  patient including NON-VA medications and
  Herbal/OTC
• Documentation that patient was educated on and
  was able to verbalize all new and old medications
  including use, dosage and side effects
• Documentation that patient medication instruction
  sheets were given to patient

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More Components

• Documentation of potential drug-nutrient and
  drug-drug interactions.
• Patient advised to contact provider with any
  questions or concerns
• Documentation that patient was/was not able to
  understand instructions
• If patient unable to understand medication
  instructions, spouse/family member was educated
  on medications.

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Discharge Counseling Note Example

• EDUCATION
• MEDICATION TEACHING
• A complete list of medications was provided
  to the patient
• upon discharge.
• Patient was educated on and was able to
  verbalize all new
• and old medications including use, dosage,
  and side effects. Topics
• also included potential drug-nutrient and
  drug-drug interactions.
• Patient was advised to call provider with any
  questions or concerns.
• Patient unable to understand instructions.
• If patient unable to understand medication
  instructions,
• spouse/family member was educated on
  medications.

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• QUESTIONS?