a nurse is providing discharge teaching to a client who has heart failure and a new prescription This is a topic that many people are looking for. star-trek-voyager.net is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, star-trek-voyager.net would like to introduce to you Discharge Counseling. Following along are instructions in the video below:
Patients from the hospital can be a complex process in an ideal situation. Health care care providers are not distracted or interrupted. While discharging.
A patient the plan of care well coordinated and communicated clearly the patients caregivers are present. When the discharge plan is explained and the providers confirm patient comprehension in this video. We will discuss how to foster this type of environment discharged from the hospital is a vulnerable time of transition for patients patients leaving the hospital may face challenges with new diagnoses functional limitations changes to their medication regimen.
And other complex self care responsibilities. The information given to patients at discharge is important for their safety. Unfortunately.
This information is often given quickly and without confirmation that the patient and family have understood what has been said the consequences of poor communication are serious during the first few weeks following hospital. Discharge nearly half of patients experience at least one medical error approximately one in five patients suffer. An adverse event.
Most of these are related to medications and approximately one in five medicare patients are rehospitalization to patients about their medications during the discharge process has the potential to improve patient outcomes after discharge national safety organizations encourage healthcare providers to discuss what medications were changed during hospitalization how they were changed and why we should also teach patients what side effects to watch for and what to do if they occur. Most providers arent trained in counseling about medications. But good discharge counseling can empower patients to manage medications.
More effectively improve patient satisfaction with the discharge process and reduce the risk of adverse events and readmission in this video. We will illustrate some challenges that patients and healthcare providers face during the discharge process and then we will demonstrate several best practices in providing patient centered discharge counseling. What time do i come in mr.
Wallace discharge information. I was just up here singing mr. Williams and thought id stop by and check in before going down to the er and what times your ride coming.
Mr. Wallace. Shes taking a late lunch.
Im not sure exactly okay we could go ahead and go over some discharge information. Now we changed several of your medicines. While youve been in the hospital.
Many of them have stayed the same though you know the ace inhibitor. The one we talked about holding because your blood pressure was low. Yeah we can go ahead and restart that we also stopped your ranitidine.
We put you on a map. Result you can take twice a day for four weeks. We also change your dose of warfarin.
So now youre gonna take four milligrams on monday wednesday friday and five milligrams the rest of the week. You get your inr check that your piece of food you need to get that done in a week or so we also wanted to start you on some iron to get your blood counts back up you tend to get constipated. So you can talk to your pc.
Thing about that angels got a copy of it shell give it to you okay listen. Its been great taking care of you mr. Wallace good luck oh hey doc.
Mr. Wallace hi. Im eli angela had to go with the patient to mri.
She wanted me to give you a list of your discharge medications and other paper. Okay sounds like the doctor went over some things. With you already do you have any question said something about some lets see lisinopril warfarin hydrochlorothiazide.
Acetaminophen. No i dont see it on here must not be are you sure you heard it right now take a moment to reflect on what you just observed. How did this episode of discharge counseling.
Go what would you have done differently. How clear was the providers communication. How could they have better handled distractions or engaged the patients family.
Do you think the patient. Understood. The instructions provided now lets take a look at an example of more patient centered discharge counseling.
Hi. Angela hey hi. Id like to review your medications with you before you go home.
Weve added. A couple new medications and then also made some changes to the ones you were on before so i think its important that we go through them im erin neal hi. How are you related to mr.
Stiles i miss wife oh great well im glad you could be here to receive his medications with us do you help him with his medications at home. I do i put all of his medicines into a pill box for him every week. Great well.
Hes lucky to have you to help i have brought an updated list of this medications. And it has all of the branded generic names as well as the directions and the dose and also i included information that i think its important for you to know about feel free to stop me as we go over these and ask any questions do you have any questions before we get started no lets go ahead. Great.
Well you have two new medications. One of them is clindamycin. Which is your antibiotic and the other is iron tablets for your low blood counts or anemia.
The clindamycin is going to be four times a day for seven days. It can be difficult to take a medication four times a day. But its important that you take them as directed until theyre all gone.
I think its easier to remember to take a medicine. If you associate it with your mealtime. So you can take it with breakfast lunch dinner and then again at bedtime.
It can also be tough on the stomach. So taking it with food could help prevent okay. If you happen to miss a dose take it as soon as you remember unless.
Its almost time for your next dose. You should not play catch up and take two doses at once. And theres also a side effect that id like to inform you about it can cause a severe diarrhea even.
Though thats rare its good for you to know about and you need to call the doctor. If that happens you took their lunchtime dose today. So youll have two more doses left.
When you get home okay. Yes. Thats an important point.
So youll have two more doses. And so its important that you get your prescription filled. Today.
When you leave the hospital should i take it with food before i go to bed. He just likes to have a snack before he goes to bed. Yes that should be fine you can take it with a snack at bedtime your other new medicine is your iron supplement for your blood counts your bottle will actually say ferrous sulfate.
Youre gonna take this medicine. Twice a day and i recommend taking it with food because it can cause an upset stomach. The biggest side effect that people may notice with this medicine is constipation.
If you notice that youre constipated. You can always take an over the counter stool softener. It can also turn your stool or your bowel movements.
A dark flat color. This is a normal and expected side effect. So dont let that scare.
You what questions do you have about the iron can i take it with my antibiotic yes you can take with your antibiotic. But you cant take it with your thyroid medication are the levothyroxine now well go over some of the changes that weve made to your medications. Before you came.
In you are taking insulin glargine. 30 units at bedtime. We found that your blood sugars were running low.
While youve been in the hospital. So we decreased that dose to 20 units. We also stopped your oral diabetes pill called pioglitazone the most serious side effect of insulin is getting low blood sugar or hypoglycemia.
How do you feel when your blood sugar gets too low. Its odd. I feel hungry.
But im also a little sick at my stomach well because youre also taking metoprolol the most common signs of hypoglycemia or low blood sugar may not have to you the most likely sign that you will feel is increased sweating so when your blood sugar is flow. You should take a glucose tablet or some juice. Its gonna be really important for you and your family to recognize the signs of low blood sugar and know how to treat it okay youll continue taking your other medications like you were before you came into the hospital.
Except for the pioglitazone youll keep taking the lisinopril and metoprolol for blood pressure. The simbas statin for your cholesterol. They asked from for your heart.
And then also the lip of thyroxine for your thyroid. How do you usually take your levothyroxine at home. I take it right when i get up in the morning.
So dont forget thats perfect. We recommend taking it on an empty stomach before breakfast also remember you should not take that medicine at the same time as your new iron tablets. What questions do you have so if he takes his thyroid pill.
In the morning. Then he should take his iron pills at lunch and dinner. Yes.
Thats perfect now. I do this next part with all of my patients to make sure that ive explained things clearly can you tell me your two new medications. And how youll be taking them.
Lets say theres an antibiotic. Theres some kind of myosin clindamycin clindamycin and some iron pills. Im gonna take the clindamycin four times a day with food you need to take the iron pills with food.
Too and thats lunch and dinner thats right and which medication. Wed be stopping it was my diabetes pill. Exactly the pioglitazone youll also decrease your insulin glargine from 30 units to 20 units.
Mr. Styles. Heres the updated list of your medications and here your prescriptions.
Remember to get a phillips back thanks. Lets reflect on this counseling session as well it illustrates several good take home points for discharge counseling. First engage the family as well as the patient whenever possible ii.
Communicate clearly this means. Avoiding jargon and being specific about instructions. When counseling about medications clearly discuss new medications.
And changes that were made to the pre hospital medications. Third check in with the patient and family from time to time to be sure youre explaining things well. Ask what questions they have finally and most importantly take a minute to confirm patient understanding through teach back as shown in the video.
A good teach back has a few key elements first make it normal practice. Doing teach back and let patients. Know you do this routinely second put the burden on your shoulders.
Its your job to explain things clearly. Its not the patients fault. If youre unclear or try to convey too much information third be specific.
What are the one or two main things for which you would like to confirm understanding finally if the patient has trouble repeating back the key information teach it again and reassess comprehension providing high quality. Discharge counseling isnt always easy but clear communication can go a long way toward improving medication management after hospital discharge. .
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