Planned Dsicharges

1. HOSPITAL DISCHARGE PLANNING FOR SPINAL
CORD INJURED PATIENTS
Presented By :
Vishnu . P .V
Spine Nurse Counselor
Indian Spinal Injuries Centre

2. “The aim of discharge planning is to reduce
hospital length of stay and unplanned
readmission to hospital, and improve the co-
ordination of services following discharge
from hospital.”
AIM OF THE TOPIC
2

3. INTRODUCTION
 Discharge from hospital to home requires the
successful transfer of information from clinicians
to the patient and family to reduce adverse events
and prevent readmissions. Engaging patients and
families in the discharge planning process helps
make this transition in care safe and effective.
 Comprehensive discharge planning will be
initiated once SCI patient is stabilized.

4. COMPONENTS OF DISCHARGE
PLANNING CONTAINS:
CLINICAL
HISTORY
DIAGNOSTIC
EVALUATION
EXPLAINED
PROGNOSIS
MANAGEMENT
REHABILITATION

5. BASELINE ASSESSMENT AT
SCENE &
UPON ARRIVAL TO ER
ABCs / ATLS assessment includes
Vital Signs & Glasgow Coma Score
Neck / Spine stabilization
Maintaining BP
Multisystem support
May be sedated

6. IMMEDIATE
MANAGEMENT
 Once a person is injured, the first priority is to
stabilize the patient’s vital functions and manage
shock.
 Immobilize head and neck in neutral (in most
cases using a back board and a cervical neck
collar)

7. DIAGNOSTIC
MANAGEMENT
Neurologic Examination
AIS Scoring
X ray films
 Magnetic resonance scanning
CT Myelogaraphy

8. PATIENT RESPONSE TO
INJURY
Explained
Prognosis
hopelessness
sense of
suffering
Depression
Recovery
delayed
anxiety
Social -
relationship
concerns
Nonacceptance

9. PATIENT RESPONSE TO
INJURY
Explained
prognosis
Health care
providers
Quality of
care
Good
Recovery
Acceptance
Secondary
conditions

10. TREATMENT FOCUSES
ON:
1. Preventing further injury
2. Enabling people to return to an active and
productive life within the limits of their disability

11. The IDEAL Discharge Planning strategy highlights the key
elements of engaging the patient and family in discharge
planning :
Include the patient and family as full partners in the discharge planning process
Discuss with the patient and family five key areas to prevent problems at home:
1. Describe what life at home will be like
2. Review medications
3. Highlight warning signs and problems
4. Explain test results
5. Make follow-up appointments
Educate the patient and family in plain language about the patient’s condition,
the discharge process, and next steps at every opportunity throughout the
hospital stay
Assess how well doctors and nurses explain the diagnosis, condition, and next
steps in the patient’s care to the patient and family and use teach back.
Listen to and honor the patient and family’s goals, preferences, observations,
and concerns

12. THINGS TO BE CONSIDER IN
DISCHARGE..
 Discharge Prescriptions
 Equipment and Supplies
 Home and Car Modifications
 Follow-up Appointments
 Post-Discharge Care and Services
 Your Length of Stay
 The Day You Leave

13. HOW LONG WILL I STAY ?
This question is common among patients,
families and friends. The length of stay will
depend on different factors, such as diagnosis
of patient and care needs, patients level of
function, the amount of progress toward
patients goals, and patients funding source.

14. SPINAL REHABILITATION
Rehabilitation is “ the restoration of persons
with disabilities to the fullest physical, mental,
social, sexual, vocational and economic
usefulness of which they are capable.”

15. GOALS OF
REHABILITATION
 Promote mobility
 Reduce spasticity
 Improve bladder and bowel control
 Prevent pressure ulcers
 Reduce respiratory dysfunction
 Promote expression of sexuality
 Control pain
 Nutritional management and weight gain
control
 Effective health maintenance

16. MULTIDISCIPLINARY TEAM
 SCI consultant
 Nurse
 Physiotherapist
 Occupational therapist
 Orthotist
 Psychologist
 Peer counselor
 Assistive technologist
 Social worker
 Vocational counselor
 Patient & family

17. ROLE OF MULTIDISCIPLINARY
TEAM
 Various professionals assess and treat the
patient separately with discipline-specific goals.
 To make the patient independent according to
their priority and preferences.

18. RULES OF GOAL
PLANNING
SMART
S = Specific
M = Measureable
A = Achievable
R = Realistic
T = Time-dependent

19. GOAL PLANNING AT
ISIC
 It is a process in which whole team sit together
and assess patient's present condition, set target
for the patient according to their capabilities”
 Reassess goals in between and in set
timeframe
 Change the goals if required

20. APPROPRIATE DISCHARGE
PLANNING
INVOVES:
 Patient and their family
 Relevant members of the multidisciplinary team

21. HERE COMES THE NEED
OF SPINE NURSE…
“ SCI nurse helps patients to achieve their
optimal level of functioning or their
highest level of wellness.”

22. MULTIDIMENSIONAL ROLE
OF A SPINE NURSE
SPINE
Nurse
Leader
and
Collaborator
Provider
of
Care
Coordinator
Of
Care
Client
Advocate
Educator
and
Coach
25

23. PSYCHOLOGIST

24. ROLE OF PSYCHOLOGIST
“Assists individuals in coping with, and
adjusting to chronic or acute conditions,
traumatic or congenital injuries (such as an
SCI) or illnesses”

25. INTERVENTIONS
 Individual psychotherapy
 Family therapy
 Couple counseling
 Problem solving and coping skills
 Behavior management
 Stress management and relaxation
 Referrals to specialized services

26. VOCATIONAL COUNSELOR

27. ROLE OF VOCATIONAL
COUNSELOR
 To assists those individuals to secure gainful
employment commensurate with their abilities
and capabilities through local job searches and
awareness of self-employment and
telecommuting opportunities

28. PEER COUNSELOR

29. ROLE OF PEER COUNSELOR
“Support provided by peers i.e. people in
similar situation to the person receiving the
support”

30. DUTIES OF A PEER COUNSELOR
 Orientation and Information Regarding the
Rehabilitation Unit.
 Patient Assessment
 Family Assessment
 Individual Counseling
 Vocational Counseling
 Family and Marital Counseling
 Couple and Sexual Counseling
 Health Education:

31. OCCUPATIONAL
PHYSIOTHERAPIST

32.  Maintain and improve JROM
 Independence in ADL’s
 Independence in bed mobility
 Wheelchair training
 Transfer techniques
 Improve muscle strength
 Graded standing
 Balance training
 Gait training
ROLE OF OCCUPATIONAL AND
PHYSIOTHERAPIST
35

33. ASSISTIVE TECHNOLOGY ORTHOTIC
DEPARTMENT

34. TECHNOLOGY AND ORTHOTIC
DEPARTMENT
 The term "assistive technology" refers to any piece of equipment
that helps the disabled to move, communicate or otherwise
function in their daily lives.
 It's important that patients get the right type of aid and equipment
to help them overcome their specific challenges.
37

35.  HOME MODIFICATION
38

36. BRACES
39

37. ADAPTIVE DEVICES
Feeding can be made easier by the help of
some devices like Universal cuff
40

38. Adaptive devices
 Reachers
 Buttoning and unbuttoning devices
7/5/2015 41

39. MONITORING AND FOLLOW -
UP
THE FOLLOWING SHOULD BE IN PLACE
BEFORE DISCHARGE:
 All required arrangements for transport, care and
equipment needs etc
 Full reports from all professionals involved with their
care
 Appropriate transport arrangements made for any future
outpatient or review appointments.
 Follow-up should be done when feasible and clinically
indicated.
 Assess ongoing community reintegration services and
social support through community resources (if available)
42

40. “It is very satisfying to watch as
a patient becomes semi-independent,
or a client is able to return to work. There
are generally no dramatic turnarounds,
but slow, steady progress.”
43

41. ElearnSCI.org – a global
educational initiative of ISCoS
Website address
www.elearnsci.org9/16/20147/5/2015 447/5/2015 44

42. 45