LR19 / Clinical risk – Discharging Patients With No-one at Home

Romania




Type of Patient Safety Practice
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Handover
Patient safety theme the SCP/clinical risk management practice is aimed at
Clinical risk management procedure aimed to assure that guidelines for discharge planning at time of referral, pre procedure and post procedure promoted optimal patient safety following procedures on the patients that suffer an endoscopic examination under sedation. The discharge guidelines were necessary requiring patients to have a caregiver at home with them for the first 24 hours following endoscopic procedures due to the lasting effects of moderate sedation.
Objective of the CRM practice
This study resulted from a clinical practice issue. The researchers sought to establish whether current discharge guidelines were necessary requiring patients to have a caregiver in the home with them for the first 24 hours following endoscopic procedures due to the lasting effects of moderate sedation. Results from analysis of data from 103 subjects suggests a large number of patients have experienced a postprocedure issue, making it prudent to advise patients they must have a responsible adult to accompany them home and supervise them for 24 hours following the procedure.
Short description of the CRM practice, including any references for further information
A flow chart (guideline) was drafted for discharge planning of patients admitted to IPU to minimize unnecessary admission. The flow chart included discharge planning at the time of referral, immediately preprocedure, and postprocedure (Figure 1). Time of Referral Postprocedure criteria are discussed with patients, and the discharge is planned. a If no caregiver is available, plan for admission or RDNS/private care. If these options are not available, discuss the necessity of the procedure with the referring doctor. Immediately Preprocedure If caregiver is available, proceed and plan discharge a If no caregiver is available, plan postprocedure admission a If no caregiver is available and the patient refuses admission, discuss with the medical officer. Postprocedure If a caregiver is available, the patient can be discharged a If the patient is to be admitted, admit him or her to the hospital ward after the procedure. a If the patient refuses planned admission, follow the management strategy for those patients requesting discharge. a In front of a witness, discuss the risks of discharge without caregiver support with the patient again. a Document the discussion and have the witness countersign the report. a Allow the patient to discharge him- or herself a Arrange an appropriate follow-up telephone call the following day, as planned with the patient before discharge. a If the patient is not answering the telephone on the day after discharge, call a contact person or the police to investigate. A telephone survey was carried out postprocedure to assess if patients were deemed to be safe at home, document pain and discomfort levels, and note if the patient thought they could have managed without their caregiver. [ P.112, 1] Strategies were implemented such as home health visits for veteran patients at 8:00 PM, 12:00 AM, 4:00 AM, and 9:00 AM when other alternatives were not available. Ongoing intensive education and planning preprocedure has kept the use to a minimum. This service is only available for military veteran patients due to limited resources. Other strategies were implemented such as updating the preprocedure information leaflets to include “you must have someone with you overnight.” Preprocedure calls were made the afternoon before a patient’s procedure to identify any potential problems. In the case of inadequate home support, the medical director decided these patients will be admitted overnight. Currently, the discharge criteria is strictly adhered to and if patients are unable to provide a caregiver, referral to home health visits, admission to RGH, or postponement of the procedure will occur to ensure safe practices and minimize patient risk. [ P.114, 1]
Innovator of the SCP, country of origin
Country of origin – Australia, Repatriation General Hospital, Adelaide, South Australia
Involved health care staff
The involved staff was represented by people working in Quality Management Unit, Staff Nurse, Registered Nurse
Tested in which countries/health care systems, health care context(s) and/or clinical specialty/specialties, including references
Tested in Australia [ P.111, 1] The Investigation and Procedures Unit (IPU) at the Repatriation General Hospital (RGH) in Adelaide, South Australia performs approximately 2,000 endoscopic procedures annually with the majority of patients aged over 65 years. Many of these patients have comorbidities giving them an American Society of Anesthesiologists (ASA) Status of 2 or greater and classifying them as an anesthetic/sedation risk [2] . Anesthetists are generally available during procedures and are often requested for specific patients identified as high risk.
Summary of evidence for effectiveness, including references
This study resulted from a clinical practice issue. Discharge guidelines recommended for patients with Gastrointestinal investigations to be accompanied by someone at home, in the first 24 hours after endoscopic investigations, given the risk, including adverse events resulting from sedation. [3] The results of the survey showed no one recovering at home suffered any adverse events (e.g., fall or admission to hospital). The survey suggests, however, that there is enough evidence, despite a small patient sample, that the discharge criteria post procedure needs to remain as they are. A significant number of patients have experienced a post procedure issue which makes it prudent to advise patients they must have a responsible adult to accompany them home and supervise them for 24 hours [p.113, 1]. Results from analysis of data from 103 subjects suggests a large number of patients have experienced a post procedure issue, making it prudent to advise patients they must have a responsible adult to accompany them home and supervise them for 24 hours following the procedure. [p.114, 1].
Summary of evidence for transferability (transferability across health care systems or health care contexts or clinical specialties), including references
Not sufficient information for transferability Replication of this study in other countries with patients of various age groups is indicated before widespread change to practice is warranted. Findings, however, do support the need for patients to have someone in attendance with them following moderate sedation for endoscopic procedures to address safety issues. [p.114, 1].
Summary of available information on feasibility, including references
For the purpose of the survey, it was deemed appropriate to contact approximately 100 patients which represent 5% of the number of patients who undergo gastrointestinal (GI) examinations in IPU annually. From mid December 2002 to late February 2003, 103 of 197 outpatients were surveyed via telephone the day following their procedure. Patients were selected from procedure list documentation solely on their outpatient status (i.e., inpatients were excluded). The interviewer was unable to make contact with 94 outpatients; hence they were excluded from the sample. Patients were questioned on whether or not they felt “themselves” again by the following morning, any noted dizziness or falls, disorientation, agitation, pain and discomfort, and nausea or vomiting. Patients were also queried as to whether they could remember any of the instructions given to them by the nurse and doctor as well as information related to follow-up visits to the general practitioner or hospital. Patients were also asked if they had someone to care for them overnight along with their thoughts on whether they could have coped at home without a caregiver. [ P.113, 1] Results from analysis of data from 103 subjects suggests a large number of patients have experienced a postprocedure issue, making it prudent to advise patients they must have a responsible adult to accompany them home and supervise them for 24 hours following the procedure. [ P.114, 1]
Existing implementation tools, including references
Planning and reviewing guidelines for patient discharge postendoscopically has significantly reduced potential problems and promoted safe practice for patients postprocedure. [p.111, 1].
Potential for/description of patient involvement in the CRM practice, including references
The patients’ involvement consists in their participation to the telephonic survey.
Bibliography (for each reference: author(s), year, title, journal/internet link, page(s))
[1] Sally Gall, RN, ACGEN, Jeff Bull, RN, ACGEN, MRCNA, Clinical risk – Discharging Patients With No-one at Home, GASTROENTEROLOGY NURSING, VOLUME 27 • NUMBER 3, 2003, [pages 111-114]  [2] American Society of Anesthesiologists. (2003). ASA physical status classification system. Retrieved August 31, 2003, from http://www.asahq.org/clinical/physicalstatus. htm. [3] Australian and New Zealand College of Anaethetists. (2000). Recommendations for the perioperatve care of patients selected for day care surgery. Retrieved September 18, 2003, from http://www.anzca.edu.au/
Reviewer
Dr Georgeta Popovici, National School of Public Health and Management, Romania
Organisation
National School of Public Health and Management, Romania
Any additional information on the CRM (e.g. implementation barriers and drivers)
-'
Top
izmit escort
usak escort elazig escort
vidio bokep
antep escort escort bayan