Discharge Planning

meanmaryjean, DNP, RN · Apr 17, 2013

Perhaps you could share what is happening NOW so we would have some more information about your current practice and resources?

Julius Seizure · Apr 17, 2013

Sure! I work in peds cardiac surgical ICU.....we started giving our hypo plastics binders to take home that included med schedules, formula instructions, follow up appointment schedules, and a "resume" of their diagnosis and med hx (one page that the healthcare provider can glance over if there is an emergency or ER visit). Now we are discussing expanding those binders to give to all complex discharges, not just single ventricles. I'd like to expand the resources that we include. Maybe developmental info - something from PT about how to work with your baby to keep they developmentally on track? Or a letter to the siblings about how their new baby sister or brother is special? Just wondering if you all had any ideas about what would be good to include.

I also think we need to improve how early we start discharge planning....seems that we sometimes scramble to teach the parents everything in the last 4 days and its overwhelming for them. It should start much earlier, but it just doesn't seem to happen.....ideas how to change that?

umcRN, BSN, RN · Apr 17, 2013

Unless our patients are vent dependent they will transfer to the acute care heart unit and discharge from there. Discharge teaching all takes place there. I do know that we have an extensive single ventricle program, they get binders, home pulse ox machines (pre glenn pts), baby scales. They get a daily phone call from our single ventricle program nurses who ask for their morning sats, weight and how their feeding is going. A nutritionist checks in weekly. Most of our kids are enrolled in a state supported infants and toddlers program which focuses on a variety of therapy (PT/OT, Speech) and they would also be followed at our hospital if needed. I'm sure there are other elements of this program I don't know about as I don't work on the floor or in outpatient but it seems to work well. I don't know what kind of discharge teaching is done for our other complex but not single ventricle patients as again, they are discharged from the floor.

umcRN, BSN, RN · Apr 17, 2013

Also as far as teaching in general, I used to work NICU and we had plenty of complex patients discharged from there and we had a discharge teaching program that started at admission. It included ten steps home and each step had a few sections. All steps had to be documented as complete prior to discharge. It started with the basics like "welcome to the NICU" which included info about the unit, breastfeeding resources etc and went from there all the way to nearing discharge where parents would have to bring in any special equipment the baby required and learn how to use it and ultimately spend a night or two "rooming in" and doing all the work - especially helpful for trach/vent/gtube babies.

Julius Seizure · Apr 18, 2013

Sounds like a more "fleshed out" version of what we do...we just need to implement better. Our pre-Glenn's also get pulse ox probes and baby scales :) hopefully I can build on what we have to make the process easier and more effective for our unit. Thanks for the response!