Co-ordination of Safe Discharge Plan
New injuries – even minor ones — caused by a fall may have a significant impact on the older person’s ability to function in the environment from which they came. For example:
Assess Pre-Injury ADLs and IADLs
A quick assessment of pre-injury function – including ADLs (Activities of Daily Living) and IADLs (Instrumental Activities of Daily Living) – will help to determine how functionally independent the person was before the fall.
ADLs
Activities of Daily Living
One way to remember them is: “the things you do during the first twenty minutes of your day.”
- Transferring
- Toileting
- Bathing
- Dressing
- Feeding
- Continence
Important Note
IADLs
Instrumental Activities of Daily Living
One way to remember them is: “the things you learned to do when you left your parents’ house.”
- Meal preparation
- Housekeeping
- Medication management
- Finances
- Transportation/Driving
- Shopping
- Phone and use of technology
Important Note
Assess Function
Some assessment of function in the department is imperative before discharge. As a minimum the person needs to be able to ambulate independently if he is going to leave the department. More completely if the discharge is going to be an enduring one, the person will need to be able to function independently or with adequate support at home. That may take some coordination of discharge planning.
If you would like to learn more about this topic, visit the Functional Assessment and Discharge Planning module.
Discussion: Co-ordination of Safe Discharge Plan
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PT and/or walk down hall
what
yep
okay
ok
good
Patient’s acquire functional assessment both on arrival as well as prior to discharge
noted
Social work, OT, and PT can extremely helpful with discharge planning!
family involvement
great topic
family involvement, need to ensure safety
potential LHIN referral
Family/ caregiver involvement is paramount for identifying home living environment and responsibilities for ADL/IADL’s
COmmunity paramedic referral. Explain exactly what would be beneficial for this patient. Often it’s about mobility aids being added in the home – extra handles, more room for walkers etc.
LHIN referral, community paramedic
Refer to CACC re:home care
Refer to LHIN/CCAC if no adequate home supports.
followup with ccac to ensure the proper support is achieved at home so that the patient does not end up back in the hospital
ok
ensuring the adequate supports are in place for these patients is a must, they will soon be back in the ED if they are not
discharging a senior who is loosing their functions of daily living or such is difficult at best. community resources and family involvement is a must.
Great to keep in mind for referral (community nursing or community paramedic
Need to feel safe at home.
order to be assessed for home care rn / community paramedic program until able to be seen by OT and assessed for long term homecare
ok
ok
yaaaas
makes sense
none
done
done
Great ideas
Yup
yes
ok
N
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Got it
THIS IS A DIFFICULT PROCESS. MULTIPLE VARIABLES AND REQUIRES COORDINATION BETWEEN CASE MANAGEMENT, PT/OT, PRIMARY CARE, AND FAMILY.
Okay
good case
ok
ok
ok
okay
Good
good follow up
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Done
ok
..
great information
It is good to have OT to eval before discharge home if available.
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Adequate PT is necessary to return to proper functioning
we get the gem nurse and the OT to help with these then case review with geriatrician,link with family and ccac prior to discharge
x
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Family and social support are important.
ok
ok
good stuff
ok
ok
ok
o
frequent checks
agree
ok
ok
challenging if there are no caregivers
Discharging patients before they are at their baseline or without adequate supports in place is asking for a return ED visit.
ok
great
ok
okay
sometimes challenging to recognize that person needs Social services and can’t function independently
important to be able to differentiate between ADLs and IADLs
F/U
ok
ok
how would someone assess for pre-injury function if they just came into the ED? I understand for in a long-term care, it would make sense to check for ADLs and IADLs, but I don’t think its possible for a person coming in to the ED
Antes del alta médica evaluar el apoyo social y familiar
always good to assess support in ADLs
yes
ok
Great points, but difficult in practical application — lack of available inpatient beds or respite beds; wait times for home care services. Ideally, a geriatric assessment service (maybe PT or OT, geriatric nurse, social worker) would be available in the ER to assist with discharge planning to ensure safety after discharge.
i agree
agree
ok
k
Don’t leave the room if you don’t know if they can walk
love it
good tool
yes
explore all available resources for patient.
early talks with social work to assist with evaluation of home situation
ensure safe environment for dc and utilize case management for arranging follow up
Discharge planning is important, ADL’s have to be doable
My rule – If you can’t walk, you can’t go home (assuming they could walk before).
ok
ok
ok
All patients who were ambulatory before this incident have a “road test” in our department prior to discharge to ensue they have to means to ambulate at home
really good basic info that is often over-looked when discharging
Elderly usually had blunt trauma. I would simply perform a quick head to toe physical examination. I would simply ask to call her close relative after taking permission from elderly. I would perform functional assessment of elderly. The patient is alert but incoherent. I would advice for X-ray chest and USG whole abdomen. Monitor all the vital signs closely for next 24 hours in hospital.
I am surprised I have never heard of IADL’s but it is very important and simplifies remembering. Being in the community as noted the first 3 IADL’S this is a good tool to assess risk of future ambulance call or hospital admission when in a pt’s residence. This seems more objective than a PERIL score.
good stuff.
safe discharge is key in preventing preventable re-admission.
Good memory tool
yes
Making sure the patient is well enough to be discharged and then setting up the needed disciplines on behalf of the patient
Agreed, assessment of baseline ADLs and IADLs and what/if anything has changed recently or since admission to ED are pivotal. I have seem patients decline functionally in ED after being held overnight e.g. awaiting diagnostic tests/consultants in AM/another team consult. So the importance of keeping patient moving/getting them up in the chair, up on the commode etc if able/with support if at falls risk, is so crucial.
I meant being held overnight after already being in ED for the day, so in ED for over 12-16 hours, barely up from bed during that time. A person with limited functional reserve is that much more vulnerable.
makes sense
Good information to be aware of, although not really relevant to my duties.
good review
m
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follow-up
good to know
Got it
The GEM nurse service in the Emerg has been incredible; Added to this is the availability of OT/PT assessments during the day, both have contributed to a rather holistic discharge planning at my shop.
the role of social health worker comes in here to visit the discharged person home and make sure all the needs are addressed.
I’ve worked in departments with GEM nurses and those without and their presence is incredibly important in this aspect of the patient’s care. Much more difficult without this component of the team.
family and social support its too necessary
home support is crucial
Home support by family members or care givers is essential
agreed
soporte en el hogar
🙂
Pre injury function and functional assessment post illness/injury is essentiak
hmmm
xx
Gem is instrumental in developing followup
kkkk
Follow-up required and endurance of home suppory
GEM is a key component of thorough care and safe dc plans home in collaboration with ED team
We have a QRP, (quick response team) that will come and arrange next day home care for a patient being discharged from the ER along with further assessment of ADL once they get home. In helps us a lot in giving confidence that the patient will be safe once returning home.
ensure they are dicharged to a place where they get good care.
Ensure follow up,
we get the gem nurse and the OT to help with these then case review with geriatrician,link with family and ccac prior to discharge