Hospital stays can be very hard. And, if a patient and their family are confronted with a terminal prognosis, it can be devastating. To make such situations even more challenging, families are often forced to fight through difficult emotions and quickly become an objective decision maker for their loved one’s care. If hospice is the next care step for the patient, it can be very hard to manage the details once discharge status is granted.
So, to help, we’ve compiled a list of important information and practical steps for caregivers to use in order to effectively prepare their loved one for quality, comfortable care during and after discharge.
Potential Delays Happen
Before patients can leave the hospital, a physician must write a discharge order, which is typically processed by the nurse. Various factors can delay this process such as impending test results or the timing of the written order. Due to 24-hour observation visits to the hospital, discharges can even happen at midnight; however, a nurse must first process the order, which may not happen until she has time. This can cause several hours of delay, so be prepared to wait and periodically check-in with the attending nurse to see the progress of the discharge order.
Gather Any Needed Equipment
Once a patient has been granted their awaited discharge status, families must begin preparing for their loved one to arrive home. Taking into account the patient’s needs, there are items to be purchased that are obvious and less obvious, such as:
Medical equipment - Though things like oxygen tanks or hospital beds are ordered by the physician, someone will need to be home to receive the delivery before the patient’s arrival.
Bedsheets and other hospital bed accessories - If a patient needs a hospital bed, remember to order sheets that will fit those dimensions- (usually extra-long twin sheets). For those who are incontinent, consider ordering a waterproof barrier like a mattress overlay or under-pad.
Fans - Depending on a patient’s medical condition, they may require a certain amount of air circulation in the room.
Make the Necessary Arrangements
Beyond the specific medical items that need to be ordered, there are a few other logistical matters that should be handled ahead of time. Making a brief to-do list can help caregivers keep track of any arrangements made for the following things:
Transportation - Can the patient ride in a car or will they need an ambulance? Keep in mind that calling an ambulance to bring discharged patients home or to a hospice facility does not come with the same urgency as an emergency. Patients can wait up to a few hours for an ambulance to transport them.
Accessibility - Are there steps in the home that the patient will have difficulty navigating? Is the bathroom on the same floor as the room where they will stay? If not, a bedside commode might be necessary.
Medications - Now that the patient is discharged, new medications will need to be picked up from a pharmacy. This usually means dropping off the prescriptions and going back to pick them up once they are filled. Clarify which pharmacies will have these medications.
Medical Contact - Once the patient is out of the hospital, the family needs to answer several questions regarding care. Who will be contacted for answers? (Many times, the patient’s primary doctor was not involved in their hospital stay and they were cared for by a hospitalist. Make sure the right person is contacted). Who will be the secondary caregiver? How should power of attorney or advanced directives be managed? What kind of bereavement support will be needed?
End-of-life is a trying time for all involved, and while these points and process tips are helpful, professional support is often needed when transitioning into hospice care. We’ll share ways hospice care nurses help families manage the details and provide quality and compassionate care for everyone in an upcoming article. Stay tuned.