For many years as a young adult, I greeted the winter holiday season with trepidation. It took many years to figure out that I was the one in charge of managing my ‘holiday’ stress. But then again, I have never been hospitalized during Christmas. That brings a whole different level of stress and anxiety–not just for what’s going on with you, but what’s going on in the hospital with staffing, communication, supplies, and scheduling.
While hospitals make every effort to discharge patients so they can be home with families (and require less staff), going home may not always be safe or well planned. In this holiday issue of The Flame, we offer suggestions to prevent an unsafe discharge. Don’t go home (from the hospital) for the holidays until you review them.
And while we’re talking about being in the hospital, not sure what gift to give your loved one’s nurse when visiting them? Let me recommend the universal gifts of kindness, compassion, and a little extra patience. It’s the true spirit of the holidays in action!
— Betty Long, RN, MHA, President/CEO, Guardian Nurses Health Advocates
Don’t Go Home for the Holidays – Until You Read This!
There is nothing that gets our team of nurse advocates fired up like a poor discharge from the hospital!! There is story after story, week after week, about patients coming home from the hospital without the proper planning and the appropriate resources for them to recover safely at home.
Unfortunately, the holiday season does not stop the flow of patients in and out of the hospital. People still get sick, emergencies still happen, surgeries might still be necessary and patients will be discharged home.
Only a physician can authorize a patientʼs release from the hospital, but the actual process and preparation of discharge planning can be completed by a number of people. Some hospitals have a dedicated discharge planning manager on staff, but your point person could also be a social worker, nurse, or other hospital representative. During the holidays, who knows?
Being in the hospital over the holidays can be a challenging time for many reasons, but before you or someone you love is discharged home, make sure you read these suggestions.
- Do not leave the hospital until your nurse or your physician carefully reviews your discharge instructions and you completely understand all of them! (Coming in and handing you 10 pages of printed instructions does not count!)
- Pay close attention to the medications that are being prescribed for you at discharge. Do you have prescriptions for all of them? Do not leave the hospital until you do.
- Ask if the hospital has a pharmacy that would be able to fill the prescriptions being ordered for you? (Not all hospitals do). If there is one, check the hours it’s open to ensure that you don’t miss out.
- Know where is the closest 24 hour pharmacy is to your home. If the discharge is late afternoon/evening, you’ll want to know.
Skilled Home Care Services aka ‘Home Care’
- There is a difference between ‘skilled’ home care support and non-skilled support. Skilled support is typically covered by health insurance; non-skilled is not. Skilled home care provides wound care, physical therapy, nursing assessment, etc.
- When your physician is planning to discharge you, ask about whether you will need skilled home care. If yes, the hospital staff will need to make a referral to a home care agency. If you know which agency you’d like to use, let the staff know so that they can call. Many agencies are struggling to keep up with demand so you may not get the agency you want.
- Make sure you get the name and phone number from the hospital staff of the agency that accepted the referral.
- There is a law that states that once a referral is received and accepted, home care agencies must see patients at home within 48 hours of discharge. Patients also have a right to assert that they want to be seen. To ‘get around this,’ say you are discharged on Monday. An agency may call you and say that they will ‘come on Thursday’ (which is longer than 48 hours) and if you say, ‘Great,’ the agency has gotten ‘approval’ for the greater than 48 hours’ first visit. Scheduling in home care is a constant juggling act.
Supplies and Durable Medical Equipment (DME)
- Will you need supplies when you get home? Do you have wounds that will need dressing changes? Will you require suction? If yes, that means you need to know the name and phone number of the DME company that is being used so that if anything isn’t delivered, you know who to call.
- Make sure the hospital sends you on your way with at least two days of supplies because your home care agency will not bring supplies on their first visit. Once they’ve evaluated you, they can order them. The hospital staff may tell you that ‘home care will supply everything’ but that is not true.
- Will you need oxygen when you get home? Do not leave unless the case manager or discharge planner has called an oxygen company and set up delivery of your supplies for before you arrive home. And again, get the phone number and name of the agency.
Follow-up Appointments or Testing
- In your discharge instructions, there may be an entry for you to ‘follow up with a neurologist.’ Make sure you have the office phone number to call. If a specific provider is indicated, make sure you have that name and office number. Even better if the appointment was already made for you!
- If you need additional testing, like a radiology test or bloodwork, confirm that you have a physician’s order for the testing. Again, even better if the test was already scheduled for you!
Urgent or Emergent Issues
- Understand who and what number to call if you need help once you get home—and that means 24 hours a day, including weekends! Hospital staff may suggest that you ‘go on your portal’ to send a message, but get a phone number (direct, cell number, if possible) so that you can get hold of a healthcare provider in a more timely manner.