Monday, August 4, 2008

When to Discharge a Patient?

Being in the public health system, it appears there is the constant pressure to discharge patients to allow for the opening of beds. However, being a student, I find it is sometimes difficult to know exactly when the point of discharge should be.
I encountered a situation the other day whereby I had to teach a young patient to use crutches. The doctors indicated that as soon as he had been taught and felt comfortable to use crutches, it was ok for the patient to be discharged. This patient had been rest in bed for a few days, so ambulating once again was an adjustment for him. After being taught how to use them and how to go up/down stairs, the patient practiced numerous times and appeared to mobilise effectively. The only point of concern was that twice during our session he had a slight posterior sway and required my steadying, but this was presumed to be due to the few days of bed rest.
As the patient essentially performed the tasks correctly and safely, and he had no complaints, I spoke with the nursing staff to practice ambulating with him overnight and if he appeared to be mobilising safely, it was ok from physiotherapy perspective to be discharged in the morning. I documented that he was safe for inpatient physio discharge, but did note that he had an occasional posterior sway and if the nursing staff noticed this again overnight, they could request a physio review in the morning.
The physio who was with me at the time seemed to think this was ok, but when my supervisor checked my notes the next day, he suggested that I review the patient again just to ensure he did not repeat the sway from the day prior. Unfortunately, the patient had already been discharged. My supervisor informed me that if I ever had any concern about a patient, I should not feel pressured to discharge the patient. As I had documented the patient had an occasional sway in his notes, if the patient was discharged and fell when using the crutches, the patient could sustain further injury and the blame could fall upon my head.
I guess it’s just a timely reminder that despite a patient or ward staff being eager for discharge, it is important to resolve any concerns you may have, as not only is this vital to the patients wellbeing but also to protect yourself from blame. I know I will keep this in mind from now on.

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