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Discharge Planning Project

Danielle Giaritelli, SN
University of South Florida


Discharge Diagnosis
R.F., is an 89 year-old female patient who was admitted to Florida Hospital Tampa on
January 11, 2015 after she fell inside her room at Zephyrhills Assisted Living Facility. She
reported she hit her forehead and the back of her head when she fall, but didnt lose
consciousness. She complained of dizziness, headache, and severe pain in her neck, back, and
shoulders. Upon arrival to Florida Hospital Tampa, the patient underwent a CT Scan without
contrast of her head and neck, which revealed a mild brain bleed in the frontal lobe, but was not
serious enough to remove. The patients hospital stay was focused on controlling her pain level
and education on fall prevention. She was discharged two days later on January 13, 2015 with no
The patient understood why she was hospitalized and that preventing falls in the future is
very important to her quality of life. It is also important that the patient understood what a
subdural hematoma is because that was the outcome of her fall. Fortunately, it wasnt serious
enough to remove, so it was explained to the patient that the safest treatment would be to allow
the blood to gradually be absorbed by the body. Even though the brain bleed wasnt as serious
this time, it is still crucial to educate the patient on how to prevent falls in the future for their
safety and to prevent readmission. The patient was weak throughout their hospital stay, but said
they used a walker at home, which is why emphasis was placed on educating the patient about
using their walker every time they went somewhere whether she was feeling weak or not.
Because the patient lived in an assisted living facility, she could call for help whenever
necessary. Another part of patient teaching was making sure she understood when going to the


bathroom or to the shower she called for help just as she did during her hospital stay. The actual
diagnosis itself was important to make sure the patient understood what happened, but also it was
essential to teach the patient different methods to reduce the risk of her falling again. Although
neither of the topics listed above are part of the core measures, fall prevention is a significant
part of patient care.
There was a reconciled list of medications for the patient, but there werent any new
prescriptions or refills at the time of discharge. The list included drug name, dosage, frequency,
and route to provide the patient with the most accurate list and ensure all the correct medications
are given to the patient. The list did not include when the last dose was and the next expected
dose, but did say the frequency and that the patient should continue all the medications they were
previously taking before admitted to the hospital. During the patients hospital stay, it was
important to make sure they understood why they were taking medications and any side effects
that may be expected. Atorvastatin, which the patient understood was to help manage high
cholesterol, was given once a day at a night and the patient knew to do this at home as well. She
was reminded to be aware she may experience confusion, headache, and constipation and to try
and avoid drinking large amounts or grape juice each day while taking the medication. Another
medication the patient understood was Citalopram. She knew it was to help with her depression
and also to notify a healthcare provider if she had worsening suicidal ideation and it may cause
confusion and weakness. Lisinopril was a medication that the patient understood was to help
control their blood pressure. She also understood that it side effects she might experience are
dizziness, headache, and to be cautious when getting up quickly as it may cause hypotension.


Solifenacin is a medication the patient took and knew that it helped with her overactive bladder,
although she said she didnt know if it actually helped. However, she knew it may cause a
headache and confusion and to notify health care professional if swelling of the lips or face
occurs. The patient said she was taking her medications for a while at home, so she knew why
she was taking each one and the side effects she may experience.
Home Assessment
The patient lives alone in her own apartment, but it is located inside an assisted living
facility. The floors are carpet, but she has no additional rugs. She also uses a walker anytime she
is walking somewhere. Her dresser is next to her bed and she claims she keeps anything she
needs within reach. It is important items are within reach otherwise it could be a potential hazard
for her to climb onto something in order to reach it. Her bathroom is located across from her bed,
but every time she goes for a shower or to use the toilet she calls for assistance. There are seats
in the shower and grab handles that she can hold on too. She wears a medic alert bracelet, which
allows her to press the button in a case of emergency, and notifies the staff at the facility. This is
a key element to patient safety because it allows them to always be able to call for help. The
patients daughter lives in Zephyrhills and is able to transport her when needed to go places. All
of the patients meals are cooked for her at the facility and they have a pharmacy on site where
she gets her medications. Although it is convenient, the patient has to pay for the medications out
of pocket. The patient said that her husband worked all his life before he passed so she would
never have any financial concerns. As far as the patient says she can afford the medications, but
are still very expensive. Fortunately, they are not a financial burden for her.
Follow Up


The patient was discharged under the condition that the facility where she lives places a
bed alarm on her. The physician felt comfortable discharging her as long as the staff was closely
monitoring her. The idea of a bed alarm was smart because it will notify the staff if she tries to
get up and doesnt call for help. The patient also has to have a visit with physical therapy each
week to help build up her strength. Her gait was unsteady and she was still feeling weak at
discharge, so it was important to ensure her safety by setting up appointments with physical
therapy. There wasnt a set follow up appointment, except that the patient was instructed to make
a follow up appointment with her primary care physician, Dr. Martiniz, one to two weeks after
her discharge date.
The most important considerations to address to the patient in order to prevent
readmission were ways she could prevent falls. This included informing her to see if there were
non-slip grips for underneath her walker. This would help her walker from sliding and prevent
her from losing balance. Also, making sure she lived in a well lit home. Walking around in the
dark isnt safe for anyone and is a sure way to trip over something. As stated earlier, making sure
everything for the patient is within reach so they dont have to stand on something to grab it.
Reminding the patient of the importance of wearing her alert bracelet incase something happened
and to call for help when needing to go to the bathroom. Encouraging the patients to meet with
physical therapy so she can work on stabilizing her gait and building up strength to move around
better. Also, making sure there isnt any lose cords on the floor or objects that would make it
easy to trip. There are several ideas that were told to the patient to educate her on how she can
prevent falls in the future and prevent having to be readmitted.



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