What’s your response to this dq??
During my practicum, the safe transition of medical was a problem faced by the organization. Transition of care refers to the movement and coordination of care from one setting to another (AHRQ, 2018). How can we provide a safe transition of care for all patients? The whole team (doctors, nurses, case managers, PT/OT, pharmacist, dieticians, and specialist) plays a critical role in planning for a safe discharge and ensuring a smooth transition of care from hospital to home or other care settings, which should start on the day of admission. Care providers must communicate important information to the patient, families, caregivers, and among themselves in a timely manner. Physicians must ensure that patient understand their medical conditions/plan of care, coordinate patient’s health care to various settings and providers and receive enough knowledge and resources upon discharge to home or other healthcare settings (The Joint Commission, 2012). Case managers collaborate with the interdisciplinary team to discuss patients’ needs such as SNF placement, home health care, DME, transfer to high level of care, home PT/OT, order medical supplies, IV antibiotics, and ensure patient has a safe place to recover. Nurses must ensure that patient/families/caregivers receive a clear discharge instruction including recommendations, medication regimens, follow-up care, education on self-care, warning signs of worsening conditions, who to contact in case of emergency, and how to promote health and prevent illness in the patient’s preferred language (The Joint Commission, 2012). Providing a safe and effective transition of care from the hospital to home or other health care settings prevent readmission and adverse events, which is the care team’s responsibilities.