First Week: final placement

The situation was that I had a patient who had been admitted onto the general medical ward at Fremantle hospital for pneumonia and was 86 years old. She had just been deemed medically stable by the medical team. Premorbidly she lived at home alone and ambulated independently. Since being admitted to hospital she had deconditioned considerably to a point where it would be unlikely for her to return to premorbid function and thus return to living at home.

Task: My task was to conduct a mobility and chest review on this patient to determine their level of function to assist with discharge planning.

Action: Upon review I found that her chest was clear and that she was in fact not at her baseline function. She was mobilizing with a wheeled zimmer frame short distances and required moderate to maximal assistance with mobility. At this stage the patient was at a high level care functional status. I discussed with the patient her options for when she left the hospital as the medical team were under the impression she would prefer to go straight to a nursing home as she was not motivated to participate in rehabilitation to improve her mobility so she was able to go to a hostel.

Result: After talking to her however I found that she would much prefer to go to low level care where she could do things for herself and was motivated for rehab. She realized that for her to achieve this goal she would need to undertake further rehab to achieve low level care functional status. Therefore I liaised with the ward OT to determine an appropriate discharge plan for this patient to optimize their quality of life. We decided that this patient would benefit from slow stream rehab with a transitional care program to improve their mobility so that they could achieve a low level care status and live in a hostel.

Evaluation: I think I was effective with the discharge planning for this patient. By effectively communicating with the patient I was able to determine that the patient was in fact motivated to improve their mobility so that they could be discharged to a hostel rather than a nursing home, therefore improving their quality of life.

Strategies: Strategies that were essential for this situation were good communication and also knowledge of discharge options. I found that there are numerous options to choose from when planning patient discharge and that it is essential to be familiar with all of them as discharge planning is such a large part of our role as a physiotherapist.