Correggio(lat.44 5300N; long.11 4300E) SCENARIO FROM THE - - PowerPoint PPT Presentation

Correggio(lat.44° 53’00’’N; long.11° 43’00’’E)

SCENARIO FROM THE LITERATURE

Less than 60% of patients understand their discharge instructions In elderly people transition care is associated with high rates of medication errors and unintentional medication discrepancies(low cognition at discharge is common; cognition often improves one month past hospitalization) Almost 20% of hospitalized seniors are re-hospitalized within 30 days Current discharge strategies may be ineffective but patient comprehension and recall of discharge instructions could be improved by supplementing free texts with pictographs within a standardized counseling at a low literacy level

SCENARIO FROM THE REAL LIFE

Over 80% of patients hospitalized into my ward has more than 70 ys. More than 50% of these have some cognitive problems and a family caregiver The discharge letter is for the primary care physician, not for the patient COPD is the condition for which you have in our area the highest percentage of early re-hospitalizations

Hospitals in the Local Health Authority of Reggio Emilia: prevalence of re-admissions to 30 and 90 days for patients discharged during the first 9 months of 2011

Principal Diagnosis Total number

• f patients

admitted Patients re- admitted within 30 days % of patients re-admitted within 30 days Patients re- admitted within 90 days % of patients re-admitted within 90 days

Arrhythmia

263 30 11.4% 63 24.0%

Cerebrovascular Diseases

1290 110 8.5% 211 16.4%

COPD

376 65 17.3% 114 30.3%

Congestive Heart Failure

497 79 15.9% 143 28.8%

Coronary Artery Disease

1074 167 15.5% 265 24.7%

Diabetes

190 20 10.5% 42 22.1%

Hypertension

324 32 9.9% 60 18.5%

Pneumonia

806 87 10.8% 159 19.7%

Renal Failure

245 33 13.5% 62 25.3%

PROCEDURE OF COUNSELING AT DISCHARGE

THE DAY BEFORE DISCHARGE

PROCEDURE OF COUNSELING AT DISCHARGE

THE DAY OF DISCHARGE

THESE ARE THE FOCUS

• 1. DIAGNOSIS

2.

• 2. STAGE OF THE DISEASE

STAGE OF THE DISEASE

• 3. NAME OF MEDICATIONS/DOSAGE/MODE OF INTAKE/SIDE

EFFECTS

• 4. NON PHARMACOLOGICAL THERAPY
• 5. LIFESTYLES
• 6. FOLLOW-UP

THESE ARE THE FOCUS

• 1. DIAGNOSIS
• 2. STAGE OF THE DISEASE
• 3. NAME OF MEDICATIONS/DOSAGE/MODE OF INTAKE/SIDE

EFFECTS

• 4. NON PHARMACOLOGICAL THERAPY
• 5. LIFESTYLES
• 6. FOLLOW-UP

Discharge diagnosis(1):”acute respiratory failure from acute exacerbation of COPD in a patient with center- and pan-lobular enphysema” Discharge diagnosis(2):”acute/sudden worsening of your ability to breath/breathing with the appearance of hard to breath/cough/phlegm caused by an infection/inflammation of your lungs already sick of COPD”

COPD is characterized by airflow obstruction,usually progressive, not changing markedly over several months

THESE ARE THE FOCUS

• 1. DIAGNOSIS

2.

• 2. STAGE OF THE DISEASE

STAGE OF THE DISEASE

• 3. NAME OF MEDICATIONS/DOSAGE/MODE OF INTAKE/SIDE

EFFECTS

• 4. NON PHARMACOLOGICAL THERAPY
• 5. LIFESTYLES
• 6. FOLLOW-UP

Active reduction of risk factors,vaccinations,short- acting inhaled bronchodilators Add long-acting inhaled bronchodilators and pulmonary rehabilitation Add inhaled corticosteroids Add Oxygen.Surgery?

THESE ARE THE FOCUS

• 1. DIAGNOSIS

2.

• 2. STAGE OF THE DISEASE

STAGE OF THE DISEASE

• 3. NAME OF MEDICATIONS/DOSAGE/MODE OF INTAKE/SIDE

EFFECTS

• 4. NON PHARMACOLOGICAL THERAPY
• 5. LIFESTYLES
• 6. FOLLOW-UP

corticosteroids antibiotics long-acting bronchodilators short-acting bronchodilators

Times of the drug intake

THESE ARE THE FOCUS

• 1. DIAGNOSIS

2.

• 2. STAGE OF THE DISEASE

STAGE OF THE DISEASE

• 3. NAME OF MEDICATIONS/DOSAGE/MODE OF INTAKE/SIDE

EFFECTS

• 4. NON PHARMACOLOGICAL THERAPY
• 5. LIFESTYLES
• 6. FOLLOW-UP

X _?_ hours

THESE ARE THE FOCUS

• 1. DIAGNOSIS

2.

• 2. STAGE OF THE DISEASE

STAGE OF THE DISEASE

• 3. NAME OF MEDICATIONS/DOSAGE/MODE OF INTAKE/SIDE

EFFECTS

• 4. NON PHARMACOLOGICAL THERAPY
• 5. LIFESTYLES
• 6. FOLLOW-UP

If y can quit smoking y can slow progression of COPD and by doing so increase your lifespan

THESE ARE THE FOCUS

• 1. DIAGNOSIS

2.

• 2. STAGE OF THE DISEASE

STAGE OF THE DISEASE

• 3. NAME OF MEDICATIONS/DOSAGE/MODE OF INTAKE/SIDE

EFFECTS

• 4. NON PHARMACOLOGICAL THERAPY
• 5. LIFESTYLES
• 6. FOLLOW-UP

Short, simple questionnaire for monitoring long-term follow-up of COPD. Aimed at primary care

• practice. Validated in 3

international studies. 8 items, six-point scale, responds to exacerbations. Self-administered. Covers a wide range of symptoms.

COPD ASSESSMENT TEST(CAT)

bagnuloa@ausl.re.it