Have you guys ever had experience to make a decision for your patient to be safe for discharge? It is happening to me with a couple of my patients.
A gentle man who suffers right hemiparesis from stroke. He is quite capable in terms of physically, however his balance is still questionable. In addition, he has right neglect, dyspraxia, dysphasia, spatial disorder, big problems in proprioception and sensation, and is impulsive as well. He walks with supervision on even surface, but he requires constant verbal cues for right foot clearance, right side awareness, and motor planning. As a result of these problems, the right side of his body hit everywhere like doorways, trolleys, W/C, and stools etc that he was totally unaware of hitting. He is easily to stumble over anything as you can imagine. And he cuts a corner or turns himself very quickly due to impulsive, so he is easily to lose his balance as he does so.
He also has problems on his right hand which is his dominant side. Because of his sensory problem and dyspraxia, he quite often puts his right hand onto a hot meal without any attempting of picking up fork/spoon/knife according to his family. One day, it happened three times within 1 min in front of me while I was talking to his family in his room. That happened really quick because of impulsive and nothing we could do to stop him from that. He was aware it was wrong, because he wiped his right hand right away, but he did it twice after that. Fortunately the meal was warm and not hot. However he has burning marks on his fingers from previous repetitions. This is another episode from his family. He grabbed knife by holding the blade side instead of holding proper way. There are some minor areas that I still concern regarding safety issue on him.
Now, isn’t that enough to be concerned his safety issue? I know some of his issue would not be necessary to be recovered before discharge and might not be happened for long period of time or will not be ever. Maybe I am too cautious regarding safety issue.
He has been seeing by his doctor and nurses that walking around without any problems with his family in corridor. Well, most of the corridors at the hospital are wide enough with even surface and do not have lots of equipments around, thus easy for him to manoeuvre I would think. Plus, they have not seen him turning or stumble yet, so his doctor was wondering why physio was holding him back to be discharged.
I explained to his doctor why I did not feel safe for discharge, however I have got impression that his doctor was still unclear why. I just can’t work it out where I should draw the line to be safe for discharge. He will be able to get some help from community services, and I know his wife will help him as needed because she is very supportive, but she can’t be babysitting him 24 hrs a day. He might be fine (I hope) at home, but what if something happen to him?
Do you guys have any suggestions for me?
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2 comments:
Speak to your supervisor sk. Has there been a team meeting regarding this patient?
Trudi
Yes, my supervisor had been addressed this issue and I received no specific answer from my supervisor unfortunately. Because I was the only one treating this patient and my supervisor was too busy to watch my patient's condition. So it was all up to me, even in the team meeting.
Later on I was informed that the speech was not ready for D/C yet also. So I had extra time for this patient to work on the safety and more balance issue!
But still unclear where the D/C line is.....
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