Transition, Discharge and System Navigation
Sam, a fourth-year nursing student, started the first week of his consolidation in a busy internal medicine unit within a large teaching hospital. Today, Sam is caring for a patient, Mrs. Lianna Rossi, who was admitted for an upper GI bleed 3 days ago. She had an endoscopy yesterday where they found an ulcer that was cauterized with no reported complications. Mrs. Rossi was on a continuous pantoprazole drip (Protonix) yesterday before the endoscopy and then transitioned to 40 mg IV BID after the procedure. As per the pharmacist’s recommendation and physician’s order, this morning she will start her first dose of pantoprazole 40 mg PO daily in preparation for discharge. The patient was started on a clear fluid diet for dinner yesterday after her scope but will have her first full fluid meal today.
On this unit, there are interprofessional rounds for all the admitted patients which include: two team lead nurses (each representing half of the unit called PODS), the charge nurse, the discharge planner (also an RN), internal medicine doctor, resident, the physician’s assistant, physiotherapy and occupational therapy team, dietician and pharmacist. Other disciplines that are on the unit during the time for rounds are encouraged to join. Sam’s preceptor, Jamie, is the team leader for POD 1 today and will present all POD 1 patients at rounds. Sam also attended today’s round for the first time and is surprised by the number of different disciplines who attend patient rounds and the different points of view they bring on patient readiness for discharge.
Jamie presents Sam’s patient and indicates the patient is a “yellow”, which in this hospital means that this patient is 24-48 hours away from being ready for discharge. With Sam’s morning assessment, he reported to his preceptor that the patient is still on a clear fluid diet and experiencing abdominal pain, rated at 2/10. The physician asks about the patient’s medications and the pharmacist reports that they have been started on PO Protonix. The physician upgrades the patient’s lunch to a regular diet and says, “If the patient tolerates it well, they can go home at 1600. Please keep me updated”. Sam is slightly surprised that his patient might go home today and wonders if the patient is ready to go home.