Discharge Management for Traumatic Brain Injury: Difference between revisions
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== General Principles of Good Practice for Discharge == | == General Principles of Good Practice for Discharge == | ||
[[File:Mock_Discharge_Form.jpg|right|frameless|200x200px]]Good discharge planning can make all the difference to the | [[File:Mock_Discharge_Form.jpg|right|frameless|200x200px]]Good discharge planning can make all the difference to the individuals ongoing well being following a traumatic brain injury. Discharge planning should involve, from the outset, the patient and their family/carers, and the rights and wishes of the patient should always be listened to and respected. | ||
If possible, it is considered beneficial that the discharge occur in the morning, providing the afternoon and evening hours for the individual to settle into their new environment before going to sleep. Earlier in the week is also better than a friday as many services may not be available over the weekend. | |||
For patients returning home, adaptations may need to be provided prior to discharge. The video below gives a brief look at the process. | |||
For patients returning home, adaptations may need to be provided prior to discharge. | |||
The video below gives a brief look at the process. | |||
{{#ev:youtube|https://www.youtube.com/watch?v=4iVH4gu3J2c|width}}<ref>Summer Foundation Hospital Discharge Part E – NDIS Planning Available from: https://www.youtube.com/watch?v=4iVH4gu3J2c (last accessed 19.10.2019)</ref> | {{#ev:youtube|https://www.youtube.com/watch?v=4iVH4gu3J2c|width}}<ref>Summer Foundation Hospital Discharge Part E – NDIS Planning Available from: https://www.youtube.com/watch?v=4iVH4gu3J2c (last accessed 19.10.2019)</ref> | ||
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In many hospitals, there is a named professional who has overall responsibility for discharge planning. | In many hospitals, there is a named professional who has overall responsibility for discharge planning. | ||
A formal discharge meeting should be arranged, involving | A formal discharge meeting should be arranged, involving, but not limited to; | ||
* patient | * patient | ||
* hospital nursing staff | * hospital nursing staff | ||
* medical social worker | * medical social worker | ||
* rehabilitation staff | * rehabilitation staff, which may include relevant physiotherapist, occupational therapist, speech and language therapist | ||
* close family members and carers, where appropriate | |||
* close family members and carers | In some cases the individual may be able to go on a trial visit home for a day and/or overnight before actually being discharged. | ||
In some cases the | |||
== Information Provided on Discharge == | == Information Provided on Discharge == | ||
The hospital should provide information on: | The hospital should provide information on: | ||
* Symptoms of complications that could require urgent treatment | * Symptoms of complications that could require urgent treatment | ||
* Activities to avoid, and for how long | * Activities to avoid, and for how long eg. driving | ||
* Prescriptions and | * Prescriptions and Medications | ||
* Cognitive changes which may be expected, and suggestions on their management | * Cognitive changes, which may be expected, and suggestions on their management | ||
* Ongoing rehabilitation requirements | * Ongoing rehabilitation requirements | ||
* Any special dietary requirements | * Any special dietary requirements if the patient has problems with swallowing eg. soft diet, or thickened fluids | ||
* Contact details for key professionals and all health providers involved when discharged | * Contact details for key professionals and all health providers involved when discharged | ||
* If appropriate, details on how to manage incontinence/urinary catheter | * If appropriate, details on how to manage incontinence/urinary catheter | ||
Note it is very important to check with the individual and their carers/family, where relevant, that they understand the process and feel comfortable with the arrangements. | |||
== Return to Work == | == Return to Work == | ||
[[File:Disabled workers.jpg|right|frameless]]People who have suffered mild to moderate | [[File:Disabled workers.jpg|right|frameless]]People who have suffered mild to moderate traumatic brain injury may be able to return to the work they were involved in before their brain injury. Return to work is an important measure of integration into the community. One author reports that individuals with brain injury who fail to return to work have a lowered subjective wellbeing when compared to those who succeed in returning to work.<ref>Cicerone, K.D. Cognitive Rehabilitation for traumatic brain injury and stroke: Updated review of the literature from 1998 through 2002 with recommendations for clinical practice. America: Archives of Physical medicine and rehabilitation, 2000;92,(4),1596-1615.</ref> | ||
Studies show that only 30% of people with moderate | Studies show that only 30% of people with moderate traumatic brain injury and 80% of people with mild traumatic brain injury successfully return to work.<ref>Vuadens,P. & Arnold,P & Bellmann,A. Return to work after a traumatic brain injury- Vocational Rehabilitation. Pari: Springer Paris; 2006.</ref> The image shows a workplace for the people with a disability in Vietnam. | ||
==== Barriers to | ==== Barriers to Returning to Work ==== | ||
* Cognitive | * Cognitive Impairment | ||
* Loss of | * Loss of Motivation | ||
* Fatigue | * Fatigue | ||
* Lack of | * Lack of Support provided in the work environment | ||
* Inadequate | * Inadequate Communication between medical professionals and the employer/manager with the result that the employer does not know how to support the person with traumatic brain injury <ref>Law, M., Baum, C.M. & Dunn, W. Occupational performance assessment. In C.H Christiansen, C.M Baum & J. Bass- Haugen (Eds.). Occupational therapy: performance, participation & well being (3rd edition). Thorofare New Jersey: Slack Incorporated; 2005.</ref> | ||
== Common Sequelae Post Discharge == | |||
Below a few of the sequelae are listed | Below a few of the sequelae are listed | ||
* [[Heterotopic Ossification]] This build up of new bone at the joint has been found to occur in between 10% and 20% of patients with moderate to severe TBI<ref>Hsu JE, Keenan MA. Current review of heterotopic ossification. UPOJ 2010; 20: 126-130</ref>. The most common sites is the hip, followed by the elbow<ref>Mavrogenis AF, Soucacos PN, Papagelopoulos PJ. Heterotopic Ossification Revisited. Orthopedics. 2011Jan;34(3):177</ref> | * [[Heterotopic Ossification]] This build up of new bone at the joint has been found to occur in between 10% and 20% of patients with moderate to severe TBI<ref>Hsu JE, Keenan MA. Current review of heterotopic ossification. UPOJ 2010; 20: 126-130</ref>. The most common sites is the hip, followed by the elbow <ref>Mavrogenis AF, Soucacos PN, Papagelopoulos PJ. Heterotopic Ossification Revisited. Orthopedics. 2011Jan;34(3):177</ref> | ||
* Post Traumatic | * Post Traumatic Seizures (which, in turn, causes further damage to the brain[[File:Mental health thumbnail.jpg|right|frameless]] | ||
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* Degenerative Brain Diseases and Dementia | * Degenerative Brain Diseases and Dementia | ||
* Mental Health Problems | * Mental Health Problems | ||
* Pituitary Dysfunction. Pituitary dysfunction, leading to neuroendocrine dysfunction, is a recognised but potentially underdiagnosed complication of | * Pituitary Dysfunction. Pituitary dysfunction, leading to neuroendocrine dysfunction, is a recognised but potentially underdiagnosed complication of traumatic brain injury [1][2]. It is often labelled Post-traumatic hypopituitrism. This can result in "neurobehavioural sequelae" including concentration difficulties, fatigue, anxiety and depression[3]. One study[4] specifically looked at the time of onset of pituitary dysfunction, and concluded: "The risk of developing endocrine dysfunction after traumatic brain injuryincreased during the entire 5-year follow-up period." | ||
<div align="justify"> | NOTE: for more information see [[Medical Complications in Traumatic Brain Injury|Medical Complications in Traumatic Brain Injury]] page.<div align="justify"> | ||
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Revision as of 23:32, 19 October 2019
Original Editor - Wendy Walker
Top Contributors - Wendy Walker, Naomi O'Reilly, Kim Jackson, Lucinda hampton, Rachael Lowe, Admin, Simisola Ajeyalemi, Uchechukwu Chukwuemeka, Rucha Gadgil, Jess Bell and Tarina van der Stockt
General Principles of Good Practice for Discharge[edit | edit source]
Good discharge planning can make all the difference to the individuals ongoing well being following a traumatic brain injury. Discharge planning should involve, from the outset, the patient and their family/carers, and the rights and wishes of the patient should always be listened to and respected.If possible, it is considered beneficial that the discharge occur in the morning, providing the afternoon and evening hours for the individual to settle into their new environment before going to sleep. Earlier in the week is also better than a friday as many services may not be available over the weekend.
For patients returning home, adaptations may need to be provided prior to discharge. The video below gives a brief look at the process.
[1]Planning for Discharge[edit | edit source]
In many hospitals, there is a named professional who has overall responsibility for discharge planning.
A formal discharge meeting should be arranged, involving, but not limited to;
- patient
- hospital nursing staff
- medical social worker
- rehabilitation staff, which may include relevant physiotherapist, occupational therapist, speech and language therapist
- close family members and carers, where appropriate
In some cases the individual may be able to go on a trial visit home for a day and/or overnight before actually being discharged.
Information Provided on Discharge[edit | edit source]
The hospital should provide information on:
- Symptoms of complications that could require urgent treatment
- Activities to avoid, and for how long eg. driving
- Prescriptions and Medications
- Cognitive changes, which may be expected, and suggestions on their management
- Ongoing rehabilitation requirements
- Any special dietary requirements if the patient has problems with swallowing eg. soft diet, or thickened fluids
- Contact details for key professionals and all health providers involved when discharged
- If appropriate, details on how to manage incontinence/urinary catheter
Note it is very important to check with the individual and their carers/family, where relevant, that they understand the process and feel comfortable with the arrangements.
Return to Work[edit | edit source]
People who have suffered mild to moderate traumatic brain injury may be able to return to the work they were involved in before their brain injury. Return to work is an important measure of integration into the community. One author reports that individuals with brain injury who fail to return to work have a lowered subjective wellbeing when compared to those who succeed in returning to work.[2]Studies show that only 30% of people with moderate traumatic brain injury and 80% of people with mild traumatic brain injury successfully return to work.[3] The image shows a workplace for the people with a disability in Vietnam.
Barriers to Returning to Work[edit | edit source]
- Cognitive Impairment
- Loss of Motivation
- Fatigue
- Lack of Support provided in the work environment
- Inadequate Communication between medical professionals and the employer/manager with the result that the employer does not know how to support the person with traumatic brain injury [4]
Common Sequelae Post Discharge[edit | edit source]
Below a few of the sequelae are listed
- Heterotopic Ossification This build up of new bone at the joint has been found to occur in between 10% and 20% of patients with moderate to severe TBI[5]. The most common sites is the hip, followed by the elbow [6]
- Post Traumatic Seizures (which, in turn, causes further damage to the brain
- Bladder Bowel Dysfunction and Genitourinary Complications
- Nutritional Deficits
- Degenerative Brain Diseases and Dementia
- Mental Health Problems
- Pituitary Dysfunction. Pituitary dysfunction, leading to neuroendocrine dysfunction, is a recognised but potentially underdiagnosed complication of traumatic brain injury [1][2]. It is often labelled Post-traumatic hypopituitrism. This can result in "neurobehavioural sequelae" including concentration difficulties, fatigue, anxiety and depression[3]. One study[4] specifically looked at the time of onset of pituitary dysfunction, and concluded: "The risk of developing endocrine dysfunction after traumatic brain injuryincreased during the entire 5-year follow-up period."
Resources[edit | edit source]
Headway have useful information about returning to work after brain injury.
The document Brain Injury; a guide for employers by Headway has detailed information on the topic.
Headway also produce information on Self Employment after Brain Injury and Voluntary Work after Brain Injury.
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ Summer Foundation Hospital Discharge Part E – NDIS Planning Available from: https://www.youtube.com/watch?v=4iVH4gu3J2c (last accessed 19.10.2019)
- ↑ Cicerone, K.D. Cognitive Rehabilitation for traumatic brain injury and stroke: Updated review of the literature from 1998 through 2002 with recommendations for clinical practice. America: Archives of Physical medicine and rehabilitation, 2000;92,(4),1596-1615.
- ↑ Vuadens,P. & Arnold,P & Bellmann,A. Return to work after a traumatic brain injury- Vocational Rehabilitation. Pari: Springer Paris; 2006.
- ↑ Law, M., Baum, C.M. & Dunn, W. Occupational performance assessment. In C.H Christiansen, C.M Baum & J. Bass- Haugen (Eds.). Occupational therapy: performance, participation & well being (3rd edition). Thorofare New Jersey: Slack Incorporated; 2005.
- ↑ Hsu JE, Keenan MA. Current review of heterotopic ossification. UPOJ 2010; 20: 126-130
- ↑ Mavrogenis AF, Soucacos PN, Papagelopoulos PJ. Heterotopic Ossification Revisited. Orthopedics. 2011Jan;34(3):177