Psychiatric Discharge Process

Abstract

Background. Integration of research evidence into clinical nursing practice is essential for the delivery of high-quality nursing care. Discharge planning is an essential process in psychiatric nursing field, in order to prevent recurrent readmission to psychiatric units. Objective. The purpose of this paper is to perform literature overview on psychiatric discharge planning, in order to develop evidence-based practice guideline of psychiatric discharge plan. Methods. A search of electronic databases was conducted. The search process aimed to locate different levels of evidence. Inclusion criteria were studies including outcomes related to prevention of readmission as stability in the community, studies investigating the discharge planning process in acute psychiatric wards, and studies that included factors that impede discharge planning and factors that aid timely discharge. On the other hand, exclusion criteria were studies in which discharge planning was discussed as part of a multi faceted intervention and was not the main focus of the review. Result. Studies met inclusion criteria were mainly literature reviews, consensus statements, and descriptive studies. All of these studies are considered at the lower levels of evidence. Conclusion. This review demonstrated that discharge planning based on general principles (evidence based principles) should be applied during psychiatric discharge planning to make this discharge more effective. Depending on this review, it could be concluded that effective discharge planning includes main three stages; initial discharge meeting, regular discharge meeting(s), and leaving from hospital and discharge day. Each stage of them has requirements should be accomplished be go to the next stage.

<p>Self-Report for Measuring and Predicting Medication Adherence: Experts’ Experience in Predicting Adherence in Stable Psychiatric Outpatients and in Pharmacokinetics</p>

“…As a matter of fact, predischarge planning programs are considered important in assisting patients to take charge of their illness, become partners in the treatment process, reduce the likelihood of readmission 120 and at the same time become educated concerning medications and encouraged toward medication adherence. 121 It is possible that this predischarge moment would be an opportune time to study the self-reported dimensions in order to predict future adherence in outpatient settings. As far as we know, there are no studies of these self-report measures at the time of discharge.…”

Discharge planning and Mental Healthcare Act 2017

“…Discharge planning should begin immediately after admission and be updated throughout the inpatient stay. [ 15 ] We should ensure that the discharge plan sufficiently addresses the practical and social reasons that influenced the admission. For example if a schizophrenia patient has been re-admitted due to relapse following medication noncompliance since he is living alone, or if a female patient with severe depression has a husband who suffers from alcoholism, such issues should be addressed during the discharge planning.…”

“…It should also be documented that the patient understands and agrees with the discharge plan, including the medications and the follow-up details. [ 15 ] It would be a good practice to use the regional language wherever applicable.…”

The development and implementation of a discharge checklist for psychiatric inpatients: a pilot study

“…2,4 Readmission rates are often a key outcome measure within psychiatry, and have been shown to be influenced by discharge planning. [6][7][8][9][10] Notably, readmission within 30 days of discharge has been demonstrated to be a valid quality-of-care measure, and inversely associated with standardised discharge processes. 7,[11][12][13][14] Effective planning optimises outcomes by ensuring continuity of care, medication adherence, and potentiates early intervention, while increasing mental health literacy.…”

“…2,6,[9][10][11][12][13]15 Poor discharge planning/execution hinders stable recovery due to fragmentation and the discontinuity of care services. 2,7,8,16,17 This is particularly a concern within mental health, where patients commonly lack support structures, have reduced insight, and co-morbid physical and social issues. 18 Recognising their significance, the New Zealand Ministry of Health National Guidelines recommends all psychiatric discharge planning include a checklist.…”