Cath Lab Psychosocial Goals
Proper Admission/Discharge Screening is Critical for Cath Patients
What transpires upon first contact with the Cath Lab patient has a direct effect on their discharge disposition and rate of post-procedure complications.
There are many psychosocial considerations and needs of Cath Lab patients that many health care professionals may not consider. This article should prepare the reader to:
- Explain the concept of initiating discharge planning at first contact with the patient.
- Explain the clinical impact of patient education both PRE and POST procedure.
- Identify key areas of focus to ensure patient safety beyond discharge.
- Recognize potential problems and address them appropriately using various resources.
- Identify potential discharge problems early enough to allow time to work on solutions.
Discharge Planning Begins with First Contact
The following are important things to consider as you check your patient in:
- Just because the patient had a ride TO the hospital, does not mean that they have a ride home.
- Just because the patient has a ride home does not mean that they have overnight care.
- Make sure the patient understands the REASONS that they should not be alone after discharge and throughout that night. Many truly do not understand the risks and think they can "tough it out". Do not mince words when explaining bleeding potential and other risks to the patient, and clearly go over their limitations. Make sure they have understood by having them explain it back to you.
- Is the patient homeless? If so, a call to social services or the patient coordinator should be made early on in order to arrange appropriate care.
Always keep in mind that outpatients can easy turn into inpatients. You must have a "Plan B" for that possibility before the leave the prep/holding area. Remember, in all of the above scenarios, you don't have to go it alone - your patient coordinator can be an excellent resource.
If the Patient is Admitted Overnight, You Need to Ask:
- Are they a single parent or are they themselves the primary caregiver of a mentally or physically incapacitated spouse, parent or significant other? You might be surprised as to how many responsibilities for others that people who are supposed to be living in their "Golden Years" can have.
- Do they have pets that need care?
- Who else may be significantly impacted by their admission? Depending on test results or possible complications, it is important to know BEFORE the procedure if they want anyone called and to get that phone number.
Assumptions can be Dangerous…
Just because the patient states that they live with their spouse or significant other does not mean that the other person is capable of caring for them. Your patient may be the primary caregiver in their home. Keep in mind, the overnight caregiver for the patient has to have enough presence of mind to recognize when there is a problem, react to it appropriately and call 911 if necessary.
On the other hand, in the case of a capable spouse or other caregiver - they may be apathetic, have other plans or simply do not understand the risks. This is most likely to be a problem when the Cath result comes back "normal". It is important to drive home the fact that the post-procedure complications that can occur are usually from the procedure itself, regardless of whether or not they do or do not have abnormal findings on their test. Make sure that the spouse or significant other is present for the patient instructions and receives the proper education. Again, make them repeat instructions back and demonstrate when appropriate.
When Care is Seen as a Threat to Independence
Many of the single elderly can view the assignment of an overnight caregiver as a threat to their independence. It is not far-fetched for some people to "lie" about having someone available to stay with them overnight.
It is especially important within this group that they are assured that their need for overnight care has nothing to do with their age - that this is a procedural protocol for everyone who undergoes this procedure, regardless of age.
Some elderly may fear that family will see this as an excuse to “put them away in a nursing home for good” - be sure to explain the reasoning very clearly to the family as well - to assure all.
Even when the patient verbally agrees to have someone with them overnight, discuss with them details of why that is important anyway. Verbal agreement does not always match intentions. A few words could make a difference in changing their mind and saving them from complications that will land them in the emergency room later on.
CHART! CHART! CHART!
Early charting allows staff along the continuum of care to make adjustments accordingly. It makes sure that the whole team is on the same page and can save many mistakes. If your facility does not have a form that covers the issues mentioned above, make one. Check-off lists and prompters can help to ensure a steady standard of care for all patients. However, don't be an "instant-check-off" person. Give your attention to each item and do not check anything based on assumption. After all, it is all about the patient!
