General Care of the Hospitalized Patient
GENERAL PRINCIPLES
• Although a general approach to common problems can be outlined, therapy must be individualized. All diagnostic and therapeutic procedures should be explained carefully to the patient, including the potential risks, benefits, and alternatives.
• The period of hospitalization represents a complex interplay of multiple caregivers that subjects the patient to potential harm by medical errors and iatrogenic complications. Every effort must be made to minimize these risks. Basic measures include the following:
î Use of standardized abbreviations and dose designations
î Excellent communication between physicians and other caregivers
î Institution of appropriate prophylactic precautions
î Prevention of nosocomial infections, including attention to hygiene and discontinuation of unnecessary catheters
î Medicine reconciliation at all transfers of care
• Hospital orders
î Admission orders should be entered promptly after evaluation of a patient.
î Daily rounds should include assessment for ongoing need of IV fluids, telemetry, catheters, and supplemental oxygen, all of which can limit mobility.
° The need for daily labs should be reassessed each day while patients are admitted in the hospital.
• Discharge
î Discharge planning begins at the time of admission. Assessment of the patient's social situation and potential discharge needs should be planned.
î Early coordination with nursing, social work, and case coordinators facilitates efficient discharge and a complete postdischarge plan.
î Patient education should occur regarding changes in medications and other new therapies. Adherence is influenced by the patient's understanding of the treatment plan.
î Prescriptions should be written for all new medication, and the patient should be provided with a complete medication list including instructions and indications.
î Communication with physicians who will be resuming care of the patient is important for optimal follow-up care and should be a component of the discharge process.