A 65 year old resident is admitted to a Skilled Long Term Care Facility for a hip fracture. The resident has a Wound Vac and open wound upon admission to the Nursing Facility. The resident is due to receive Physical therapy and rehabilitation and go home. The resident must also receive wound care once per shift from the wound nurse or floor nurse depending on the shift. The resident is an alcoholic and is married with four children. The resident comes from a low income housing area with multiple flights of stairs and the housing area does not have handicap accessible apartments. Resident has Medicaid and Medicare at the time of admission the resident has not had a 60 day well stay and cannot use his Medicare to pay for services. The resident also has a diagnosis of diabetes and high blood pressure. The resident has a history of depression and mood disorder. The resident’s family is really involved in the care of the resident and insisting that the resident have treatment for drinking before returning home as this is the cause of the fall that created the fracture.
Introduction:
In long term care a team approach is the only way to run an effective nursing facility based on collaboration, community accountability, acknowledgement, recognition and professional respect. Although, teamwork is the part of health care services that holds together and provides an effective way to ensure not only safety and care but error reduction through performance, skills, and attitudes of team members is important in all sectors of care it is essential in a skilled nursing facility. Not only does the resident and their family need to have trust in the facility but the team members must be able to relay on the family for correct and accurate information. As a resident begins the journey of discharge to home all cards so to speak need to be on the table so the team can ensure a safe and timely return to home with or without assistance. When looking at team based
Cited: Hartford, J. A. (2013). Transitioning in the nursing home INTERDISCIPLINARY TEAM APPROACH TO IMPROVING TRANSITIONS ACROSS SITES OF GERIATRIC CARE Retrieved from http://www.caretransitions.org/documents/manual.01-05-04.pdf Kozlowski, S. W. and B. S. Bell. ―Work Groups and Teams in Organizations.‖ Bormann, W. C., D. R. Ilagan, D. R., and R. Klimoski. In Comprehensive Handbook of Psychology: Vol. 12 Industrial and Organizational Psychology. New York, Wiley. http://www.ahrq.gov/professionals/education/curriculumtools/teamstepps/longtermcare/module2/igltcteamstruct.pdf http://www.who.int/hia/evidence/doh/en/ http://www.healthypeople.gov/2020/LHI/