Institutional Affiliation
Running Head: IMPLEMENTATION 1
IMPLEMENTATION 6
Phase 3-Implementation
Institutional Affiliation
Student Name
Owing to the increasing rates of hospital readmissions arising from poor transitional care it is essential to implement a program that will see to it that the current challenges facing transitional care are addressed and that there is an increase in specialized nursing to help foster the provision of transitional care. Currently, the health care committee has proposed a number of interventions that need to be implemented by the project manager to see the improvement of transition care, especially in relation to dealing with elderly patients (Morphet et. al., 2014). Some of these interventions that have been proven to result in the reduction of patient readmission rates among them patient needs assessment, patient education, medication reconciliation, timely outpatient appointment as well as the provision of telephone follow-up services (Morphet et. al., 2014).It is essential that once the patients are discharged from hospitals that they continue to receive enhanced communication, medication safety and that their caregivers receive advanced care planning and training on how to best manage the associated common medical conditions (Ortiz, 2019). As a result of the currently proposed interventions, the project aims to target the challenges on transition care by defining the role of home-based services, the significance of caregiver support, community partnerships and the importance of new transitional care personnel (Ortiz, 2019). The project manager has gone as far as proposing the time frame that it will take to see the realization of the effects of the project, a practical budget as well as the resources and tools that will be used in the project to see the successful realization of the transitional care program.
The Time Frame of the Project
| ACTIVITIES | TIMELINE |
| Ascertaining the current state of Transitional Care in Hospitals (Patients Admissions, Level of Communication and Coordination among the Nurses, Level of Interaction between the Healthcare providers and the Nurses) | 6 months |
| Ascertaining the Level of Nursing Expertise in Hospitals (Level of Education and Expertise of the Nurses) | 6 Months |
| Making Home Visits to the Patients to Ascertain the Level of Expertise of the Caregivers | 6 Months |
| Consolidation of the Collected Results | 6 Months |
The enactment of the transitional care program includes the inclusion of a defined timeline on how the different roles will be attained. Going by the evaluations by the project manager, the planned timeline that it will take to achieve concrete improvements includes having six scheduled visits to the hospitals for two years. The two-year time frame includes a close working relationship with elderly patients, health care providers, as well as the patient caregivers, all of whom are key stakeholders in the transitional care process. The first six months of the proposed time frame will include the use of the observation method to ascertain the current state of transitional care in the hospitals. In this time frame, notes will be taken on how the parents are received in the hospitals, their admission to the emergency departments, the communication and coordination of the nurses when dealing with the elderly patients, as well as the level of interaction between the caregivers and the health care providers in the event that the patients are released from hospitals.
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