D/C issues

During the first week of my cardio prac I was given a pt that had come with an increasing SOB and AF from a rehab home. The thing about the pt was that he was just D/C from the ward 2 days ago to this rehab facility and was there for further rehab. The first time around he had come in with an infective exacerbation of COPD.

The first time I got him up for a walk he was only able to ambulate 30m and required 2 rests because of his increased SOB. The doctors wanted to D/C this pt soon as that felt like he was medically stable. They requested for the PT to do a 6MWT and with the test this pt was able to ambulate only 40m in 6 mins. It took him a good 4 mins to recover from his SOB. From his prior 6MWT results he amb 165m.

With this info in hand I had a chat to my supervisor and we deemed him unfit for D/C home. However every other health professional dealing with him had all written in his notes that he was safe for D/C home! With a chat to the doctors it was decided to send him back to the rehab home as he still required intensive rehab before going home as he lived by himself, had stairs in his house and was independent prior to admission. Once all the arrangements were made this pt was D/C to the rehab home.

I believe it is important to discuss the pts situation with the doctors and the medical team during the ward meetings. Even though everyone else is deeming this pt safe for discharge with the information we have we know that this pt will be a risk to himself if he does not receive further rehabilitation. It all about team work and working hand in hand with the other professionals as each one of us specialise in our own areas. It is always about the patients care and safety.