Planning for our patients during times of transitions (for example: hospital to home, home to rehabilitation facility) involves collaboration with a number of healthcare professionals. Please address the following questions:

• How does your facility promote interprofessional collaboration during times of patient transitions?
• What is the role of the nurse in patient transitions?
• What gaps can you identify in this process related to quality of care? (If you are not currently in practice, please use a previous role or clinical experience in your answers.)

Solution:

Patients are most delicate during transmissions between different levels of care e.g. from a hospital to hospice care. In most cases, readmissions happen when the receiving healthcare professional lacks sufficient information concerning the continuation of the patient care plan (Scott et al., 2017). In our organization, we enhance inter-professional and inter-organizational collaboration through a transition team created to ensure all patients’ transition processes are successful. The team is made up of nurses, case managers, and physicians who collaborate to identify the patient’s needs and communicate with the receiving providers or organizations. The team also ensures that the patient has sufficient information for self-care (including both pharmacological and non-pharmacological interventions)….Please click the icon below to purchase the full answer at only $5