DESTINATION HOME
Have you got your passport?
Bruyère Continuing Care worked with patients, families, and external partners such as the Champlain Community Care Access Centre to discuss how to facilitate a smooth, safe and timely transition from hospital to home. Patients and their caregivers often felt unprepared to manage at home and experienced anxiety with the discharge process. The majority of the information was given to them just before they left the hospital and not throughout their stay.
Now, Bruyère’s discharge process starts soon after admission. Patients and caregivers complete the Path to Home Passport together to provide information and skills during their stay in hospital that will prepare them to safely go home.
“The Path to Home Passport is evidence of true partnerships,” says Sandra Schmidt, RN and Project Lead for Transforming the Patient Experience at Bruyère. “The process allows the care team to share knowledge and increase patient confidence and competence so they can experience a safe and successful transition home.”
Patients are the experts in the management of their own care and therefore are owners of their passport. The Path to Home Passport is designed in three areas: All About Me, My Needs, and My Path Home. The members of the care team and their roles are explained to the patient and caregiver so that they are aware of the person on the care team that can best answer their questions. There is also a section dedicated for follow-up appointments and tests where patients and caregivers can see at a glance their appointments.
The completed passport has information that is relevant to their unique situation and provides them with written information that is evidenced-based. The process facilitates a true partnership with their care team to share knowledge with the patient and increases their confidence and competence to experience a safe and successful transition home.