Design and Evaluation of Adherence to the Transition-discharge-hospital Plan in Patient-family Caregiver With Chronic Pathology in a Health Institution of the Metropolitan Area of Bucaramanga

Noncommunicable chronic diseases are pathologies that over time require skills in the patient and family caregiver; to ensure safe and continuous care once they are discharged from health institutions. The approach of them represents multiple challenges in need of greater communication and education; for this, the importance of generating strategies through different interventions must be taken into account.

In this order of ideas, the program Plan of discharge or discharge consists of a coordinated intervention and executed by nursing staff that captures the patient dyad with chronic illness-family caregiver from his admission, stay and hospital discharge. The previous approach consists of a systematized guide that contemplates the following activities: 1) assessment of the family caregiver patient dyad to define the competence for care in the home (CARING), the level of risk and complexity of the care associated with the treatment in the home, according to defined risk: polypharmacy, parenteral medications, control medications and / or invasive devices; 2) education and instruction to the patient and the family caregiver during the hospital stay, anticipating the care needs at the time of discharge, with delivery of booklets, brochures and instructions, and 3) telephone follow-up for up to one month, by means of a 2-call call. week. (Melo Melo, Vargas Hernández, Carrrillo, & Alarcón Trujillo, 2017).

In a study carried out by (Sanchez, Carrillo Gonzalez, & Barrera, 2014) they refer that there exists a great variety of literature on the plan of transition and hospital discharge, in which it is possible to evidence a heterogeneous level opposite to concrete guidelines, to advance these plans, although this management is recommended in benefit of the users since the evidence on the effectiveness of the development of plans of care, as fundamental part of the continuous, safe and integral care of the patients and their families is very limited.

The support of professionals, institutions and the health system must respond to these demands to ensure the right to quality care for the sick person and the support required by his or her family caregiver, as well as other factors that influence access, security, continuity, social support with the use of appropriate information and communication technology and the strengthening of capacities for self-management and competence for care. (Carrillo Gonzalez , Sanchez Herrera, Gomez, Carreño, & Chaparro Diaz, 2017).

It is important to highlight that in a study conducted by (Sara Gutiérrez 2014) its objective was to identify the way of educating both the patient and the family at the time of discharge, it was possible to identify that the nursing staff does not give education to patients of the instructions issued by the medical staff; patients and their caregivers do not understand the care received and therefore 86% do not comply with the latest indications as well as 50% of re-entries is given for not having understood or had education in front of the care and instructions given at the time of discharge of the patient. (Gutierrez Suarez & Freire, 2014).