Read the Transitional Care Plan Scoring Guide to better understand how each criterion will be assessed.Provide the key plan elements and information needed to ensure safe, high-quality transitional care and improved patient outcomes.
Read the Transitional Care Plan Scoring Guide to better understand how each criterion will be assessed.Provide the key plan elements and information needed to ensure safe, high-quality transitional care and improved patient outcomes.
Include elements such as emergency and advance directive information, medication reconciliation, plan of care, and available community and health care resources.
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Explain the importance of each key element of the transitional care plan.
Identify potential effects of incomplete or inaccurate information on patient outcomes and the quality of care.
Cite credible evidence to support your assessment of each element’s importance.
Explain the importance of effective communications with other health care and community services agencies involved in the transition.
Identify potential effects of ineffective communications on patient outcomes and the quality of care.
Identify barriers (actual or potential) to the transfer of accurate patient information from the sending organization to the ultimate patient destination.
Consider barriers inherent in such care settings as long-term care, sub-acute care, home care services, and home care with support.
Identify at least three barriers.
Develop a strategy for ensuring that the destination care provider has an accurate understanding of the patient medication list, plan of care, and follow-up plan.
Cite credible evidence to support for your strategy.
Write clearly and concisely, using correct grammar and mechanics.
Express your main points and conclusions coherently.
Proofread your writing to minimize errors that could distract readers and make it difficult to focus on the substance of your plan.
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