Module 11: Navigating Systems in the Service of Developing a Comprehensive Discharge Plan

Introduction to the Module

You will have the opportunity to explore the key components of effective discharge planning for hospitalized individuals with intellectual and developmental disabilities. 

Introduction of the Subject Matter Experts: 

Dr. Sarah Ailey Ph.D., APHN, RN FAAN

Dr. Ailey is a professor in the Department of Community, Systems, and Mental Health Nursing at Rush University in Chicago, Illinois. Her research and scholarly practice focus on improving the lives of people with disabilities, particularly intellectual disabilities, by translating research into practice within community and inpatient hospital settings. Dr. Ailey is the Project Director for The PATH-PWIDD (Partnering to Transform Health Outcomes with Persons with Intellectual and Developmental Disabilities) Program, a 5-year project funded by the Administration for Community Living (ACL) under the initiative Closing the Health Disparity Gap: Strengthening the U.S Healthcare Workforce.   

Dr. Holly Brown DNP, RN, PMHNP-BC, PMHCS

Dr. Brown is an Associate Professor at the Wegmans School of Nursing at St. John Fisher University and Associate Director of the Golisano Institute for Developmental Disability Nursing. Her academic work focuses on achieving health equity for individuals with intellectual and developmental disabilities (IDD) through nursing education.  She is the Senior Psychiatric Nurse Practitioner at Hillside Children’s Center in Rochester, New York, caring for youth diagnosed with IDD and co-occurring psychiatric conditions

What you will learn:   

1. Identify key considerations for safe and comprehensive discharge 
2. Discuss components of comprehensive hand-off to the caregiver(s) (i.e., family or community)
3. Devise a discharge plan that clearly identifies:
   • Patient and caregiver needs
   • Medications with reconciliation
   • Services ordered (social services, home care, PT, OT, etc.)
   • Follow-up appointments
   • Any durable equipment
   • Expected outcomes  
4. Apply knowledge to the patient described in the associated case study