 |
Patient personalised clinical management plan |
 |
Patient personalised clinical management plan
On discharge from hospital, all heart failure patients should receive a summary that includes:
- Contact details of the heart failure team (hospital/community/urgent care centre) and information on how to access them in event of queries or deterioration;
- Their diagnosis and the potential cause of their deterioration;
- Current medications, why they should take it and description of any monitoring required; and
- Follow up plans:
a. Individualised guidance on self-management, lifestyle and drugs not to take (e.g. NSAIDS);
b. Heart failure passport (paper copy or app) or similar (e.g. traffic light-based symptom monitor) - Click here for more information
c. Understanding of ‘sick day rules’; and
d. Assessment of functional abilities and social care needs.
Inform the patient that their clinical management plan is shared and is accessible with those professionals involved in care and those who maybe involved in care in case of an emergency/deterioration.
Contents:
- Detection
- Diagnosis
- Acute Heart Failure: Diagnosis and management
- Chronic heart failure: Management and treatment
- Discharge and follow-up
- Palliative and psychological care
- Digital support
In this section
- Discharge - Home
- Clinical checklist for safe discharge
- Standardised discharge documentation
- Patient personalised clinical management plan
- Structured follow up post-admission
- Discharge from heart failure clinic
- Patient initiated follow up
- Resources for discharge
About this pathway
Not found what you need? Search here:
(c) British Society for Heart Failure, 2022-
