General Assessment of Preparedness
As noted above, the General Assessment of Preparedness (GAP) is a list of potential psychosocial and logistical barriers to patients being able to secure and engage in the intended care plan. This list of concerns largely derives from those raised by patients and their caregivers (Grimmer K 2006). Your QI team should assign ownership to the review of this list, or it will not get done routinely. Following completion of the risk assessment (7P) at admission and on the day of discharge, components of this list should be addressed as needed during the hospitalization. For example, transportation to subsequent follow-up appointments may be a day-of-discharge checklist item, whereas functional status and cognitive status may have to be addressed daily as these may change over time. Unlike the Universal Patient Discharge Checklist, described above, not all elements of the GAP will pertain to all patients, and as such, some elements may be not applicable. It is intended more as a checklist to remind users of issues to consider and address with patients and their caregivers. Different GAP elements may be addressed during different phases of the hospitalization. Suggested times to consider each are provided, though many will overlap and require ongoing evaluation.
| Admission |
Prior to Discharge |
Discharge |
- Caregivers and social support circle for patient identified.
- Functional status evaluation completed.
- Cognitive status assessed.
- Abuse/neglect presence assessed.
- Substance abuse/dependence evaluated.
- Advanced Care Planning documented
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- Functional status evaluation completed.
- Cognitive status assessed.
- Ability to obtain medications confirmed.
- Responsible party for ensuring medication adherence identified and prepared (if not patient).
- Home preparation for patient’s arrival (eg, medical equipment, safety evaluation, food).
- Financial resources for care needs assessed.
- Transportation home arranged.
- Access (eg, keys) to home ensured.
- Support circle for patient identified.
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- Understanding of diagnosis, treatment, prognosis, follow-up, and postdischarge warning signs and symptoms confirmed with teach-back.
- Transportation to initial follow-up arranged.
- Contact information for home caregivers obtained and provided to patient.
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Examples of tools that institutions may use or modify for their own purposes in order to address areas identified through the GAP checklist can be found in the Clinical Tools section under Risk Specific Resources.
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