Completing a safe patient discharge as a nurse involves multiple steps. For instance, the nurse reviews the patient’s medical records, the discharge instructions, and medication reconciliation. It is also crucial to verify post-discharge services, medical devices, and complete patient education.
Nurses learned in school that safe patient discharge starts on admission. If we want to discharge the patient safely, we have to make sure that we admit the patient correctly. Thus, the admitting physician should consult the subspecialties, and the ancillary services as soon as he/she identifies the need.
Some of the subspecialty services are surgical services, infectious diseases, critical care services, and more. The ancillary services are Physical and Occupational Therapy, language pathologist, dietary, discharge planning, and more. The different subspecialties and ancillary services make up the multidisciplinary team. Besides, the team makes recommendations for patient care to promote safe patient discharge.
What Exactly Is A Safe Patient Discharge?
A safe patient discharge involves the coordination of patient care with the discharge planning team. Thus, the discharge nurse will ensure that the patient transitions out of the healthcare facility free of preventable harm. Moreover, the nurse reviews all the instructions that the patient needs to follow upon leaving the hospital. Therefore, the nurse reviews the patient’s initial chief of complaints and admitting diagnosis and follow up care.
The discharge instructions usually include a summary of the symptoms, diagnosis, diagnostic testing with the results, and the recommendations. Besides, the admitting provider describes the treatment plan and the patient’s response to the prescribed plan. The patient’s symptoms often improve or subside upon discharge.
Review The Patient’s Medical Records
The nurse needs to review the patient’s medical records to validate the identifiers and the clinical summary. Thus, the nurse should verify that the patient’s information, the medical diagnosis, treatment plan, and referral services are accurate. It is crucial to inform the provider of all discrepancies when the nurse encounters them in the discharge instructions.
The patient’s medical records review includes a summary of the history and physical, conclusive findings of all diagnostic testing. The records also include the treatment plan with recommendations, medication reconciliation, and referral services.
Medication Reconciliation For Safe Patient Discharge
It is a Patient Safety initiative to conduct a medication review before discharging the patient. Medication reconciliation can prevent medication errors and promotes safe patient discharge. Therefore, the process involves the review of the medication that the provider and nurse collected on admission.
It is significant for the nurses to ensure that the patient’s medication list is current. Thus, the nurse should compare the admission medication list with the discharge medication list to avoid preventable errors. It is the nurse’s responsibility to verify the medication list before completing the patient’s disposition. Besides, the patient might not have the ability to identify unintentional mistakes.
A thorough medication review will prevent adverse drug events related to prescribing errors. The primary provider decides what medication to renew and to discontinue based on his or her clinical judgment. The nurse should be vigilant when checking the discharge medication list.
I usually highlight the changes that the provider makes on the medication list. The patient can easily identify the difference. In addition, I discuss the new medications with the case manager or the pharmacist. Besides, the patient might need to take one or a few doses home. It is unsafe for the patient to find out that the new medications are not available at the local pharmacy.
I had a bad experience after picking up my mom from the hospital. I went to the pharmacy to pick up her prescription late in the evening, but the pharmacy was closed. Therefore, I had to call the main number and asked if the pharmacy could transfer the prescription to another location. I was able to obtain the medication the next day because it was not available at that location. Thus, my mom missed the evening dose of that medication.
Review The Discharge Instructions To Promote Safe Patient Discharge
As the discharge nurse, you have to verify the clinical information in the discharge summary. Thus, you should quickly review the reason that the patient came to the hospital. Believe it or not, sometimes the doctors will dictate the incorrect clinical summary in the patient’s records. After all, the doctors are human and make mistakes by omission.
The nurse has to compare the information with the patient’s admission summary to identify gaps in the clinical documentation. If you notice any discrepancy in the clinical review, you should inform the doctor as soon as possible. It is normal to advocate for your patient to promote their safety.
You can call or page the doctor and let him or her know about your discovery. For example, Sir or Ma’am, the patient came in for shortness of breath and had a CT scan. The patient ‘s diagnosis is bilateral pulmonary embolism, but I noticed that the summary mentioned viral meningitis. Hi
You should inform the doctor that the treatment plan did not include meningitis work up. Therefore, I would like to clarify that the clinical summary is for the same patient. Nurses, the doctor will appreciate the call and will remember the phone call. Thus, you are building your professional reputation. Lastly, you have to verify that there is a discharge order in the medical records.
Identify Post- Discharge Services
Once you conclude that the information in the discharge instructions is correct, you should review the post-discharge services. You have to verify the type of services and ensure that the patient is fully aware. For instance, the patient might need physical therapy at home or while in rehabilitation.
You should be able to guide the patient if he or she has questions about the post-discharge services. The case manager or social worker usually provides all the information to the patient. Thus, you can contact one of them or review their latest patient’s notes. Your action truly validates your dedication to promote safe patient discharge.
If the patient needs oxygen at home, I highly recommend that you discuss that with discharge planning. You should make sure that the patient has an oxygen tank upon discharge. Besides, discharge planning will coordinate the oxygen services for the patient. Therefore, you will only need to confirm the process.
Prevent Adverse Events
I can tell you that accidents happen sometimes, and the patient goes home without oxygen. The patient will most likely return to the hospital because of the missing oxygen. This example does not reflect a safe patient discharge process. The hospital will not receive any reimbursement if the patient returns for the same reason twenty-four hours following discharge.
The case manager already discussed all services with the patient and made all arrangements with the company. If the patient is transferring to another facility, you should make sure that discharge planning completes the transfer packet. The package includes a face sheet, the transfer summary, medication reconciliation, a code sheet, and other forms.
Manage Hospital Medical Devices
You verified the patient’s information and clinical summary. Therefore, you can start removing the medical devices before discharging the patient. You should remove all invasive lines ( peripheral and central lines) per your scope of practice.
Please follow your facility’s policy and complete necessary training before you remove the central lines and other drains. I used to work at a facility where I actually received training to remove the Peripheral Inserted Central Catheter -PICC. You should verify if the surgical drains will remain in place or not.
As the nurse, you should remove the telemetry monitor and all other devices that the patient will no longer need. If the patient needs to take the medical devices or drains home, you have to educate the patient about them. You can also review the clinical documentation to validate education that other services provided to the patient.
Return Personal Belongings To The Patient
I always make sure that the patient takes his or her charger, phone, and all other electronic devices. I believe that it is our job to verify that the patient takes all his or her stuff back home. Therefore, nurses should ascertain that the patient has his or her assistive devices before the disposition.
As the nurse, you have to document your discussion with the patient and that you return all belongings upon discharge. This safe patient discharge process will prevent the patient from filing lost items claims. The hospital will most likely reimburse the patient.
Sometimes you have to secure the patient’s valuable items on admission because the patient was incoherent. Some examples are credit cards, money, expensive jewelry, and more. The discharge nurse needs a second person to witness that you did give everything back to the patient.
Some patients bring their home medications to the hospital, and nurses often secure them in a safe location. You have to remove the medicines and return them to the patients before discharge. You have to document that you gave all the locked items to the patient. Please verify if the home medications remain the same before you return them to the patients.
Validate The Patient’s Documents
You do need a witness for all controlled substances and valuable items. The second signature will validate the presence of all returned items, and this process validates safe patient discharge. You also need to obtain the patient’s signature. When you are discharging a patient next time, I hope you will find these instructions helpful.
After you obtain the patient’s and a witness‘ signature, place a copy in the chart to send to medical records. You have to give a copy of the inventory log to the patient. If the patient is confused, please reach out to the point of contact listed in the medical records.
Educate The Patient To Promote Safe Patient Discharge
You have to educate the patient about home care and restrictions. The patient needs to know who and what number to call when they return home. Besides, the patient should receive education about abnormal symptoms, and the appropriate actions to take.
The nurse should discuss follow up appointments with the patient and validate the patient’s understanding. The patient should receive education about the diagnosis and the disease process. Thus, education should include disease prevention and management.
It is crucial to educate the patient about Abnormal symptoms to prevent him or her from returning to the hospital. Besides, CMS and the private insurance companies do not reimburse the hospitals when the patient returns with the same complaints within thirty days.
As a nurse, you should educate the patient using Lay language to prevent confusion. Please teach the patient about everything that the doctor wants him or her to follow. For example, you can provide education about Lovenox self-injection.
If you’re teaching a patient about Lovenox, you need to teach the patient about injection techniques and dirty syringes disposal. In addition, the patient t needs to know the indication for the medication, side effects, expected outcomes, and adverse reactions. Besides, you should teach the patient about symptoms of a hematoma and when to call the doctor’s office versus 911.
Evaluate The Educational Session
By now, you should have completed the patient education process. Successful patient education means that you have educated the patient and he or she successfully returns demonstration. For example, the patient selects the correct anatomical site to inject the Lovenox using proper techniques. Lastly, the patient verbalizes the signs and symptoms of a hematoma.
The nurse has to document the teaching session, the topics of discussion, and the patient’s response. You should also obtain the patient’s signature when possible to validate teaching. You should also give the patient copies of the teaching materials. Thus, you can also refer the patient to other available resources when applicable.
After you educate the patient, offer the patient assistance to put his or her clothes on. You will not believe how many times some patients remain in the hospital following an incident right after discharge. It is always best to discharge all patients safely.
It is time to share some final thoughts about discharging patients safely. Releasing a patient can be an overwhelming and complex process, especially when the patient is transferring to another facility. If the patient is going home with home services, please coordinate with the discharge planner.
It is the nurse’s responsibility to ensure that the patient has enough supplies to take home when necessary. For instance, a patient with wound care instructions will benefit from additional wound care supplies upon discharge. The nurse should tell the patient if he or she is on activity restrictions i.e no bending, lifting, and twisting.
You should streamline the discharge process and make it safe and free of harm. The nurse has to review the patient’s medical records, the complete discharge instructions, the medication reconciliation. Also, the nurse manages the medical devices and educates the patient. It is also prudent to validate home care services with the discharge planner. Do you believe safe patient discharge can prevent adverse events? please download the discharge checklist below, leave a comment, share and subscribe.
Nurse Sophie has been a registered nurse for over a decade. I have a Master's degree in nursing, and my clinical experiences include staff nurse, clinical nurse supervisor, and manager, and most recently, nurse consultant in Patient Safety and legal nursing. I was always passionate about system operations and practice standards.
I have completed over 2000 hours of medical chart reviews. I am an expert in clinical investigations, and I also develop event timelines. I can assist the legal team with the Discovery process: Deposition, Interrogatories questionnaire, event timelines, locate expert witnesses, and more. I provide and formulate clinical opinions based on the investigative summary.
Nurse Sophie, MSN, RN, LNC
Legal Nurse Consultant
Patient Safety Specialist
Email: [email protected]