DISCHARGE PLANNING

REQUIREMENTS #

• Patient’s folder
• Treatment chart (manual or electronic)

STEPS #

1. Review patient assessment data and admission notes
2. Estimate possible duration of hospitalization with health team members
3. Discuss with the unit staff patient treatment plan for nursing care
4. Identify with health team issues that has to be discussed with patient about his/her treatment and after care
5. Establish rapport with patient and relatives (Refer to steps)
6. Educate patient and relatives on the disease condition and its management
7. Discuss with patient and family the possible duration of hospitalization
8. Encourage them to express their fears and ask questions
9. Involve patient and relatives in the care process
10. Obtain signed referral forms to specific therapist if applicable
11. Arrange a visit between any of the following therapist and the patient/relatives to make assessment and plan for continuity of care if necessary
    1. Public Health Nurse
    2. Nutritionist
    3. Social Worker
    4. Physiotherapist
12. Inform patient of any change in treatment plan as soon as it is agreed upon and indicate progress being made towards discharge
13. Conduct home visits to ascertain relative’s preparedness to receive patient and closest referral point if any
14. Document circumstance of discharge.
15. Give emotional support all through procedure and provide patient with necessary explanations