Discharge Planning

Angie SzumlinskiCompliance

There has been a lot of discussion on how to safely manage a discharge to home during visitation restrictions. As with any discharge, the risks associated with an “incomplete” or “bad” discharge are huge! One example: a resident with a cardiac valve replacement enters a skilled nursing facility for rehab. There is no visitation other than window visits and/or Zoom/Facetime and very little communication between the family and staff.

Resident is discharged home, staff review discharge paperwork with the resident (alone) and hand the paperwork to the resident. Resident puts the paperwork in his bag with personal belongings, goes home and promptly forgets about the paperwork. The family is unaware of discharge orders and unable to visit as resident is in a congregate living environment. The resident resumes the medication regimen prescribed prior to the cardiac surgery and doesn’t add the prescribed Plavix as ordered at discharge.The good news is the resident suffered no apparent, negative outcomes but the risk is there!

How are you managing discharge planning with your residents and families? Here are a few ideas that may help prevent harm to a resident once discharged:

  • Don’t assume the resident is able to remember the discharge instructions. Some studies have shown that when under stress, the average person remembers about 2% of what the doctors tell them.
  • If a resident has had surgery with anesthesia, it can take up to 6 months for the medication to clear their system. Medications can, and often do, cause confusion/delirium in seniors, making them higher risk for not following physician orders.
  • If the resident is being discharged with specific dressing orders, enteral feedings, etc. schedule a window visit with the primary caregiver. Perform the dressing change, initiate the enteral feeding, etc. so the caregiver can observe and take notes.
  • Consider developing a library of educational videos for discharge planning. Many hospitals have this educational option and it only makes sense during the pandemic that we should also consider a “library” of videos.
  • Scan and email all discharge orders including medication orders to the primary caregiver, DPOA or guardian to ensure all documents reach the home when the resident does.
  • Offer to call prescriptions into the pharmacy of choice so that the medications are available when the resident is discharged. Most pharmacies deliver and/or have a drive-through window so the resident/caregiver don’t have to enter the store.
  • Don’t forget the home health option! Many residents would benefit from a home health visit even if they think they are “fine.” Even one visit with an RN to review their discharge papers, etc. may prove to be beneficial for the resident.
  • Document, document, document! We tend to not take credit for what we do for our residents. We need to be documenting all of the interventions from admission to discharge and everything in between!

As always, do the right thing for the right reason. During this pandemic we can’t afford to let anything “slip by” us. There are no safe shortcuts and making assumptions regarding a resident’s ability to remember discharge orders is dangerous. Be safe, stay well and stay tuned!