You’re preparing to discharge a patient to home. It’s a busy day as usual, but you want to make sure you explain everything to the patient so they don’t experience any complications which could lead to hospital readmission. Here are some tips to keep in mind.
 
1. Explain the Paperwork Thoroughly.
Make sure you read through the discharge paperwork with the patient and their family members to ensure they understand everything completely. Discharge instructions should be written in a patient-friendly language and should include educational materials to help successfully transition the patient from the hospital. In 2013, researchers reported that in adults age 65 years and older, 40% could not accurately describe the reason for their hospitalization and 54% didn’t accurately remember follow-up appointment instructions (Horwitz et al, 2013).
 
Remember that after reviewing the discharge instructions, the patient should be able to “repeat back.” This includes telling you why they were in the hospital, how they will manage at home, what medications they are on and why, and follow-up plans (specialist visits, home care, physical therapy, lab work, diagnostic images, etc).
 
2. Review medications.
Medication errors are a top reason for hospital readmissions. Medication reconciliation should be completed with the patient when they are first admitted. At discharge, thoroughly review the current medication list with the patient and family members, as medications may have changed during the hospitalization. Be sure to discuss:

• Any new medications that have been added
• Any changes to medications they were taking prior to the hospitalization
• Plans for obtaining medications from the pharmacy

Another thing to keep in mind is that your patient may not be familiar with the brand name or generic name of a medication. For example, the patient might not know the generic name clopidogrel but are familiar with the brand name of Plavix. Encourage the patient to ask the pharmacist about any medication that is unfamiliar and confirm that it is correct.
 
3. Never make assumptions.
As healthcare professionals, we often assume that the patient knows certain things about their disease process or medications. It’s important to review everything with the patient. A good way to make sure your patient and their family members understand what you have discussed is to ask, “What questions do you have?” Asking open-ended questions puts the patient at ease and allows them the freedom to share their thoughts and concerns.
 
4. Follow Up.
Often, patients will need follow-up appointments after their discharge. These may be with their primary care provider as well as any specialists (i.e. cardiology, wound care, pulmonary, etc). Make sure that the phone numbers for these providers are included on the discharge paperwork along with the recommended timeframe for the follow-up. Stress the importance of these visits and recommend that the patient calls to make the appointments as soon as they are able. If the patient is to follow up with a specialist they are not already established with, provide them with a list of providers in your network that is available. 
 
If indicated, the case manager at your facility should send in the request for home care services (visiting nurse, home health aide, physical therapy, occupational therapy, palliative care, or hospice care). Let the patient know that the home care company will be calling them – usually the next day – to set up services. Again, make sure the number for the company is present on the discharge paperwork, in case any questions arise.
 
If follow-up includes laboratory or diagnostic testing, make sure the patient has a prescription. Also, review where they can go for this testing (hospital outpatient lab or independent lab service company) and any pretesting instructions.
 
Overall, it is important to consider the discharge process throughout the patient’s hospitalization. Educate patients about their health conditions and thoroughly explain their medications at the time of administration. You have the power to make significant positive outcomes to your patient’s health and their overall discharge experience! The education you provide can help them long after discharge, and ultimately prevent them from being readmitted. 

Reference:
Horwitz, L., Moriarty, J., Chen, C., Fogerty. R., Brewster U., Kanade, S., ...Krumholz, H. (2013). Quality of discharge practices and patient understanding at an academic medical center. JAMA Internal Medicine, 173(18). doi: 10.1001/jamainternmed.2013.9318

 

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