Do you do assessments after a patient is discharged? - page 2
We do assessments at 8am and 2 pm on my shift. If someone is discharged at 9 am and you haven't gotten to the assessment yet is it necessary even if they are still there for hours? Some nurses on our... Read More
Dec 13, '12If someone is waiting for discharge, I would not do a head to toe assessment (i.e. I would not listen to breath sounds, check pedal pulses, etc, etc) unless they had an obvious change in condition that warranted it. I would check on them and chart each time I did (e.g. "Pt sitting in chair, NAD, A&Ox3. Pt awaiting ride home. Pt states his wife is on the way.").
Dec 13, '12Quote from Twinmom06In my mind, they are not discharged until they are out the door. For example, a doc writes discharge orders on his AM rounds...say 0700. Pt waiting for ride. At 0900 he gets a slew of meds. No ride there, pt not sure when his ride will come. Yes, I would give him his meds.so then to those of you that assess the discharged patient waiting for their ride (or whatever the delay is) do still give them their medications? As in they are officially discharged at 0900 but their ride isn't coming until 1100 and they have a 1000 med - do you still give them the med?
Dec 13, '12We don't sign/release the order anywhere in our hospital until they are on their way out the door, so if they are waiting for a ride we don't release the order until the ride is there, otherwise they lose their room and would have to sit in the lobby. So, I would do that final assessment on my first round.
Dec 13, '12Quote from Twinmom06It depends on a lot of things. Is it a med that they have at home? Then, no. I would just tell them during discharge teaching that they need to take their own med from home because I didn't give it to them that day. Is it a new med that they have a script for? I will ask them if they are stopping by the pharmacy before going home. If there will be a significant delay, I will give it. It also depends on the type of med, the importance of the med, and the effect it may have on the patient.so then to those of you that assess the discharged patient waiting for their ride (or whatever the delay is) do still give them their medications? As in they are officially discharged at 0900 but their ride isn't coming until 1100 and they have a 1000 med - do you still give them the med?
I also like that EPIC has this little grid that the nurse can fill out showing when the next med is due and whatnot. I'm a bit anal about that little grid.
Dec 14, '12Well, realistically....I think it depends on a lot of factors specific to the situation. If I had 5 patients to assess and the patient being discharged was on that list then I would put the discharged patient at the bottom of the list. If the patient was still there after my other 4 assessments were finished then I would go ahead and do an assessment on the patient being discharged. If I had only gotten 2 or 3 patient's assessments completed and the discharged patient's ride was there....then they would obviously not get an assessment. It would really depend on the whole picture though. Some patient's transportation is known to take several hours to arrive. If they're going to be there for meals and routine vitals, etc. then I'd still want to have their vitals checked and I'd still be checking on them and therefore might as well go ahead and chart all that information instead of having to say later, "Well, I didn't do an assessment because they were supposed to be discharged 5 hours ago."
Dec 14, '12Quote from dudette10This.Yes. Twice in my short career my assessment findings reported to the MD have delayed or canceled discharge. I am responsible for confirming the stability of the patient at discharge, so yes, I do an assessment.
you really should do the assessment. Earlier this month, I was engaging in the drudgery of getting VS on a discharged pt who was still there, b/c HE WAS STILL THERE, and it was assessment time.
He was post op, and had temp of > 101.
I reported it to the doc, and he and the other docs then had a discussion about whether to proceed w discharge. They felt it was likely post op atelectasis, but decided to keep him overnight, based on what one of the docs said "It's not worth it. CYA." It's the whole liability issue.
So I CYA, and do the assessment. Always think about an attorney reading the chart, and having to defend what you did/did not do in court.
Dec 14, '12Quote from Nurse ABCDoing full assessments on discharged patients sounds like a very low yield activity to me. They were assessed during the previous shift; if I don't get a full assessment done before they high-tail it out the door that's just how the cookie crumbles.We do assessments at 8am and 2 pm on my shift. If someone is discharged at 9 am and you haven't gotten to the assessment yet is it necessary even if they are still there for hours? Some nurses on our unit don't bother with it reasoning that if they have a discharge order they are stable enough to go home and thus don't need one. Others say they receive everything as normal until they actually leave. What's your opinion?
Of course, I always do a focused assessment on every patient:
"Hey George, howsit going?"
"Real good, MN-Nurse, I can't wait to get the heck outta here."
The above represents quite a bit of assessment.
Dec 14, '12Thanks for your thoughts. In our hospital, patient's usually get discharged at 10 am ( in which case I've already done their 8 am assessment) but we have one discharge nurse who is responsible for all the discharges on our unit. So it can be 3 pm and some patients are still there because she hasn't given them their papers yet, they don't have a ride yet, etc. (It's not a good system for our floor but that's another topic.) I have always treated them the same with meds, assessments, etc until they are out the door literally but have been told by a couple of the nurses who have been there a while that once they have a discharge order I should not be giving meds and doing full assessments which is why I asked what others did. I will keep doing what I'm doing then because I agree there could be a change in status.