How do you do a discharge planning

Daytonite, BSN, RN · Mar 7, 2008

Since your first post I found an author who uses the same mnemonic for teaching and discharge planning (Pamela McHugh Schuster, Concept Mapping: A Critical Thinking Approach to Care Planning, page 80 - 82).

M

= Medications

E

= Environment (assessment of the patient's home or health care agency needs for after discharge and contacts that will need to be made)

T

= Treatments (teach patient or family the purpose and techniques of any treatments and activities that need to be done)

H

= Health Knowledge of Disease (teach the patient about their disease, its signs and symptoms and when they need to call the physician for changes in their condition)

O

= Outpatient/Inpatient Referrals

D

= Diet

Those things ARE the components of a discharge plan. What more are you looking for? A form? The book that the above information came from had a form that was just a blank piece of paper with those six things written on it with lots of space to freely write notes on and that was all. This would not be something that would be easily made into a check off sheet.

LexaRN, BSN · Mar 7, 2008

Since your first post I found an author who uses the same mnemonic for teaching and discharge planning (Pamela McHugh Schuster, Concept Mapping: A Critical Thinking Approach to Care Planning, page 80 - 82).
M
= Medications
E
= Environment (assessment of the patient's home or health care agency needs for after discharge and contacts that will need to be made)
T
= Treatments (teach patient or family the purpose and techniques of any treatments and activities that need to be done)
H
= Health Knowledge of Disease (teach the patient about their disease, its signs and symptoms and when they need to call the physician for changes in their condition)
O
= Outpatient/Inpatient Referrals
D
= Diet
Those things ARE the components of a discharge plan. What more are you looking for? A form? The book that the above information came from had a form that was just a blank piece of paper with those six things written on it with lots of space to freely write notes on and that was all. This would not be something that would be easily made into a check off sheet.

Thanks for citing that book! I checked that book in our library and it has. Ya, I need a sample form..thanks again!:heartbeat

Therese SN13 · Oct 9, 2011

M=Medications

E=Exercise

T=Treatment

H=Hygiene & Health maintenance

O=Outpatient Referrals

D=Diet

at least, this is what i learned 2 days ago.

LadyinScrubs, ASN, RN · Oct 10, 2011

Discharge planning starts when the patient is admitted. Normally, there is a discharge planning committee for the floor--the RN case manager, dept manager, MSW, and some others. There is certain criteria that the managers/RN case managers use to determine when and where the patient should be discharged. Keep a patient too long in an acute care facility--beyond what Medicare believes should be appropriate--and the hospital may have to absorb the portion of the bill Medicare declines. If the pt is discharged and readmitted within a certain amount of time, the hospital will be penalized. This was implemennted to stop hospitals from discharging patients too early.

During the floor case management meetings, the floor committee will look at the case to see if the steps to discharge is ongoing and the case is managed correctly.. Did the nurse fail to follow the MD's order for a dx test and there is a delay in diagnosing the pt and a delay to reschedule the test (loss of one day).

Did the pt have a fall that exacerbated the care and extend the pt's hospitalization (more loss and and extension of time in the hospital).

Is the doctor dragging his feet and not discharging the patient when the pt should be discharged.

Did the family drop the patient (often elderly or disabled pts) in the ED so they could go on vacation or take the weekend off. Now that the pt is ready for discharge, the family can't be found.

Is the patient homeless and his condition requires he have a home. Does the pt need rehab or a SNF--are there any available.

Is the pt ready for a lower level of care and there are no beds available.

Does the ped pt need a high level of home care and the public facility the child lives in cannot do the care.

Is the pt an HMO member and now that the pt is stablized must be moved to the HMO facility.

Does the pt have insurance? If not, will the pt stay in the hospital after stabilization or be transferred to a county facility?

There are many areas to consider when doing discharge planning. The discharge planner is a RN (most often a BSN) who must be able to talk and be the patient & hospital's liaison with the insurance company, home health companies, the doctor, and Medicare. This is the reason why discharge planning starts when the patient is admitted--the admitting clerk must get insurance info, and all the other pertinent info about the client. No info available for the discharge planner and the process slows down.

First thing to remember: no discharge happens without the doctor's order. However, the hospital can put serious pressure on the doctor if the pt does not fit the criteria for hospitalization in an acute care facility.

I have never heard of a nurse understanding the criteria of discharge planning because the criteria is based on Medicare reimbursement and a complex set of criteria.

Medicare will pay for 24 hrs of observation and after that time the pt must be admitted or discharged. You will often see beds in the ED for just this purpose or sometimes the pt is admitted directly to the floor.

There are certain computer programs that hospital's buy for discharge planners utilizaton to determine whether the pt should be admitted, when the pt should moved to a lower level of care and/or discharged. Those nurses who are not discharge planners will have no idea the criteria for discharge.