MD discharge orders and standing orders

[Keeps]

Does anyone know if there is some type of regulation that states a time frame from when an MD writes a discharge order and when the patient needs to be in fact discharged? We are having a problem with one of our sister units in that they have been told that if they get a discharge order written at say 8am they have 3 hours where they will still be covered under the standing orders. Consequently they are rushing to get the paperwork done. The patient may still be sitting in the room 4 hours later waiting for a ride but the unit counts them as gone. No care, no meds, no nothing. I have not been able to verify that this is accurate. It may just be the nurse managers way of not having to staff the 3-11 shift with more nurses. It is a PP floor and I am in NBN so many many times the moms are discharged while we are still waiting on a 1600 Total Bili. I have had nurses come up and ask me how much longer Im going to take because she feels bad that she cant medicate the mother because of the pressure to discharge them.

Thanks in advance for any help on this.

[lsyorke, RN]

A patient is a patient until they walk out the front door. Just because they've gotten a discharge order doesn't mean that they are forgotten about. I don't know of any time limit. In my hospital they are an inpatient and all orders stand until they are officially discharged in the computer, and that occurs when they physically leave the building.

[NRSKarenRN, BSN, RN]

A patient is a patient until they walk out the front door. Just because they've gotten a discharge order doesn't mean that they are forgotten about. I don't know of any time limit. In my hospital they are an inpatient and all orders stand until they are officially discharged in the computer, and that occurs when they physically leave the building.

:yeahthat:

What does your hospitals policy say regarding discharging patients?

Since this is an ongoing issue, please being concern to managements attention ASAP for guidance on issue.

Only regs regarding hospital discharge I'm aware of are from

Medicare and affect Medicare/Medicaid pts:

216.2 Late Discharge.--When a patient chooses to continue to occupy his hospital accommodations beyond the checkout time for personal reasons, the hospital may charge the beneficiary for his continued stay. Such a stay beyond the checkout time for the comfort or convenience of the patient, is not covered under the program and the hospital's agreement to participate in the program does not preclude the hospital from charging the patient. However, it is expected that hospitals will not impose late charges on a beneficiary unless he has been given reasonable notice (for example, 24 hours) of his impending discharge.

Where the patient's medical condition is the cause of the stay past the checkout time (e.g., the patient needs further services, is bedridden and awaiting transportation to his home or to a skilled nursing facility, or dies in the hospital), the stay beyond the discharge hour is covered under the program and the hospital may not charge the patient. (See 402.1, Items 19B-D, Accommodation.)

See Hospital Manual download, section 216.2:

http://www.cms.hhs.gov/Manuals/PBM/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=1&sortOrder=ascending&itemID=CMS021912

[Keeps]

Thanks for the responses. I know that from a financial standpoint the new day starts at midnight so as long as they are discharged by 11:59 that day there would be not additional charge. I haven't ever seen anything that specifically talks about time in regards to discharges. I have some real issues about this from an ethical standpoint.