Discharging a Patient

Indications for discharge
• Progress in the patient's condition
• No change in the patient's condition (Referral)
• Against medical advice
• Death

Nurse's Responsibility during Discharging a Patient
1. Check for orders that a patient need to be discharged
2. Plan for continuing care of the patient
   • Referral as necessary
   • Give information for a person involved in the patient care.
   • Contact family or significant others, if needed.
   • Facilitate transportation with responsible unit
3. Teaching the patient about
   • What to expect about disease outcome
   • Medications (Treatments)
   • Activity
   • Diet
   • Need for continued health supervision, and others as needed

4. Do final assessment of physical and emotional status of the patient and the ability to continue own care.

5. Check and return all patients’ personal property (bath items in patient unit and those kept in safe area).

6. Help the patient or family to deal with business office for customary financial matters and in obtaining supplies.

7. Keep records
   o Write discharge note
   o Keep special forms for facility

Discharge summaries usually include:
• Description of client’s condition at discharge
• Treatment (e.g. Wound care, Current medication)
• Diet
• Activity level
• Restrictions

Referral is a condition in which a client/patient is sent to a higher health care system for better diagnostic and therapeutic actions.
• Any active health problems
• Current medication
• Current treatments that are to be continued
• Eating and sleeping habits
• Self-care abilities
• Support networks
• Life-style patterns
• Religious preferences

Discharging a patient against medical advice (AMA)
1. When the patient wants to leave an agency without the permission of the physician/nurse in charge – an authorized.
2. Ascertain why the person wants to leave the agency
3. Notify the physician/ nurse in charge of the client’s decision
4. Offer the patient the appropriate form to complete
5. If the client refuses to sign the form, document the fact on the form and have another health professional witness this
6. Provide the patient with the original of the signed form and place a copy in the record
7. When the patient leaves the agency, notify the physician, nurse in charge, and agency administration as appropriate
8. Assist the patient to leave as if this were a usual discharge from the agency (the agency is still responsible while the patient is on premises)