Discharge planning takes place from the time the patient is seen in the acute care setting. It is often a collaborative effort and involves not only the nurse and the primary provider, but also the case manager, respiratory therapy, OT/PT therapy, and other members of the team. A lot of planning takes place in team meetings and in discussions with the patient. Effective discharge planning can improve the patient’s hospital experience, their overall outcomes, and decrease their readmission possibilities.

Develop a discharge plan for patients you are assigned. This will entail assessing and identifying the following:
• Patient’s high-risk factors
• Patient’s potential for self-care
• Discharge medications
• Patient’s ability to return to living situation (home, assisted living, etc.)
• Need for caregiver training or other support
• Follow-up appointments or test needed after discharge
• Patient’s chronic conditions
• Medical equipment that will be needed
• Safety in the home setting if going home

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